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Rakete S, Asenbauer E, Böhm S, Leiz S, Peters J, Nowak D, Bose-O'Reilly S. Mercury poisoning of a 4-year-old child by indirect contact to a mercury-containing facial cream: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211025227. [PMID: 34262770 PMCID: PMC8243084 DOI: 10.1177/2050313x211025227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
We report the severe mercury poisoning of a 4-year-old child by a so far unknown
route of exposure, namely, by skin-to-skin contact. The child was admitted to
the hospital with episodic pain in his extremities, tachycardia, hypertension,
increased sweating, behavioral changes and weight loss. Extensive examinations
eventually revealed an acute mercury poisoning. The initial mercury levels were
19 µg/L in urine (reference level 0.4 µg/L) and 37 µg/L in blood (reference
level 0.8 µg/L). A facial cream bought online, containing approximately 18%
mercury, was identified as the primary source of intoxication. The symptoms
improved after disposal of the cream and chelation therapy. Further analyses,
home visits and interviews suggested that the child was accidently intoxicated
by skin-to-skin contact with the mother, although other routes of exposure such
as dust ingestion and surface-to-skin contact cannot be excluded. The mercury
levels in urine and blood samples of the child and other family members as well
as in domestic dust samples decreased considerably over time.
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Affiliation(s)
- Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich, Munich, Germany
| | | | - Susann Böhm
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich, Munich, Germany
| | - Steffen Leiz
- Department of Pediatrics, Klinikum Dritter Orden, Munich, Germany
| | - Jochen Peters
- Department of Pediatrics, Klinikum Dritter Orden, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich, Munich, Germany
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich, Munich, Germany.,University Children's Hospital Regensburg (KUNO-Clinics), Clinic St. Hedwig, University of Regensburg, Regensburg, Germany.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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2
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Magdalan J, Sozański T, Nowak K, Zawadzki M. Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report. J Forensic Leg Med 2021; 78:102129. [PMID: 33581407 DOI: 10.1016/j.jflm.2021.102129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male. CASE REPORT Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 μg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition. DISCUSSION Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism.
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Affiliation(s)
- Jan Magdalan
- Department of Toxicology and Internal Medicine, Lower Silesia Specialist Hospital T. Marciniak in Wrocław, Fieldorfa 2, Wrocław, PL 54-049, Poland; Department of Pharmacology, Wroclaw Medical University, Jana Mikulicza-Radeckiego 2, Wrocław, PL 50-345, Poland
| | - Tomasz Sozański
- Department of Pharmacology, Wroclaw Medical University, Jana Mikulicza-Radeckiego 2, Wrocław, PL 50-345, Poland
| | - Karolina Nowak
- Institute of Toxicology Research, Kasztanowa 45, Borowa, PL 55-093, Poland
| | - Marcin Zawadzki
- Department of Forensic Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 4, Wroclaw, PL 50-345, Poland.
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3
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Cappelletti S, Piacentino D, Fineschi V, Frati P, D'Errico S, Aromatario M. Mercuric chloride poisoning: symptoms, analysis, therapies, and autoptic findings. A review of the literature. Crit Rev Toxicol 2019; 49:329-341. [PMID: 31433682 DOI: 10.1080/10408444.2019.1621262] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Among mercury-related intoxications, the re-emerging of mercuric chloride poisoning has been recently described in literature. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the analytical procedures or the treatment have been published and no exhaustive analysis of all these factors exists in literature. The classic symptoms associated with toxicity of mercuric chloride is a combination of renal, gastrointestinal (GI) and central nervous system (CNS) damages, eventually leading to death. Fatalities related to exposure to mercuric chloride have been reported since the nineteenth century. To date, there have been 45 published cases in the medical literature in which the intoxication or the death is attributed to mercuric chloride. In this review, we will describe the modern medical treatments, with particular attenztion to the developments of the lasts two decades, in order to provide an exhaustive description of the clinical symptoms, the post-mortem findings, and the analytical procedures to act out when mercuric chloride intoxication occurs. The analysis of the data obtained permitted us to accurately describe all the organs and apparatus involved in mercuric chloride intoxication. The target organs were the kidneys, the GI tract and the CNS. A description of the analytical procedures for the determination of mercuric chloride in biological materials, to carry out in vivo and in post-mortem samples has also been described.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,State Police Health Service Department, Ministry of Interior , Rome , Italy
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health , Bethesda , MD , USA
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Stefano D'Errico
- Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
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4
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Luo J, Han X, Dou X, Zhang L, Yang S, Yang M. Accumulation of Arsenic Speciation and In Vivo Toxicity Following Oral Administration of a Chinese Patent Medicine Xiao-Er-Zhi-Bao-Wan in Rats. Front Pharmacol 2017; 8:491. [PMID: 28790918 PMCID: PMC5524916 DOI: 10.3389/fphar.2017.00491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
Realgar-containing traditional Chinese medicines such as Xiao-Er-Zhi-Bao-Wan (XEZBW), have been widely used for thousands of years. However, events associated with arsenic-induced ailments have increasingly become a public concern. To address the toxicity of XEZBW, we studied the histopathology and blood biochemistry of rats exposed to XEZBW using technology like high-performance liquid chromatography-inductively coupled mass spectrometry to determine arsenic speciation. Our results demonstrated that dimethylarsinic acid (DMA) increased from 18.57 ± 7.45 to 22.74 ± 7.45 ng/g in rat kidney after oral administration for 7 and 14 days, which was 10-fold higher than the levels observed in controls. Trivalent arsenite As(III) showed a large increase on day 7 (26.99 ± 1.98 ng/g), followed by a slight decrease on day 14 (13.67 ± 6.48 ng/g). Total arsenic levels on day 7 (185.52 ± 24.56 ng/g) and day 14 (198.57 ± 26.26 ng/g) were nearly twofold higher than that in the control group (92.77 ± 14.98 ng/g). Histopathological analysis showed mild injury in the liver and kidney of rats subjected to oral administration of realgar for 14 days. As in the XEZBW groups, a mild injury in these organs was observed after administration for 14 days. This study inferred that the toxicity of arsenic was concentration- and time-dependent. The accumulation of DMA, a byproduct of choline metabolism, was responsible for inducing higher toxicity. Therefore, we concluded that measuring the levels of DMA, instead of total arsenic, might be more suitable for evaluating the toxicity of realgar-containing traditional Chinese medicines.
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Affiliation(s)
- Jiaoyang Luo
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China
| | - Xu Han
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China.,College of Traditional Chinese Medicine, Jilin Agricultural UniversityChangchun, China
| | - Xiaowen Dou
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China
| | - Lei Zhang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China
| | - Shihai Yang
- College of Traditional Chinese Medicine, Jilin Agricultural UniversityChangchun, China
| | - Meihua Yang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China
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5
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Pelclova D, Vlckova S, Bezdicek O, Vaneckova M, Urban P, Ridzon P, Diblik P, Navratil T, Klusackova P, Vlcek K, Benesova O, Trestik P, Homolka J, Zakharov S. Is Chelation Therapy Efficient for the Treatment of Intravenous Metallic Mercury Intoxication? Basic Clin Pharmacol Toxicol 2017; 120:628-633. [DOI: 10.1111/bcpt.12725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Daniela Pelclova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Stepanka Vlckova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Manuela Vaneckova
- MR Unit; Department of Radiodiagnostics; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Urban
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
- National Institute of Public Health; Centre for Industrial Hygiene and Occupational Medicine; Prague Czech Republic
| | - Petr Ridzon
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Pavel Diblik
- Department of Ophthalmology; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Tomas Navratil
- J. Heyrovský Institute of Physical Chemistry of the CAS, CR v.v.i.; Prague Czech Republic
| | - Pavlina Klusackova
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Kamil Vlcek
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
| | - Olga Benesova
- Department of Internal Medicine; Hospital Kromeriz; Kromeriz Czech Republic
| | - Pavel Trestik
- Department of Internal Medicine; Hospital Kromeriz; Kromeriz Czech Republic
| | - Jiri Homolka
- 1st Department of Tuberculosis and Respiratory Diseases; First Faculty of Medicine; Charles University and General University Hospital in Prague; Prague Czech Republic
| | - Sergey Zakharov
- Department of Occupational Medicine; Charles University; First Medical Faculty and General University Hospital in Prague; Prague Czech Republic
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6
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Pelclová D, Šťastná J, Vlčková Š, Vlček K, Urban M, Laštovková A, Doležel Z. Is Central Europe Safe from Environmental Lead Intoxications? A Case Series. Cent Eur J Public Health 2016; 24:120-2. [PMID: 27434242 DOI: 10.21101/cejph.a4640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/26/2016] [Indexed: 11/15/2022]
Abstract
Preventive measures in Central Europe were successful in suppressing both occupational and environmental lead exposure so that they did not constitute a severe public health problem. However, rare lead intoxications still appear. We report on lead intoxication in four family members where the source was removed lead ceiling paint. The symptoms of the lead intoxication started several weeks after removal and the inhalational exposure to the minimum dust residues lasted for more than three months before the poisoning was diagnosed. Father developed anaemia and saturnine colics. He and his two daughters received antidotal treatment which had to be repeated in the children. Finally, all recovered completely.Lead intoxication may be easily overlooked due to the unspecific symptoms. It is necessary to think of this rare poisoning which may be caused by old paints, historical ceramics and lead shots, in addition to commercial products imported from abroad.
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Affiliation(s)
- Daniela Pelclová
- Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jana Šťastná
- Department of Paediatrics, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Czech Republic
| | - Štěpánka Vlčková
- Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Kamil Vlček
- Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Michal Urban
- Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Andrea Laštovková
- Department of Occupational Medicine, First Medical Faculty, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Zdeněk Doležel
- Department of Paediatrics, Faculty of Medicine, Masaryk University and Faculty Hospital Brno, Czech Republic
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7
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Ding E, Zhao Q, Bai Y, Xu M, Pan L, Liu Q, Wang B, Song X, Wang J, Chen L, Zhu B. Plasma microRNAs expression profile in female workers occupationally exposed to mercury. J Thorac Dis 2016; 8:833-41. [PMID: 27162656 DOI: 10.21037/jtd.2016.03.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Circulating microRNAs (miRNAs) have attracted interests as non-invasive biomarkers of physiological and pathological conditions. Several studies have examined the potential effects of mercury exposure on miRNAs expression profiles of general population environmentally exposed to mercury. The objective is to identify mercury-related miRNAs of female workers occupationally exposed to mercury. METHODS In this case-control study, we used a microarray assay to detect the miRNA expression profiles in pooled plasma samples between (I) chronic mercury poisoning group; (II) mercury absorbing group and (III) control group in the discovery stage. Each group has ten individuals. In addition, we conducted a validation of eight candidate miRNAs in the same 30 workers by quantitative real-time PCR. RESULTS In the discovery stage, eight miRNAs were conformed following our selection criteria. In the validation stage, RT-PCR confirmed up-regulation of miR-92a and miR-486 in the mercury poisoned group (P<0.05) compared to the other two groups. The results were consistent with the microarray analysis. CONCLUSIONS Plasma miR-92a-3p and miR-486-5p might prove to be potential biomarkers to indicate responses to mercury exposure. However, further studies are necessary to prove the causal association between miRNAs changes and mercury exposure, and to determine whether these two miRNAs are clear biomarkers to mercury exposure.
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Affiliation(s)
- Enmin Ding
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Qiuni Zhao
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Ying Bai
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Ming Xu
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Liping Pan
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Qingdong Liu
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Bosheng Wang
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Xianping Song
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Jun Wang
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Lin Chen
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
| | - Baoli Zhu
- 1 Department of Occupational and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China ; 2 Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China ; 3 School of Public Health, Southeast University, Nanjing 210009, China
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8
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Dwyer DS, Weeks K, Aamodt EJ. Drug discovery based on genetic and metabolic findings in schizophrenia. Expert Rev Clin Pharmacol 2014; 1:773-89. [PMID: 24410607 DOI: 10.1586/17512433.1.6.773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent progress in the genetics of schizophrenia provides the rationale for re-evaluating causative factors and therapeutic strategies for this disease. Here, we review the major candidate susceptibility genes and relate the aberrant function of these genes to defective regulation of energy metabolism in the schizophrenic brain. Disturbances in energy metabolism potentially lead to neurodevelopmental deficits, impaired function of the mature nervous system and failure to maintain neurites/dendrites and synaptic connections. Current antipsychotic drugs do not specifically address these underlying deficits; therefore, a new generation of more effective medications is urgently needed. Novel targets for future drug discovery are identified in this review. The coordinated application of structure-based drug design, systems biology and research on model organisms may greatly facilitate the search for next-generation antipsychotic drugs.
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Affiliation(s)
- Donard S Dwyer
- Professor and Director of Basic Research, Departments of Psychiatry and Pharmacology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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9
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Preiss J, Preiss M. Assessing Neuropsychological Impairment Using Reitan and Wolfson's Screening Battery. Arch Clin Neuropsychol 2013; 28:492-8. [DOI: 10.1093/arclin/act027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Oz SG, Tozlu M, Yalcin SS, Sozen T, Guven GS. Mercury vapor inhalation and poisoning of a family. Inhal Toxicol 2013; 24:652-8. [PMID: 22906171 DOI: 10.3109/08958378.2012.708677] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute mercury vapor poisoning is a rare but fatal toxicological emergency. People are exposed to mercury in daily life by the way of foods, vaccines, antiseptics, ointments, amalgam or occupation. We present here, the clinical picture and management of four members of the same family who were exposed to elemental mercury. Three of the family members were seen in another hospital with malaise, fever, eritematous rash and pulmonary problems. Their questioning revealed the mercury exposure. Having a suspicion of heavy metal intoxication, blood and urine mercury levels were measured and mercury intoxication was diagnosed. On admission to our hospital, two patients already had chelation therapy. In three of them we found three distinct abnormalities: encephalopathy, nephrotic syndrome and polyneuropathy. The fourth family member had minor symptoms. This family is an example for the inhalation exposure resulting from inappropriate handling of liquid mercury. During the first days, flu like illness ensues. Then, severe pulmonary, neurological, renal, hepatic, hematological and dermatological dysfunctions develop. Blood and urine mercury levels should be tested on suspicion, but it must be kept in mind that blood level is unreliable in predicting the severity of mercury toxicity. The priority in the treatment should be removing the patient from the source of exposure. Then British anti-Lewisite, edetate calcium disodium, penicillamine, Sodium 2,3-dimercaptopropane-1-sulfhonate and 2,3-dimercaptosuccinic acid can be used for binding the mercury. We conclude that since mercury-containing devices are present in daily life, physicians must be able to recognize the clinical manifestations and treatment of mercury poisoning.
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Affiliation(s)
- Serife Gul Oz
- Internal medicine, Hacettepe University Medical School, Sihhiye, Ankara 06100, Turkey.
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11
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Pelclova D, Sklensky M, Janicek P, Lach K. Severe cobalt intoxication following hip replacement revision: Clinical features and outcome. Clin Toxicol (Phila) 2012; 50:262-5. [DOI: 10.3109/15563650.2012.670244] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Chakera A, Lasserson D, Beck LH, Roberts ISD, Winearls CG. Membranous nephropathy after use of UK-manufactured skin creams containing mercury. QJM 2011; 104:893-6. [PMID: 21062753 DOI: 10.1093/qjmed/hcq209] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Chakera
- Nuffield Department of Medicine, Old Road Campus University of Oxford, Oxford OX3 7BN, UK.
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13
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Mercury as a cause of fulminant hepatic failure in a child: case report and literature review. Clin Res Hepatol Gastroenterol 2011; 35:580-2. [PMID: 21820988 DOI: 10.1016/j.clinre.2011.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/03/2011] [Accepted: 06/20/2011] [Indexed: 02/04/2023]
Abstract
Fulminant hepatic failure (FHF) in children is devastating unless urgent liver transplantation is undergone. Intoxication or drug-related FHF is a well-known group of causes leading to FHF. Mercury intoxication is described in the literature to cause hepatitis but not described to cause DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome and FHF in the same patient. We describe a child with mercury intoxication and FHF with clinical features fulfilling DRESS syndrome criteria. To our best knowledge, this is the first case report of fatal acute liver failure secondary to mercury intoxication in the English literature. Mercury intoxication should receive a worldwide attention to its consequences in order to minimize the morbidities and mortalities that arise from its intoxication.
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Abstract
Dermal absorption of some chemicals and drugs can cause systemic toxicity. We evaluated several case reports from the past decade, which discuss the dermal absorption of a specific chemical and potential local and systemic effects. We focused on herbicide and pesticide exposure along with exposure to cutaneous medication, occupational contact, and cosmeceutical exposure. Although causality cannot be established in most cases, it is critical to be aware of the possible effects of topical absorption that may not be immediately apparent. We recommended further studies on specific chemicals to ascertain causality and determine the highest exposure level with no observed adverse affect level (NOAEL) and the reference dose (RfD). Post-marketing epidemiology data in most geographical areas are markedly limited. A weak link in public health resides in the inadequate reporting and workup of alleged chemically related adverse effects. This arena mandates a re-thinking of how to increase this reporting, and workup, as a backup to our preclinical and clinical studies. Public awareness and funding will be rewarded by increased evidence to backup pre-approval pre-marketing studies.
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15
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Chelation for heavy metals (arsenic, lead, and mercury): protective or perilous? Clin Pharmacol Ther 2010; 88:412-5. [PMID: 20664538 DOI: 10.1038/clpt.2010.132] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite clinical experience that spans more than half a century, chelation for toxic heavy metals represents one of the most controversial and misapplied interventions in clinical toxicology. The prompt use of chelating agents to treat acute, life-threatening intoxication is an indication that is largely supported by experimental animal data and limited clinical research. Although chelating agents administered for chronic intoxication may accelerate the excretion of heavy metals, their therapeutic efficacy in terms of decreased morbidity and mortality is largely unestablished. Recent investigations suggest that their use in such settings might be associated with deleterious effects. Careful attention to risk-benefit issues is warranted, particularly in clinical situations in which the etiological role of heavy metals in the patient's illness is in question.
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16
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Rihova Z, Honsova E, Merta M, Jancova E, Rysava R, Reiterova J, Zabka J, Tesar V. Secondary Membranous Nephropathy—One Center Experience. Ren Fail 2009. [DOI: 10.1081/jdi-65304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Tudela E, MacPherson C, Maibach HI. Long-term trend in patch test reactions: a 32-year statistical overview (1970–2002), part II. Cutan Ocul Toxicol 2008; 27:187-202. [DOI: 10.1080/15569520802143436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Geier DA, Geier MR. A case series of children with apparent mercury toxic encephalopathies manifesting with clinical symptoms of regressive autistic disorders. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2007; 70:837-51. [PMID: 17454560 DOI: 10.1080/15287390701212141] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Impairments in social relatedness and communication, repetitive behaviors, and stereotypic abnormal movement patterns characterize autism spectrum disorders (ASDs). It is clear that while genetic factors are important to the pathogenesis of ASDs, mercury exposure can induce immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with ASDs. The Institutional Review Board of the Institute for Chronic Illnesses (Office for Human Research Protections, U.S. Department of Health and Human Services, IRB number IRB00005375) approved the present study. A case series of nine patients who presented to the Genetic Centers of America for a genetic/developmental evaluation are discussed. Eight of nine patients (one patient was found to have an ASD due to Rett's syndrome) (a) had regressive ASDs; (b) had elevated levels of androgens; (c) excreted significant amounts of mercury post chelation challenge; (d) had biochemical evidence of decreased function in their glutathione pathways; (e) had no known significant mercury exposure except from Thimerosal-containing vaccines/Rho(D)-immune globulin preparations; and (f) had alternate causes for their regressive ASDs ruled out. There was a significant dose-response relationship between the severity of the regressive ASDs observed and the total mercury dose children received from Thimerosal-containing vaccines/Rho (D)-immune globulin preparations. Based upon differential diagnoses, 8 of 9 patients examined were exposed to significant mercury from Thimerosal-containing biologic/vaccine preparations during their fetal/infant developmental periods, and subsequently, between 12 and 24 mo of age, these previously normally developing children suffered mercury toxic encephalopathies that manifested with clinical symptoms consistent with regressive ASDs. Evidence for mercury intoxication should be considered in the differential diagnosis as contributing to some regressive ASDs.
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Affiliation(s)
- David A Geier
- Institute of Chronic Illnesses, Inc., Silver Spring, Maryland, USA
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Bhan A, Sarkar NN. Mercury in the environment: effect on health and reproduction. REVIEWS ON ENVIRONMENTAL HEALTH 2005; 20:39-56. [PMID: 15835497 DOI: 10.1515/reveh.2005.20.1.39] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Mercury is a heavy metal that is found naturally in the environment in various forms. Human activity can release mercury into the air, water, and soil. Mercury is also released into the environment after its conversion to methylmercury by bacteria. Mercury was once used in medicine, but the medicinal aspect changed because of its devastating poisoning effect on humans and animals. Today, mercury is one of the most potent neurotoxins known, having a number of adverse health effects in animals and humans. As the sources of mercury are many, the general population is exposed to mercury in day-to-day life, in occupational settings, and in cases of accidental exposure. In addition, ignorance about the use of mercury in cosmetics and religious materials has opened an additional source of exposure. Therefore, making people aware of mercury's effects on health, its sources of entry into the environment, and its chelating remedies becomes a necessity so that strategies can be adopted to minimize use and exposure.
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Affiliation(s)
- Ashima Bhan
- Department of Reproductive Biology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
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