Mercury toxicity - Revision history

Danbot: Add MedicationDose entries for succimer, dimercaprol, penicillamine

2026-03-20T21:17:16Z

Add MedicationDose entries for succimer, dimercaprol, penicillamine

← Older revision		Revision as of 21:17, 20 March 2026
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	==Disposition==		==Disposition==

			==Medication Dosing==
			{{MedicationDose
			\| drug = Succimer
			\| dose = 10mg/kg PO TID x 5 days, then 10mg/kg BID x 14 days
			\| route = PO
			\| context = Oral chelation
			\| indication = Mercury toxicity
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Dimercaprol
			\| dose = 2.5-5mg/kg IM q6-12hr
			\| route = IM
			\| context = Chelation, severe or inorganic mercury
			\| indication = Mercury toxicity
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Penicillamine
			\| dose = 250mg PO QID x 1-2 weeks
			\| route = PO
			\| context = Oral chelation, alternative
			\| indication = Mercury toxicity
			\| population = Adult
			}}

	==See Also==		==See Also==

Elcatracho: /* See Also */

2021-03-09T06:52:41Z

Elcatracho: /* Chelation therapy */

2021-03-09T06:51:56Z

Chelation therapy

← Older revision		Revision as of 06:51, 9 March 2021
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	*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr		*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr
	**Contraindicated in organic mercury poisoning as can paradoxically increase mercury levels		**Contraindicated in organic mercury poisoning as can paradoxically increase mercury levels
	*DMSA (succimer) 10mg/kg TID x 5days then 10mg/kg BID x 14days		*[[DMSA]] (succimer) 10mg/kg TID x 5days then 10mg/kg BID x 14days

	==Disposition==		==Disposition==

Alexgrohmann: /* Chelation therapy */

2020-02-22T12:28:13Z

Chelation therapy

← Older revision		Revision as of 12:28, 22 February 2020
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	*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr		*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr
	**Contraindicated in organic mercury poisoning as can paradoxically increase mercury levels		**Contraindicated in organic mercury poisoning as can paradoxically increase mercury levels
	*DMSA 10mg/kg TID x 5days then 10mg/kg BID x 14days		*DMSA (succimer) 10mg/kg TID x 5days then 10mg/kg BID x 14days

	==Disposition==		==Disposition==

Alexgrohmann: /* Chelation therapy */

2020-02-22T12:27:02Z

Chelation therapy

← Older revision		Revision as of 12:27, 22 February 2020
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	**Avoid in renal failure		**Avoid in renal failure
	*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr		*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr
	**~~contraindicated~~ in organic mercury poisoning as can ~~paridoxically~~ increase mercury levels		**Contraindicated in organic mercury poisoning as can paradoxically increase mercury levels
	*DMSA 10mg/kg TID x 5days then 10mg/kg BID x 14days		*DMSA 10mg/kg TID x 5days then 10mg/kg BID x 14days

Alexgrohmann: /* Management */

2020-02-22T12:26:25Z

Management

← Older revision		Revision as of 12:26, 22 February 2020
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	*ABC's		*ABC's
	*Decontaminate		*Decontaminate
			**Of note, mercury can penetrate through latex and nitrile gloves
	===Inhalation injuries===		===Inhalation injuries===
	*[[Oxygen]]		*[[Oxygen]]

Alexgrohmann: /* Chelation therapy */

2020-02-22T12:24:05Z

Chelation therapy

← Older revision		Revision as of 12:24, 22 February 2020
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	===Chelation therapy===		===Chelation therapy===
			The choice of chelating agent is dependent of the type of mercury poisoning.
	*[[Penicillamine]] 250mg PO QID x 1-2wks		*[[Penicillamine]] 250mg PO QID x 1-2wks
	**Avoid in renal failure		**Avoid in renal failure
	*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr		*[[Dimercaprol]] (BAL) 2.5-5mg IM Q6-12hr
			**contraindicated in organic mercury poisoning as can paridoxically increase mercury levels
	*DMSA 10mg/kg TID x 5days then 10mg/kg BID x 14days		*DMSA 10mg/kg TID x 5days then 10mg/kg BID x 14days

ClaireLewis at 15:20, 27 August 2019

2019-08-27T15:20:35Z

← Older revision		Revision as of 15:20, 27 August 2019
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	===Elemental Mercury===		===Elemental Mercury===
	====Acute Exposure====		====Acute Exposure====
	*Metal fume fever		*[[Metal fume fever]]
	**Usually self limited course of fever, chills, shortness of breath, metallic taste in throat, lethargy, confusion, vomiting, renal tubular necrosis		**Usually self limited course of [[flu-like illness]]; [[fever]], chills, [[shortness of breath]], metallic taste in throat, [[lethargy]], [[confusion]], [[vomiting]], renal tubular necrosis
	***Rarely may progress to respiratory compromise and death		***Rarely may progress to [[respiratory distress\|respiratory compromise]] and death
	*Worse presentation in children		*Worse presentation in children
	**May develop pneumothorax, pneumomediastinum and interstitial emphysema		**May develop [[pneumothorax]], pneumomediastinum and interstitial emphysema
	*Small airway obstruction secondary to desquamation		*Small airway obstruction secondary to desquamation

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	#Hyperexcitable state/emotional lability		#Hyperexcitable state/emotional lability
	*Other findings		*Other findings
	**Headache, visual disturbances, peripheral neuropathy, ataxia		**[[Headache]], [[visual disturbances]], peripheral neuropathy, [[ataxia]]
	===Inorganic Mercury===		===Inorganic Mercury===
	====Acute Exposure====		====Acute Exposure====
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	====Chronic Exposure====		====Chronic Exposure====
	*Chronic exposures usually secondary to inhalation exposure		*Chronic exposures usually secondary to inhalation exposure
	*Symptoms include renal failure, dementia, acrodynia		*Symptoms include [[renal failure]], [[dementia]], acrodynia
	**Acrodynia (AKA pink disease) = painful erythema and edema of hands and feet, rash, tachycardia, hypertension and irritability.		**Acrodynia (AKA pink disease) = painful erythema and edema of hands and feet, [[rash]], [[tachycardia]], [[hypertension]] and irritability.
	*Neuropsychiatric disturbances		*Neuropsychiatric disturbances
	===Organic Mercury===		===Organic Mercury===
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	**Acute presentations usually show signs days to weeks after exposure		**Acute presentations usually show signs days to weeks after exposure
	*Neuro symptoms predominate		*Neuro symptoms predominate
	**Tremor, ataxia, paresthesias, memory difficulties, visual disturbances, hearing loss		**Tremor, [[ataxia]], [[paresthesias]], memory difficulties, [[visual disturbances]], [[hearing loss]]
	*May also cause thrombocytopenia and agranulocytosis		*May also cause [[thrombocytopenia]] and [[agranulocytosis]]
	*Highly '''fetotoxic'''		*Highly '''fetotoxic'''
	**Easily crosses placenta		**Easily crosses placenta
	**May lead to severe ~~mental retardation~~ (like those with Minamata disease), developmental delay, ataxia and seizures in offspring		**May lead to severe intellectual disability (like those with Minamata disease), developmental delay, ataxia and seizures in offspring
	**Controversy exists over exposure from regular diet		**Controversy exists over exposure from regular diet
	***Albacore tuna may contain up to 0.34ppm of organic mercury		***Albacore tuna may contain up to 0.34ppm of organic mercury
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
	*Urine and blood Hg levels		*Urine and blood mercury levels
	*CBC		*CBC
	*Chem 7		*Chem 7
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	===Evaluation===		===Evaluation===
	*Urine Hg levels (>25μg/L is elevated) for elemental and organic mercury		*Urine mercury levels (>25μg/L is elevated) for elemental and organic mercury
	**Levels >300μg/L usually symptomatic		**Levels >300μg/L usually symptomatic
	**Organic mercury poorly excreted		**Organic mercury poorly excreted
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	===[[Caustic injuries]]===		===[[Caustic injuries]]===
	*May consider milk or egg whites		*May consider milk or egg whites
	**Thought to bind Hg		**Thought to bind mercury
	*WBI		*WBI

Rossdonaldson1: /* Inorganic */

2018-08-12T22:32:33Z

Inorganic

← Older revision		Revision as of 22:32, 12 August 2018
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	**Other dangers exist though!!!		**Other dangers exist though!!!
	*The California Department of Public Health issued a health alert on May, 2014 noting mercury poisoning linked to use of skin-lightening or acne Creams from Mexico<ref>http://www.ehib.org/papers/Health_Alert%20_Mercury_Poisonings_from_Mexican_creams_5_2014.pdf</ref>		*The California Department of Public Health issued a health alert on May, 2014 noting mercury poisoning linked to use of skin-lightening or acne Creams from Mexico<ref>http://www.ehib.org/papers/Health_Alert%20_Mercury_Poisonings_from_Mexican_creams_5_2014.pdf</ref>


	===Historical Exposures===		===Historical Exposures===

Rossdonaldson1: /* Background */

2018-08-12T22:32:21Z

Background

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 ==Background==
 ===Common Exposures===
 *Industrial
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 *Seafood consumption
 **Mostly methylmercury
 ===Exists as three major forms===
 *All disrupt sulfhydryl ezymes leading to impaired cellular function
 ====Elemental====
 *Liquid metal at room temperature (Think of the Terminator recongealing)
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 *Poorly absorbed from GI tract
 **Therefor most ingestions are non-toxic
 ====Organic====
 *Exists in three major forms:
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 *Short chain forms are highly lipophilic and cross the blood-brain barrier and placenta
 **Metabolized in the liver to N-acetyl-homocysteine-methylmercury which undergoes enterohepatic recirculation
 ====Inorganic====
 *Exists as monovalent and divalent
@@ Line 48: / Line 33: @@
 **Other dangers exist though!!!
 *The California Department of Public Health issued a health alert on May, 2014 noting mercury poisoning linked to use of skin-lightening or acne Creams from Mexico<ref>http://www.ehib.org/papers/Health_Alert%20_Mercury_Poisonings_from_Mexican_creams_5_2014.pdf</ref>
 ==Clinical Features==

← Older revision		Revision as of 06:52, 9 March 2021
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	==See Also==		==See Also==
			*[[Toxicology (main)]]
	*[[Heavy Metals]]		*[[Heavy Metals]]