Intravenous self-administration of metallic mercury in attempted suicide. Report of a case with serial roentgenographic and physiologic studies over an 18-month period

This report describes a 23-year-old white man who injected metallic mercury from a thermometer into his antecubital vein in an attempt at suicide. Despite the persistence of mercury throughout both pulmonary fields on chest x-ray films over an 18-month period of observation, no clinical or physiologic derangement of pulmonary function has developed. In addition, no clinical or biochemical evidence of acute or chronic mercury poisoning in any other organ has appeared during these 18 months, even though metallic mercury is seen in the abdominal viscera on roentgenographic examination. The literature on suicidal and accidental poisoning with metallic mercury is reviewed.

The effects of mercurial poisoning on the vestibular system

The sensory epithelium with adjacent nerve endings and the secretory epithelium may both become damaged following mercury chloride intoxication. Peripheral myelinated nerve fibres in the crista ampullaris showed signs of degeneration following chronic poisonins. Ultrastructural alterations of the vestibular hair cells initially occurred in animals free from clinical signs of intoxication. The sensory epithelium and occasionally the secretory cells were affected before signs of ultrastructural damage could be detected in the myelinated nerves.

Morphological changes of labyrinthine blood vessels following metal poisoning

Metal intoxication (mercury and arsenic) in guinea pigs may cause damage to labyrinthine blood vessels by swelling of the endothelial cells, mitochondrial disintegration and sometimes protrusion of endothelial cell cytoplasm herniating into the blood vessel lumen. Chronic mercury intoxication resulted in distorted endothelial cells with an increase in the density of their cytoplasm. An altered vascular permeability is likely to occur as the result of the morphological changes.

Pathological changes of human sural nerves in Minamato disease (methylmercury poisoning). Light and electron microscopic studies

Biopsy of the sural nerve was performed on six patients with relatively mild Minamata disease of 10-year or longer duration. All of the six patients presented characteristic pathologic changes. Light microscopy disclosed the formation of irregularly shaped myelin sheaths and fine axons, an increase in them, which is suggestive of incomplete regeneration, cicatrization following the loss of nerve fibers, increase in Schwann's nuclei, and formation of Büngner's bands. Electron microscopy revealed incomplete myelinated fibers and ultrafine unmyelinated fibers associated with incomplete regeneration, formation of regeneration units, and collagen increase. The laminar encapsulation with the processes of Schwann's cells were often observed in ultrafine fibers. In view of the fact that small quantities of mercury-contaminated fishes are still being caught in the Minamata district, myelin degeneration, glycogen deposits and appearance of dense bodies in axons, and vesiculation and fragmentation of endoplasmic reticulum were observed as degenerative changes due to the effects of mercury accumulation.

Intra- and extrarenal vascular changes in the acute renal failure of the rat caused by mercury chloride

Histologic evidence of intrarenal vasomotor changes were observed in the rat in the course of acute renal failure caused by the injection of HgCl2. Male Wistar rats injected s.c. with 2.5 or 4.7 mg HgCl2 per kg b. wt. developed fibrinoid damage in the media segments of preglomerular renal vessels, mostly in the arcuate and interlobular arteries. The lesions were patchy and irregularly scattered throughout the kidneys. 24 h post-injection the lesions were very rare and of only mild degree, whereas they were fully developed and regularly seen 48 h post-injection. A high percentage of similar changes was found in certain extrarenal vascular areas especially in the mesentery and pancreas. The damaged vascular segments were usually dilated. The results of various thichrome stains and histochemical reactions suggested edema of vascular smooth muscle cells and imbibition of the media by blood plasma substances, sometimes reaching the degree of fibrinoid necrosis. These findings were confirmed by electron microscopy. The imbibition of the smooth muscle cells by blood plasma material was clearly evidenced by the demonstration of intracellular fibrin precipitations. In connection with the degeneration of smooth muscle cells, accumulations of crystal-like fibrin formations could often be shown. Subendothelial fibrin formations were not observed. 96 h after the 2.5 mg injection the changes were already regressing, but edema of the vascular wall and signs of disturbed vasotonia persisted for several days. The maximum of the vascular changes usually coincided with the maximum of azotemia and the formation of debris cylinders in the renal tubules. However, no clear relationship was recognizable in individual cases between vascular damage, extent of tubular necrosis and renal function. The pathogenesis of the vascular changes is obscure, but neurogenic factors, increased release of catecholamines and/or vasoactive agents of renal origin in connection with other factors might play a decisive role. Arterial hypertension was absent. It is assumed that the structural damage of the vascular media is mainly brought about by prolonged or recurring vasospasms, or by alternating spasm and vasodilatation with local ischemia and increased tension of the vascular wall in the dilated segments. The altered function and structure of the vascular wall might, to a certain extent, contribute to renal insufficiency.

Pathology of subacute methylmercurialism in cats

Clinical signs of toxicosis, neurologic lesions, and increased tissue residues of methylmercury (MM)were produced in 9 cats by oral administration of 1.29 and 0.86 mg of Hg/kg of body weight/day as methylmercuric hydroxide. Clinical signs, which began after 15 days of exposure, included anorexia, ataxia, hypermetria, proprioceptive impairment, blindness, vertical nystagmus, and grand mal convulsions. Significant lesions occurred in cerebrum, brainstem, and cerebellum and correlated well with clinical signs. Microscopic central nervous system lesions consisted of neuronal degeneration, necrosis and loss of neurons, swollen axons, demyelination, loss of nerve cell processes, vacuolation of neuropil, gliosis, neuronophagia, perivascular cuffs, endothelial hypertrophy and hyperplasia, leptomeningitis, and infrequent vascular necrosis. Overall distribution of central nervous system lesions was unrelated to daily dose, but more advanced lesions were produced by the smaller daily dose. Mean tissue residues of MM were generally directly related to daily dose, and the average distribution among tissues was constant, with highest concentrations in liver, followed by kidney, spleen, muscle, and brain. In utero exposure of kittens to MM, revealed transplacental accumulation.

Studies on the pathophysiology of acute renal failure. I. Correlation of ultrastructure and function in the proximal tubule of the rat following administration of mercuric chloride

Acute renal failure was induced in male rats by the subcutaneous injection of 4 mg HgC12 per kg body weight. Changes in the proximal tubule were studied by light and electron microscopy at six time intervals from 15 min to 24 h. Renal function was monitored at 6 and 24 h. Between 15 min and 3 h changes were similar in all regions of the proximal tubule (pars convoluta and pars recta). Dispersion of cytoplasmic polysome groups was widespread and mitochondrial matrices were condensed in some cells. No changes were noted in the brush border but increased endocytotic activity occurred in some convoluted tubules at 1 and 3 h. At 6 h severe changes had occurred in the pars recta in the medullary rays. Microvilli of the brush border were focally absent, the mitochondria were swollen and the endoplasmic reticulum was dilated. At this time only subtle changes occurred in the pars recta in the outer stripe of the outer medulla. However by 24 h necrosis was widespread throughout the pars recta, yet changes in the proximal convoluted portion were minimal. A significant azotemia, decreased GFR and increased FENa+ and FEK+ occurred at 6 and 24 h after HgC12 injection. Thus HgC12 at 4 mg per kg body weight produced reproducible renal failure and necrosis involving the pars recta of every nephron but necrosis did not begin in the pars recta until after 6 h while acute renal failure was probably initiated much earlier. The following hypothesis is presented. HgC12 initially interacts with the entire proximal tubule. Although injury is sublethal in the pars convoluta it is responsible for greatly diminished sodium reabsorption and is related to the pathogenesis of the renal failure through feedback mechanisms involving the macula densa and release of renin. This results in renal hemodynamic alterations, decreased GFR and other functional disturbances associated with renal failure. The development of necrosis in the pars recta appears to be a relatively late event, possibly due to further accumulation of Hg++ in this region. In any case, the necrosis appears pathogenetically dissociable from the mechanism of acute renal failure.

Effect of variation in dietary NaCl intake on total and fractional renal blood flow in the normal and mercury-intoxicated rat

We studied the effect of different chronic (3-4 weeks) dietary salt intakes on intrarenal hemodynamics of normal and mercury-intoxicated rats. Cardiac output (CO), total renal blood flow (RBF), and the zonal perfusion rate in the outer cortex (OC) and inner cortex (IC) were measured by the radioactive microsphere method. The distribution of cortical blood flow was calculated as the distribution index (DI), which reflects the ratio OC/IC. Rats were placed on a high salt diet (group I), intermediate salt diet (group II), or low salt diet (group III). For each group control rats (subgroup A) and mercury-intoxicated rats (subgroup B) were studied. No effect of the different salt intakes on the DI could be detected. The DI in group IA was 2.35 +/- 0.14; in IIA, 2.40 +/- 0.16; and in IIIA, 2.38 +/- 0.09 (P greater than 0.05). After mercury injection RBF changed from 5.32 +/- 0.36 ml/g.min(-1) (IIA) to 3.31 +/- 0.20 ml/g.min(-1), IIB and from 4.32 +/- 0.11ml/g.min(-1) (IIIA) to 1.98 +/- 0.10 ml/g.min(-1) (IIIB) P less than 0.01). The DI was lowered to 1.53 +/- 0.06 (IIB) (P less than 0.05) and to 1.16 +/- 0.10 (IIIB) (P less than 0.01). In both IIB and IIIB a marked elevation of the blood urea was noted (IIB = 97 +/- 9 MG/100 ML AND IIIB = 182 +/- 25 mg/100 ml). In group IB no effect on RBF, OC, IC, or DI could be observed (for all values, P greater than 0.05) despite similar histological renal lesions. Group IB rats also had normal blood urea levels (31 +/- 6 mg/100 ml;P greater than 0.05). We conclude (1) that variations in dietary salt intake appear to have no detectable effect on the intracortical blood flow distribution; and furthermore (2) that the mercury-induced acute renal failure (ARF) is characterized hemodynamically by a total renal and preferential outer cortical ischemia and that chronic salt loading prevents the ARF while preserving normal renal perfusion.

MERCURY POISONING IN A WILD MINK

Mercury poisoning was diagnosed in a clinically-ill wild mink (Mustela vison) on the basis of clinical signs, histopathologic lesions and tissue mercury concentrations. The probable source of mercury was through ingestion of fish from the nearby South Saskatchewan River which is known to be contaminated with mercury. This is believed to be the first documented case of mercury intoxication of a wild animal in North America.

Late changes in human sural nerves in Minamata disease and in nerves of rats with experimental organic mercury poisoning

The sural nerves of 2 human cases with Minamata disease and poisoned rats were examined histopathologically. Both showed similar findings: the myelinated nerve fibres were decreased in number, but small myelinated nerve fibres were increased: The latter were irregular in shape and their Schwann cells showed regressive changes, with high electron density of the cytoplasms and many glycogen granules. Onion bulb formation was not found. According to fibre diameter histograms, the ratio of small myelinated nerve fibres of 2-5 mum showed a high percentage. A large number of the small myelinated nerve fibres were presumed to be regenerated nerve fibres. These findings are different from other peripheral neuropathies and may be characteristics of the late changes of the sural nerve induced by organic mercury compound.

The kinetics of methylmercury administered repeatedly to rats

Female rats (65-75 days old) were given orally 0.84 or 3.36 mg Hg/kg as methylmercury chloride (MeHgCl) 5 times a week for 13 and 3 weeks, respectively. The proportion of inorganic to total mercury remained as low as 6% in whole animal though it increased to above 40% in the kidneys. Differences in organ half times and the negative correlation with time for blood to liver, brain and kidney mercury ratios indicated more than one compartment for MeHg+. Brain had 26 days half time with a 32% final equilibrium concentration in relation to the body concentrations. Brain concentrations of mercury reported on rats dosed repeatedly with MeHg+ agreed with these values which justifies their use when experiments are planned to give a certain brain MeHg+ concentration. Half time for the whole body was 34 days but patholgical changes-weight loss, tubular damage, slow gastrointestinal passage-disturbed the accumulation curves in the higher dose group. Blood to kidney ratio and uptake of MeHg+ by kidneys also changed significantly.

Mercury and Mink. II. Experimental methyl mercury intoxication

Adult female mink were fed rations containing 1.1, 1.8, 4.8, 8.3 and 15.0 ppm mercury as methyl mercury chloride over a 93 day period. Histopathological evidence of injury was present in all groups. Mink fed rations containing 1.8 to 15.0 ppm mercury developed clinical intoxication within the experimental period. The rapidity of onset of clinical intoxication was directly related to the mercury content of the ration. Mercury concentration in tissue of mink which died were similar, despite differences in mercury content of the diets and time of death. The average mercury concentration in the brain of mink which died was 11.9 ppm. The lesions of methyl mercury poisoning are described and criteria for diagnosis are discussed.

Levels of mercury and pathological changes in patients with organomercury poisoning

Autopsies were carried out on 4 adults who died during the outbreak of mercury poisoning in Iraq and on 4 infants who were exposed to organomercury in utero. Mercury levels in tissues and in some body fluids were determined. The high levels of mercury in the central nervous system and the marked neuronal degeneration are noted.

Tritiated methylmercury in the brain of squirrel monkeys

Tritiated methylmercuty hydroxide (MeHgOH) with a specific activity of 306 curies/mol was synthesized by a Grignard reagent from tritiated methyl iodide with a yield of 70%. Tritiated MeHg was given to squirrel monkeys by stomach tube in weekly doses of 0.8 mg/kg. The animals were killed after one dose or six doses. The distribution of the substance in the brain was then studied by microautoradiography and by fractionation of brain tissue into cellular and subcellular fractions. Part of the MeHg in the brain is in a water-soluble form. Methylmercuty was found autoradiographically mainly in the neuropile of the cortex. At subtoxic doses (one dose), more protein-bound radioactivity was found in the glial fraction than in the neuronal fraction. At toxic dose (six doses), the protein-bound fraction of MeHg increased significantly (P less than .02) in the neurons relative to nontoxic dose (one dose). Methylmercury was demonstrated autoradiographically in damaged neurons but not in undamaged neurons.