1. Mercury Poisoning

2. Occupational Sources  Manufacture of electric equipment, ammunitions, amalgams, felt making, disinfectants  coal plants - emit approximately half of atmospheric mercury  gold production, non-ferrous metal production, cement production, waste disposal, crematoria, caustic soda production, pig iron and steel production, mercury production (mostly for batteries)

3.  Mercury and its compounds are commonly used in chemical laboratories, hospitals, dental clinics, and facilities involved in the production of items such as fluorescent light bulbs, batteries, and explosives.  Common items that may contain mercury  Flourescent bulbs  Mercury thermometers  Watch batteries  thermostats

4. Exposure  Inhalation of Mercury Vapors - 80%  Most dangerous (lungs-blood- kidneys&brain)  Oral ingestion of liquid metallic mercury, subcutaneous routes  Urinary and fecal routes - excretory pathways

5. Toxic Dose  World Health Organization reports that the amount of mercury-absorbed daily by the average human body is 0.3 - 0.05 ug  Uptake of >100ug can be extremely lethal

6. Mechanism of Toxicity  Severe imbalance in the ratio of active to inactive glutathione, the body's most important tool for detoxifying and excreting metals  Causes Neurological impairments particularly CNS affectation

7. Common Acute and Chronic Effects and Confirmatory Diagnostic Test

8. Fulminant Symptoms  Acute /sudden/ may be intense  Rarely causes systemic poisoning  Dermatitis  Sensitization  Stomatitis  Conjunctivitis

9. Initial Exposure to High Concentrations Metal Fume Fever  Fatigue  Fever  Chills  Respiratory: cough, SOB, tightness, burning of chest and lung inflammation Mercury splashes

10. Occupational Exposure  levels: 1-44 mg/m3 (4 to 8 hours)  Chest pain  Cough  Hemoptysis  impaired lung function  Lung inflammation  Pulmonary edema

11. Chronic Symptoms  Insidious/Gradual onset  Classic triad of elementary mercury poisoning  Oral manifestations: gingivitis, salivation, stomatitis  Intentional tremors  Erethism (neurobehavioral changes characterized by anxiety, depression, irritability, emotional instability and regressive behavior; abnormal irritability or sensitivity of an organ upon stimulation)

12. Other Signs  Blue line in gums  Metallic fetid breath  Metallic or sweet taste  Tremors of facial and hand muscles  Loss of memory  Depression  Insomnia  Hyperactive knee jerks  Anxiety and irritability

13. Confirmatory Diagnostic Test  1. Urine Mercury level is above 50 mcg/dL – tentative maximum permissible concentration  2. Whole blood levels:  10 mcg/dL (methylmercury)  2 mcg/dL (inorganic Hg)

14. Specific Management/Antidote

15. Specific Management  Decontamination requires removal of clothes, washing skin with soap and water, and flushing the eyes with saline solution as needed.  Inorganic ingestion such as mercuric chloride should be approached as the ingestion of any other serious substance that causes corosion.  Immediate chelation therapy is the standard of care

16. Treatment/Antidotes  DMSA  Forms an inactive complex with mercury  Chelation for acute inorganic mercury poisoning to be excreted  Penicillamine  Increases the excretion of mercury after acute exposure to mercury vapor

17. Preventive Measures (Primary and Secondary)

18. Primary prevention  Personal Protective Equipment  Use masks, respirators, and gloves  Engineering controls  Proper ventilation via exhaust systems  Good housekeeping  Handle under fume hood to eliminate vapors  Proper container  Avoid spillage, proper waste disposal  Proper hygiene

19. Primary Prevention  Engineering Controls  Proper ventilation via exhaust systems  Handle under fume hood to eliminate vapors  Proper container (airtight)  Administrative Controls  Good housekeeping  proper waste disposal  Health education and Proper hygiene  Personal Protective Equipment  Mask, respirators, gloves

20. Secondary Prevention  Recognize early clinical manifestations to avoid serious developments  Application of physiological methods of measurement  Pre-employment and periodic examination and records  Regular monthly medical evaluations with emphasis to blood level monitoring

21. Secondary Prevention  Urine mercury over 50mcg/dL  Blood levels 10mcg/dL