Endoscopy maybe required to asses any corrosive injury.IV injections produce pulmonary emboli in a ‘milky way appearance’. Xrays – mercury is radio-opaque and where is has been ingested or injected will been shown.24 hours urine mercury level: >100 microgram/L or 500 nmol/L is associated with neuropsychiatric disturbance.It confirms a recent exposure but does not reflect total body burden. Whole body mercury level (levels >200 microgram/L or 1000 nmol/L start producing symptoms).Screening: 12 lead ECG, BSL, Paracetamol level.Monitor fluid resuscitation and general supportive measure for any organ failure.Chronic mercury toxicity – leads to multi-system disorders, predominantly neurological (tremor, neurasthenia, erethism, emotional lability, insomnia, delirium, mixed sensorimotor neuropathy, ataxia and anosmia), gastrointestinal (metallic taste, burning pain in the mouth, loose teeth, gingivostomatitis and hypersalivation), renal dysfunction (proximal tubular atrophy with mercuric deposits within the renal interstitium and macrophages) and acrodynia.Any number of neurological dysfunctions can occur covering sensory loss, motor loss, cerebellar signs and psychological dysfunction. Delayed neurotoxicity develops over weeks or months after initial exposure and usually permanent. Acute exposure to organic mercury – GI symptoms, respiratory distress, tremor, dermatitis, renal tubular dysfunction and ECG (ST segment) changes.
Massive fluid loss leading to hypotension, shock and acute tubular necrosis follows. Grey discolouration of the mucous membranes. Severe local oropharyngeal pain, metallic taste, nausea, vomiting and diarrhoea. Acute exposure to inorganic mercury salts – ingestion causes severe haemorrhage gastroenteritis within hours.Interstitial pneumonitis may occur over the following days. Acute exposure elemental mercury – occurs via inhalation, symptoms include a headache, nausea, vomiting, chills, fever, salivation, metallic taste, visual disturbances, dyspnoea and a dry cough all within a few hours.Exposure to organic mercury by ingestion, inhalation or dermal application, leading to neurological injury.Ingestion of inorganic mercury salts leading to haemorrhage gastroenteritis, acute renal failure and shock.Inhalation of mercury via aerosol (vacuuming a broken thermometer) or vapour (heating mercury) can cause a pneumonitis, acute non-cardiac pulmonary oedema and neurological injury.Incidental discovery of high mercury levels in a ‘heavy metal screen’ when the patient is asymptomatic.Accidental ingestion of elemental mercury (broken thermometer).Mercuric ions are also excreted in the urine. All types of mercury are excreted in faeces.Elimination half life varies from 30 – 70 days.Mercury has a large volume of distribution once absorbed and distributes to the kidneys, liver, spleen and CNS.Organic mercury is well absorbed from the GI tract and the respiratory tract.Inorganic mercury is well absorbed though the skin and about 10% via the GI tract.when using a vacuum to clean up a spill or heated to a vapour) it is well absorbed in the respiratory tract. Elemental mercury has minimal absorption from an intact GI tract.Mercury has no cellular function but it binds to multiple intracellular sites, causing inhibition of enzymes and disruption of cellular membranes. Organic mercury (alkoxyalkyl mercury, alkyl mercury and methyl mercury) are used in embalming fluid, fungicides, pesticides, wood preservatives and found in seafood. mercuric arsenate and it used in fireworks, disinfectants, waterproofing, processing fur or leather. Inorganic mercury has ‘mercuric’ in its name i.e. It is the inorganic and organic mercury that can cause toxicity. Elemental mercury is found in thermometers, barometers, paints, and pigments, these are benign presentations unless aerosolised. The risk of toxicity depends on the type of mercury you have been exposed to. Fortunately mercury poisoning is very rare.
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