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Mercury Poisoning, Emergency Medicine

Keri L. Carstairs and David A. Tanen Reviewed 06/2017
 


Basics

Description

Mercury: 
  • 3 forms: Elemental, inorganic salts, and organic

  • Reacts with sulfhydryl groups, causing enzyme inhibition and alterations in cellular membranes

  • Binds to phosphoryl, carboxyl, ...

Diagnosis

Signs and Symptoms

  • Naturally occurring mercury is converted into 3 primary forms, each with its toxicologic effects:

  • Elemental mercury:

    • Symptoms from inhalation occur within hours:

      • Cough and dys...

Treatment

Pre-Hospital

  • Remove from toxin exposure.

  • Decontamination:

    • Wash exposed skin.

  • For altered mental status:

Initial Stabilization/Therapy

  • Secure ABCs and monitor...

Follow-Up

Disposition

Admission Criteria

Acutely symptomatic patients: 
  • Any evidence of respiratory compromise

  • Ingestion of inorganic mercury salt that may lead to a caustic GI injury

  • Renal impairment

  • Any p...

Pearls and Pitfalls

  • Obtain a good history for workplace, environmental or accidental exposure in patients with gastrointestinal and/or neuropsychiatric complaints.

  • Monitor patients for at least 6 hr if...

Additional Reading

  • Clarkson  TW, Magos  L, Myers  GJ. The toxicology of mercury–current exposures and clinical manifestations. N Engl J Med.  2003;349:1731–1737.

  • Rocha  JB, Aschner  M, Dórea  JG, ...

Codes

ICD9

  • 961.2 Poisoning by heavy metal anti-infectives

  • 976.0 Poisoning by local anti-infectives and anti-inflammatory drugs

  • 985.0 Toxic effect of mercury and its compounds

  • 974.0 Poisoning by mercurial ...

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