Broken thermometer in hand: mercury elevation caused by improper debridement.

BACKGROUND: Mercury exposure from broken thermometers is still common in China. CASE REPORT: Here, we report a 2-year-old girl with elevated mercury concentrations in her blood and urine due to improper debridement after pricked by a broken thermometer. She underwent the first debridement at a local hospital, but radiographs showed a dot-like mercury deposit turned into multiple dispersed beads in her wrist tissue. Although the patient had no signs or symptoms of mercury poisoning, her blood and urinary mercury concentrations were significantly elevated. Several radio-opaque densities remained in her hand until a second debridement. At 2 years follow-up, her mercury concentrations in blood and urine and her hand radiograph were normal. CONCLUSIONS: Careful debridement after injury by broken thermometer is important in order to remove mercury in tissues and to prevent its dispersion and further absorption.

Vitamin-mineral supplements do not guarantee the minimum recommendations and may imply risks of mercury poisoning in dogs and cats.

Given the importance of using the vitamin-mineral supplements to guarantee the minimum nutritional recommendations for pets in homemade foods, and hypothesizing that these products may contribute to toxic metals contamination, the present study aimed to determine the concentrations of essential minerals and toxic metals in vitamin-mineral supplements available in the Brazilian market and calculate if the amount recommended by the manufacturer guarantees the minimum recommendations of NRC (2006) and FEDIAF (2020), as well as calculating the amount of toxic metals that animals would consume, according to the amounts recommended by the manufacturer. Seven vitamin-mineral supplements were analyzed. The determination of essential minerals and toxic metals was performed using ICP-OES. Comparisons were made with the minimum recommendations for essential minerals, and with the maximum tolerated levels of toxic metals established by the FDA (2011), descriptively. Most of the vitamin-mineral supplements, in the quantities recommended by the manufacturers, do not guarantee the minimum recommendations of NCR (2006) and FEDIAF (2020) for the following elements: calcium, potassium, magnesium, sodium, phosphorus, selenium, and zinc. Only one supplement had detectable selenium concentrations. Three supplements provided more than 0.02mg of mercury/kg of body weight, the safe upper limit used to establish the maximum tolerated level of this element. It is concluded that most vitamin-mineral supplements do not meet the minimum recommendations for most essential minerals and, if formulated by untrained professionals, even with supplementation, homemade foods may still be nutritionally deficient. Furthermore, some vitamin-mineral supplements analyzed may imply risks of mercury poisoning in pets.

Clinical management of chronic mercury intoxication secondary to skin lightening products: A proposed algorithm.

Mercury is a toxic substance that is commonly used in skin lightening products. Various effects on humans have been observed, which affect both users and non-users. Many studies reported delayed diagnosis and treatment, even after weeks of hospitalization. The possible reasons are non-specific clinical manifestation and lack of awareness and knowledge regarding chronic mercury intoxication secondary to skin lightening products. A thorough history of mercury exposure is crucial. Physical assessment and relevant supporting tests are indicated to establish a diagnosis. Blood and urine mercury levels are an essential examination for diagnosis and monitoring of the progress and response to treatment. The primary treatment is the discontinuation of the skin lightening products. Chelation therapy is not mandatory and is usually indicated for symptomatic patients. The prognosis depends on the duration of the product use, concentration of mercury in the skin product, and the severity of clinical presentation.

All that glitters is not gold: Mercury poisoning in a family mimicking an infectious illness.

Three siblings with inhalational elemental mercury toxicity presented with fever, rash, and upper respiratory tract symptoms. The patients were heavily exposed to elemental mercury that was spilled in their home and then vacuumed. Initial whole blood mercury levels were elevated at >200 µg/L, 153 µg/L and 130 µg/L (Mayo Clinic Laboratories lab reference range <9 µg/L) for Cases 1, 2, and 3, respectively. All three required chelation with succimer. Clinically significant elemental mercury toxicity can resemble an infectious illness. Severe morbidity and mortality can be prevented if heavy metal poisoning is considered early, through a detailed history including an environmental exposure history. For elemental mercury spills in the home, safe and effective clean-up steps are needed. Improved public health education is needed to prevent similar household exposures.

Broken thermometer in foot: a source of mercury poisoning.

A 17-year-old boy was referred after jumping from a ladder onto the ground, crushing a medical thermometer with his right foot. Some days later, he complained of loss of appetite and weakness. A radiograph of the affected foot demonstrated radiopaque densities. Blood and 24-h urine assays for mercury demonstrated toxic levels. Chelation therapy cured the patient dramatically.

Endoplasmic reticulum stress participates in the pathophysiology of mercury-caused acute kidney injury.

Acute exposure to mercury chloride (HgCl2) causes acute kidney injury (AKI). Some metals interfere with protein folding, leading to endoplasmic reticulum stress (ERS), and the activation of cell death mechanisms, but in the case of mercury, there is no knowledge about whether the ERS mediates tubular damage. This study aimed to determinate if HgCl2 causes an AKI course with temporary activation of ERS and if this mechanism is involved in kidney cell death. Male mice were intoxicated with 5 mg/kg HgCl2 and sacrificed after 24, 48, 72, and 96 h of mercury administration. The kidneys of euthanized mice were used to assess the renal function, oxidative stress, redox environment, antioxidant enzymatic system, cell death, and reticulum stress markers (PERK, ATF-6, and IRE1α pathways). The results indicate temporary-dependent renal dysfunction, oxidative stress, and an increase of glutathione-dependent enzymes involved in the bioaccumulation process of mercury, as well as the enhancement of caspase 3 activity along with IRE1a, GADD-153, and caspase 12 expressions. Mercury activates the PERK/eIF2α branch during the first 48 h. Meanwhile, the activation of PERK/ATF-4 branch allowed for ATF-4, ATF-6, and IRE1α pathways to enhance GADD-153. It led to the activation of caspases 12 and 3, which mediated the deaths of the tubular and glomerular cells. This study revealed temporary-dependent ERS present during AKI caused by HgCl2, as well as how it plays a pivotal role in kidney cell damage.

Awareness of Listeriosis and Methylmercury toxicity public health recommendations and diet during pregnancy.

BACKGROUND: Awareness of Listeriosis and Methylmercury toxicity recommendations are associated with decreased intake of high-risk foods. Whether awareness of the recommendations affect dietary quality of pregnant women in Australian is unknown. AIM: To evaluate awareness of Listeriosis and Methylmercury toxicity recommendations during pregnancy and its impact on dietary quality. METHODS: Pregnant women (n=81) were recruited from antenatal clinics. Awareness of Listeriosis and Methylmercury toxicity recommendations and high-risk foods consumption were assessed via questionnaire at 10-23 weeks gestation. Diet quality was measured using the 2005 Healthy Eating Index using a validated food frequency questionnaire at 10-23 and 34-36 weeks gestation. FINDINGS: A higher proportion of women were aware of Methylmercury toxicity compared with Listeriosis recommendations (75.3 vs. 59.2%, p<0.001). The proportion of women who decreased or avoided consumption of certain high-risk Listeriosis foods were higher in those who were aware compared with those who were unaware of Listeriosis recommendations [raw fish (96.0 vs 69.2%, p=0.046), soft-serve ice cream (93.9 vs 58.3%, p=0.004) and alfalfa/bean sprouts (68.7 vs 28.5%, p=0.006)]. A large proportion of women (96.8%) met recommendations for limiting consumption of high Methylmercury fish. There was no difference in the change in dietary quality over pregnancy regardless of women's awareness of the recommendations. DISCUSSION AND CONCLUSIONS: Awareness of Listeriosis and Methylmercury toxicity recommendations has little impact on dietary quality of pregnant women in this small study. Further research in a large representative population of pregnant women is needed to confirm our findings and to optimise dietary quality during pregnancy.

Neurotoxic effects of mercury exposure in dental personnel.

Numerous studies have reported neurobehavioural effects in dental personnel occupationally exposed to chronic low levels of mercury (Hg). Hg exposure from dental work may also induce various chronic conditions such as elevation of amyloid protein expression, deterioration of microtubules and increase or inhibition of transmitter release at motor nerve terminal endings. Therefore, clinical studies of Hg toxicity in dentistry may provide new knowledge about disturbed metal homeostasis in neurodegenerative diseases such as Alzheimer's disease, multiple sclerosis and mood disorders. The purpose of this MiniReview is to evaluate the evidence of possible relevance between Hg exposure in dentistry and idiopathic disturbances in motor functions, cognitive skills and affective reactions, as well as dose-response relationships.

Prenatal exposure to dental amalgam and risk of symptoms of attention-deficit and hyperactivity disorder (ADHD).

BACKGROUND: ADHD is multifactorial, including both genetic and environmental factors. The safety of amalgam used in dental treatment has been discussed due to its content of mercury and potential risks for negative neurodevelopmental consequences in the offspring. The aim of the study was to investigate possible associations between symptoms related to ADHD in children of three and five years of age and prenatal exposure to mercury from mothers' amalgam fillings. METHODS: Data from the Norwegian Mother and Child Cohort Study (MoBa) were used. Data were collected by questionnaires sent to participating women in week 17 (Q1) and 30 (Q3) of pregnancy and when the child was three (Q6) and five years of age (Q7). Information about exposure to amalgam during pregnancy was obtained from Q3. Information about symptoms related to ADHD was obtained from Q6 and Q7. Valid data were obtained for 42 163 children at three years of age and 23 392 children at five years of age. Logistic regression models, including mothers' age, education, body mass index, parity, smoking and alcohol consumption during pregnancy, were used to estimate the association between ADHD symptoms and prenatal exposure to amalgam fillings. RESULTS: No significant associations between number of teeth with amalgam filling, amalgam fillings placed or removed during pregnancy, and symptoms related to ADHD in children of three and five years of age were found. CONCLUSIONS: In a large, prospective cohort study, we found no indication of increased risk of ADHD-related symptoms in children prenatally exposed to mother's amalgam fillings.

Mercury Poisoning in a Toddler from Home Contamination due to Skin-Lightening Cream.

A 17-month-old child presented with hypertension, fussiness, constipation, and arthralgia due to mercury toxicity from a skin-lightening cosmetic used by her mother and grandmother. Blood mercury level was 26 mcg/L and urine level was 243 mcg/g creatinine. She was chelated with succimer. The home was contaminated and needed remediation.

Mercury poisoning in a fisherman working on a pelagic fishing vessel due to excessive tuna consumption.

OBJECTIVE: To report the case of a fisherman who developed chronic mercury poisoning due to excessive consumption of tuna while working on a pelagic fishing vessel. CASE REPORT: A 48-year-old male deep-sea fisherman developed paresthesia and pain in both legs while working at sea. He continued working for over 4 months on a pelagic fishing vessel but was eventually unable to function normally as his condition deteriorated. Upon arrival on land, he received specialist treatment, including imaging studies, for 2 months; however, the cause of the symptoms was not identified. An examination of his occupational history revealed that he had worked as a crew member on a pelagic fishing vessel catching tuna for the last 2 years and consumed tuna for two or more meals per day, every day. Two months after discontinuation of tuna consumption, he was tested for mercury. The result showed an elevated blood mercury level (BML) of 21.79 µg/l. Based on the half-life of mercury, the BML was evaluated as 38.70-53.20 µg/l when he was on board. Four months after discontinuing tuna consumption, his BML decreased to 14.18 µg/l, and the symptoms were almost ameliorated. The person responsible for preparing meals on a pelagic fishing ship should be aware that fish may contain high levels of heavy metals and should prepare meals for crew members according to the recommended levels. Crew members should also be aware that fish and shellfish may contain mercury, and hence, they should consume only an appropriate amount.

Metallic Mercury Injection in the Hand Caused by A Broken Mercury Thermometer: A Case Report.

Incorrect usage of or accidents related to metallic mercury can be hazardous. Herein, we present a case of subcutaneous metallic mercury injection in the hand caused by a broken thermometer and surgical tips for this injury. A 43-year-old female patient visited our hospital due to mercurial injection injury at the left hand suffered 4 weeks previously. On gross findings, the mercury deposition was limited to the subcutaneous layer and enveloped by granulation tissue. The blood mercury level, which had been abnormally elevated, fortunately decreased to within normal levels within five months. Nonetheless, this initial elevation indicates the possibility of systemic complications after local absorption of mercury droplets into the general circulation. In conclusion, we recommend prompt and complete excision of mercury material to prevent local and systemic complications, and excising the granulation tissue in its entirety, while retaining the mercury droplets within, is recommended.

Endoplasmic reticulum stress preconditioning modifies intracellular mercury content by upregulating membrane transporters.

Endoplasmic reticulum (ER) stress preconditioning protects cells against methylmercury (MeHg) cytotoxicity by inducing integrated stress responses such as eIF2α phosphorylation, ATF4 accumulation, and nonsense-mediated mRNA decay (NMD) suppression. Here we demonstrated that ER stress preconditioning results in the upregulation of membrane transporters, leading to a decrease in intracellular mercury content. Our analyses showed that ER stress preconditioning upregulated the expression of methionine transporters that affect the cellular influx of MeHg, LAT1, LAT3, and SNAT2; and a membrane transporter that affects the efflux of MeHg, ABCC4, in MeHg-susceptible myogenic cells. Among these, ABCC4 transporter expression exhibited the greatest elevation. The functional significance of ABCC4 transporter in the efflux of MeHg was shown by the ABCC4 inhibition study. Additionally, we identified the role of phospho-eIF2α/ATF4 pathway in the upregulation of LAT1, SNAT2, and ABCC4 and the role of NMD suppression in LAT3 upregulation. Further, we detected that ER stress preconditioning amplified membrane transporter expression most likely through the translation of the upregulated mRNAs caused by ATF4-dependent transcription and NMD suppression. Taken together, these results suggested that the phospho-eIF2α/ATF4 pathway activation and NMD suppression may represent therapeutic targets for the alleviation of MeHg cytotoxicity by enhancing mercury efflux besides inducing protective stress responses.

Endoscopic management of massive mercury ingestion: A case report.

RATIONALE: Ingestion of a massive amount of metallic mercury was thought to be harmless until the last century. After that, in a number of cases, mercury ingestion has been associated with appendicitis, impaired liver function, memory deficits, aspiration leading to pneumonitis and acute renal failure. Treatment includes gastric lavage, giving laxatives and chelating agents, but rapid removal of metallic mercury with gastroscopy has not been used. PATIENT CONCERNS: An 18-year-old man was admitted to our emergency department after drinking 1000 g of metallic mercury as a suicide attempt. DIAGNOSIS: Except from mild umbilical tenderness, he had no other symptoms. Radiography showed a metallic density in the area of the stomach. INTERVENTION: Gastroscopy was performed to remove the mercury. One large pool and several small droplets of mercury were removed from the stomach. OUTCOMES: Blood and urine mercury levels of the patient remained low during hospitalization. No symptoms of mercury intoxication developed during the follow-up period. LESSONS: Massive mercury ingestion may cause several symptoms, which can be prevented with prompt treatment. We used endoscopy to remove the mercury, which shortened the exposure time and minimized the risk of aspiration. This is the first case where endoscopy was used for the management of mercury ingestion.

Egg white-derived peptides prevent male reproductive dysfunction induced by mercury in rats.

Oxidative stress in known to contribute to the male reproductive dysfunction induced by mercury (Hg). Our study tested the hypothesis that the egg white hydrolysate (EWH), a potent antioxidant in vitro, is able to prevent the effects of prolonged Hg exposure on male reproductive system in rats. For this, rats were treated for 60 days with: a) Untreated - saline solution (i.m.); b) Hydrolysate - EWH (1 g/kg/day, gavage); c) Mercury - HgCl2 (1st dose 4.6 µg/kg, subsequent doses 0.07 µg/kg/day, i.m.); d) Hydrolysate-Mercury. At the end of the treatment, sperm motility, count and morphological studies were performed; Reactive Oxygen Species (ROS) levels, lipid peroxidation, antioxidant capacity, histological and immunohistochemical assays on testis and epididymis were also carried out. As results, HgCl2-treatment decreased sperm number, increased sperm transit time in epididymis and impaired sperm morphology. However, these harmful effects were prevented by EWH. HgCl2-treatment also increased ROS levels, lipid peroxidation and antioxidant capacity in testis and epididymis as well as promoted testicular inflammation and histological changes in epididymis. EWH improved histological and immunohistochemical alterations, probably due to its antioxidant property. In conclusion, the EWH could represent a powerful natural alternative to protect the male reproductive system against Hg-induced sperm toxicity.