Immune-associated neuromyotonia syndrome following mercury poisoning

Removal of car battery heavy metals from wastewater by activated carbons: a brief review

Spent automobile batteries are one of the most significant secondary sources of harmful heavy metals for the environment. After being incorporated into the aquatic ecosystems, these metals disseminate to various plants, microorganisms, and the human body and cause multiple adverse effects. Activated carbons (ACs) have long been used as an effective adsorbent for different heavy metals in wastewater treatment processes. Although numerous research works have been published to date on this topic, they are scattered in the literature. In this review, we have assembled these works and provided an extensive overview of the application of ACs for treating spent car battery heavy metals (CBHMs) from aquatic systems. The preparation of ACs from different precursor materials, their application in the adsorption of CBHMs, the adsorption mechanism, kinetics, adsorption isotherms and various parameters that may affect the adsorption processes have been discussed in detail. A brief comparative analysis of the adsorption performances of ACs prepared from different precursor materials is also provided. Finally, recommendations for future research works are also offered.

Mercury poisoning complicated by acquired neuromyotonia syndrome: A case report

RATIONALE

Acquired neuromyotonia syndrome is a rare form of peripheral nerve hyperexcitability syndrome. It is characterized by spontaneous and continuous muscle contractions. Acquired neuromyotonia syndrome is mainly observed in patients with autoimmune diseases or tumors, but it is a rare neurological clinical manifestation in patients with mercury poisoning.

PATIENT CONCERNS

A 56-year-old woman presented with continuous and involuntary muscle twitching in her legs for 2 months; it was accompanied by a burning sensation in the lower limbs, insomnia, fatigue, and night sweats. These symptoms did not disappear during sleep.

DIAGNOSES

Toxicological blood analysis via atomic fluorescence spectrometry revealed that the level of mercury was 0.07 μmol/L (normal level: <0.05 μmol/L). Her urinary mercury level measured using the cold atomic absorption method was 217.50 μmol/mol creatinine, which was considerably higher than the reference range (0-2.25 μmol/mol creatinine for people not in contact with mercury, 0-20 μmol/mol creatinine following long-term exposure). Upon further testing, a high level of mercury (10,572 mg/kg) was detected in the patient's cream. Accordingly, this patient was diagnosed with mercury poisoning.

INTERVENTIONS

Treatment with 2,3-dimercapto-1-propanesulfonic acid (DMPS) was initiated. Her urinary mercury level decreased to 9.67 μmol/mol creatinine, and her neuromyotonia syndrome and hyponatremia were relieved, with urine protein completely disappearing after 3 months of treatment.

OUTCOMES

After DMPS treatment, the clinical manifestations of the nervous system disappeared and electrolyte parameters returned to normal levels.

LESSONS

Acquired neuromyotonia syndrome is a rare disorder caused by the hyperexcitability of peripheral nerves, resulting in spontaneous and continuous muscle contraction. Mercury poisoning should be considered in patients with neuromyotonia syndrome. Early detection of mercury poisoning can prevent unnecessary examinations and treatments.