Full recovery from a potentially lethal dose of mercuric chloride

Acute mercuric chloride poisoning at a potentially lethal dose ended with survival: symptoms, concentration in cerebrospinal fluid, treatment

This study aims to present a case of acute mercuric chloride poisoning at a potentially lethal dose treated with the antidote - 2,3-dimercapto- 1-propanesulfonic acid (DMPS) and continuous renal replacement therapy (CRRT) combined with CytoSorb. A 21-year-old woman was admitted to a hospital with abdominal pain, vomiting, and suspected gastrointestinal bleeding after taking 5000 mg of mercuric chloride for suicidal purposes. Due to the patient deteriorating general condition and multiple organ damage, on the third day she was transported to the Clinic of Anaesthesiology and Intensive Care (CAaIC), Łódź, Poland. Laboratory tests confirmed features of acute kidney injury and high mercury levels in the blood (1051 μg/l) and urine (22 960 μg/l) - DMPS therapy and CRRT combined with CytoSorb were instituted. Due to nervous system complaints (headache, dizziness), a lumbosacral puncture was performed - the mercury concentration in the cerebrospinal fluid (CSF) was 5.45 μg/l. During a colonoscopy, significant diagnostic abnormalities revealed features of colonic mucosal necrosis. The treatment resulted in a decrease in subjective complaints, decreased mercury levels in biological material, and improved parenchymal organ function. On the 15th day of therapy, the patient was transferred to the primary care center for further treatment. The case confirms the possibility of improvement of patient condition following ingestion of a potentially lethal dose (5 g) as a result of the initiation of appropriate therapy even on the third day. The presence of mercury in CSF confirms that inorganic mercury compounds (mercuric chloride) can pass through the blood-brain barrier after oral ingestion. Int J Occup Med Environ Health. 2023;36(5):685-92.

Etlingera hemisphaerica Alters One-Dimensional Profile of Serum Proteins Due to Mercury Chloride in Rats (Rattus norvegicus)

<b>Background and Objective:</b> Several previous studies have shown that leaf ethanolic extract of <i>Etlingera hemisphaerica</i> (LE3H) has the potential to reduce the toxicity and teratogenicity effects of mercury. This study aimed to describe the effects of LE3H on the protein profile of <i>Rattus norvegicus</i> serum due to treatment with HgCl₂. <b>Materials and Methods:</b> Four groups of male rats, K1 was injected intraperitoneally (IP) HgCl₂ (5 mg kg¹ b.wt.), K2 was injected IP HgCl₂ (5 mg kg¹ b.wt.) and after 24 hrs it was gavage LE3H (0.27 mg g¹ b.wt.) every day for seven days, K3 was injected IP HgCl₂ (5 mg kg¹ b.wt.), after 24 hrs was gavage LE3H (0.55 mg g¹ b.wt.) every day for seven days. The K0 as control, received double-distilled water. On the ninth day, the experimental animals were killed via CD and blood was drawn from the heart to obtain serum. Serum samples were measured for protein content using the Lowry and serum was separated using the One-Dimensional Sodium dodecyl Sulfate-Polyacrylamide gel Electrophoresis (1D SDS-PAGE) technique. <b>Results:</b> The electropherograms showed four bands, 264.77, 219.53, 98.57 and 37.29 kDa, whose intensity significantly increased due to HgCl₂ treatment and then decreased to close to the control condition with LE3H administration. The results also revealed four bands, 31.95, 28, 06, 26, 29 and 15.09 kDa, whose intensity decreased significantly due to HgCl₂ treatment and then increased to close to the control condition by LE3H administration. <b>Conclusion:</b> The LE3H change profile of the eight blood serum protein bands due to HgCl₂ approximates the control condition in <i>R. norvegicus</i>.

Unusual Manifestation of Mercuric Chloride Poisoning as Intratubular Nephrocalcinosis - A Rare Case Report

Mercuric chloride salts are highly toxic compounds that have been linked to suicidal or accidental poisoning. Because of their high solubility, mercuric chloride salts can cause acute tubular injury, corrosive effects in the gastrointestinal system, hematemesis and hematochezia, circulatory collapse, and death. Here, we report an unusual case of mercuric chloride poisoning in a 17-year-old girl who manifested with acute tubular necrosis in association with intratubular nephrocalcinosis and emphasize the role of hemodialysis in the patient's successful recovery.

Investigation and monitoring of heavy metal poisoning

Historically, heavy metal measurement and interpretation has been a highly specialised area performed only in a handful of centres within the UK. However, recent years have seen a move to more local testing due to the repatriation of referred work into pathology networks and the increased availability of inductively coupled plasma mass spectrometry technology. While management of significant poisoning is still overseen by tertiary care poisoning specialists, management of milder cases may be undertaken locally.Non-specialist clinical scientists and clinicians need to know when heavy metal testing is appropriate, which samples are required (and any specific requirements around collection) and how to interpret and act on the results.This Best Practice article provides guidance on the investigation and monitoring of the toxic elements most frequently encountered in general medical practice; lead, mercury and arsenic. It is intended as a reference guide for the non-specialist and as a comprehensive summary for clinical toxicologists and clinical scientists.

Internal Dynamics and Metabolism of Mercury in Biota: A Review of Insights from Mercury Stable Isotopes

Monitoring mercury (Hg) levels in biota is considered an important objective for the effectiveness evaluation of the Minamata Convention. While many studies have characterized Hg levels in organisms at multiple spatiotemporal scales, concentration analyses alone often cannot provide sufficient information on the Hg exposure sources and internal processes occurring within biota. Here, we review the decadal scientific progress of using Hg isotopes to understand internal processes that modify the speciation, transport, and fate of Hg within biota. Mercury stable isotopes have emerged as a powerful tool for assessing Hg sources and biogeochemical processes in natural environments. A better understanding of the tissue location and internal mechanisms leading to Hg isotope change is key to assessing its use for biomonitoring. We synthesize the current understanding and uncertainties of internal processes leading to Hg isotope fractionation in a variety of biota, in a sequence of better to less studied organisms (i.e., birds, marine mammals, humans, fish, plankton, and invertebrates). This review discusses the opportunities and challenges of using certain forms of biota for Hg source monitoring and the need to further elucidate the physiological mechanisms that control the accumulation, distribution, and toxicity of Hg in biota by coupling new techniques with Hg stable isotopes.

Construction of fluorescent logic gates for the detection of mercury(II) and ciprofloxacin based on phycocyanin

Chemical pollutants such as heavy metals and antibiotics in the environment pose a huge threat to humans and animals. Our studies have demonstrated that the fluorescence of phycocyanin showed quenching responses towards both mercury (Hg2+) and ciprofloxacin (CIP), which acted in accordance with the "OR" molecular logic gate. In order to discriminate Hg2+ and CIP in application scenarios, cysteine (Cys) was utilized to design another "INHIBIT" logic gate, in which Hg2+ and Cys were the two inputs. Thus, an intelligent biosensor with dual-target identification capacity was successfully developed by using a fluorescent natural protein in an ingenious logic gate system.

Characteristics and treatment of elemental mercury intoxication: A case series

BACKGROUND AND AIMS

Elemental mercury toxicity is a rare condition which can be difficult to diagnose due to its nonspecific signs and symptoms. The purpose of this investigation is to describe the presenting characteristics and treatment of adult and pediatric patients with elemental mercury poisoning.

METHODS

A retrospective review was performed in six patients with elemental mercury exposure or intoxication who were treated in an outpatient medical toxicology clinic. Clinical signs and symptoms, laboratory assessments, and public health responses were reviewed.

RESULTS

Headache, anorexia, rash, and personality changes were commonly reported symptoms in pediatric patients; the adult patients were asymptomatic or reported signs and symptoms included myalgias, tremors, and hypertension. Delays in diagnosis were common. Symptomatic patients had 24-hour urine mercury concentrations greater than 20 mcg/L. Treatment, including removal from the exposure source as well as chelation with dimercaptosuccinic acid, resulted in resolution of signs and symptoms within 6 months of diagnosis.

CONCLUSION

The evaluation and treatment of patients with suspected elemental mercury poisoning frequently require a multidisciplinary approach including medical toxicologists and public health officials. A heightened awareness of the clinical presentations of this condition, as well as early identification and removal of patients from the source of exposure and consideration of chelation therapy, can result in accelerated patient recovery.

Leaf ethanolic extract of Etlingera hemesphaerica Blume mitigates defects in fetal anatomy and endochondral ossification due to mercuric chloride during the post-implantation period in Mus musculus

This study aimed to investigate the effectiveness of leaf ethanolic extract of Etlingera hemisphaerica (LE3H) in reducing defects in fetal anatomy and endochondral ossification in mice induced by HgCl₂ during the post-implantation period. Pregnant mice were divided into four groups, each consisting of 10 dams, and received drink and food ad libitum. The first group was administered LE3H (E1), the second one HgCl₂ (E2), the third one HgCl₂+LE3H (E3), and the fourth was control (E0), administered double-distilled water only. HgCl₂ (5 mg/kg bw) was administrated by injection intraperitoneally on gestation day (GD)9 and LE3H (0.39 mg/g bw) was administered by gavage on GD10. The treated and control animals were killed by cervical dislocation on GD18, dissected, and the morphologically normal living fetuses (MNLF) were collected. The MNLF of E0, E1, E2, and E3 from 5 dams were fixed with Bouin solution, and observed using the free hand razor blade technique for soft tissue examination. The remaining MNLF were fixed with 96% ethanol, and then stained with Alizarin Red S and Alcian Blue for ossification examination. Index of length of ossified part (ILOP) of humerus, index of width of ossified part (IWOP) of humerus, ILOP of femur, and IWOP of femur were calculated. E2 had higher cases of anatomical defects (74,6%) than E3 (48.9%), E1 (15.0%), and E0 (0%). E2 had humerus IWOP of 0.82±0.03, which was significantly lower than that of E0 (0.89±0.04) and E1 (0.89±0.03), while that of E1 and E0 was not significantly different from each other. Meanwhile, IWOP in E3 (0.88±0.03) was significantly higher than that in E2, but not different from that in E1 and E0. Thus, LE3H mitigated defects in fetal anatomy and endochondral ossification induced by HgCl₂ in mice.

A novel fluorometric measurement system based on triple complex for mercury (II) determination

T-BSA binary complex was formed with non-covalent interactions between fluorometric 2-thioxanthone thioacetic acid and stabilizator bovine serum albumin by fluorescence emission spectroscopy as a sensible and practical method. T-BSA concentration at 1.77 × 10^-4 M was obtained as the most suitable and reliable amount for the formation of T-BSA-Hg(II) triple complex. Trace amount of Hg(II) analyses were achieved by this new fluorometric triple complex system as the primary aim. The emission spectra from 350 nm to 650 nm were assayed on fluorometer for Hg(II) concentrations from 1.77 × 10^-8 M to 3.53 × 10^-4 M under an excitation wavelength of 337 nm. Hg(II) was found to increase the emission intensity of T-BSA by 50% even at 1.77 × 10^-7 M Hg(II). So this new system has strong sensitivity to Hg(II) ion. T-BSA-Hg(II) triple complex formation and its fluorometric characterization have not been investigated in literature yet. This study is critically important to provide Hg(II) analyses in wastewater treatments and biological samples for further studies.

Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report

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.

Use of mercury isotopes to quantify sources of human inorganic mercury exposure and metabolic processes in the human body

The pathways of human mercury (Hg) exposure are complex and accurate understanding of relative contributions from different pathways are crucial for risk assessment and risk control. In this study, we determined total Hg concentration and Hg isotopic composition of human urine, dietary components, and inhaled air in the Wanshan Hg mining area (MA), Guiyang urban area (UA), and Changshun background area (BA) to understand Hg exposure sources and metabolic processes in human body. At the three studied sites, total gaseous mercury (TGM) showed negative δ²⁰²Hg (-3.11‰ to + 1.12‰) and near-zero Δ¹⁹⁹Hg (-0.16‰ to + 0.13‰), which were isotopically distinguishable from Hg isotope values of urine (δ²⁰²Hg: -4.02‰ to - 0.84‰; Δ¹⁹⁹Hg: -0.14‰ to 0.64‰). We observed an offset of -1.01‰ to -1.6‰ in δ²⁰²Hg between TGM and urine samples, and an offset of -1.01‰ to 0.80‰ in δ²⁰²Hg between rice and urine samples, suggesting that lighter isotopes are more easily accumulated in the kidneys and excreted by urine. We proposed that the high positive Δ¹⁹⁹Hg in urine samples of UA was derived from fish consumption. The results of a binary mixing model based on Δ¹⁹⁹Hg were compared with those from a classic dietary model. The results from the MIF binary model showed that fish consumption accounted for 22% of urine Hg in the families at UA, whereas fish consumption contributed limited Hg to MA and BA. This study highlighted that Hg isotopes can be a useful tracer in understanding the sources and fates of Hg in human bodies.

Association between acute severe mercury poisoning and multiple organ failure

Acute mercury poisoning, involving a number of organs, leads to severe dysfunctions, such as acute renal failure (ARF), and even threatens patients' lives. A case of acute severe mercuric chloride (HgCl₂) poisoning with multiple organ failure was reported in this study. A 38-year-old woman orally took about 50 g HgCl₂ powder in 2015, and showed nausea, emesis, clouding of consciousness, lip and nail cyanosis, and dark red bloody fluid from bilateral nostrils. Based on chest and abdominal CT examinations, gastroscopy, and colonoscopy, the patient was found to suffer oral mucosal hyperemia and ulceration, gastrointestinal bleeding (haematemesis and hemafecia), ARF, metabolic acidosis, collapse and shock. Despite assisted respiration and relevant active treatments, the patient's condition deteriorated gradually and she was dead eventually. The study suggests that the best treatments for acute HgCl₂ poisoning accompanied with ARF are early blood purification and mercury elimination on the basis of conventional therapy.

Leaf ethanolic extract of Etlingera hemesphaerica Blume alters mercuric chloride teratogenicity during the post-implantation period in Mus musculus

This study aimed to investigate the effectiveness of leaf ethanolic extract of Etlingera hemisphaerica (LE3H) against the teratogenic effects of mercuric chloride (HgCl₂) in mice (Mus musculus). Pregnant M. musculus were divided into four groups, each consisting of 10 dams, and received drink and food ad libitum. The first, second, and third, and fourth (control) groups were administered with LE3H, HgCl₂, HgCl₂ + LE3H, and double-distilled water alone, respectively. HgCl₂ (5 mg/kg bw) was administered by injection on gestation day (GD) 9, and LE3H (0.39 mg/g bw) was administered by gavage on GD 10. Treated and control animals were killed by cervical dislocation on GD 18, dissected, and the fetuses were collected for evaluation of maternal, embryonic, and fetal toxicity. Eight parameters were measured: (a) embryo resorption or resorbed embryo, (b) dead fetus, (c) living fetus, (d) morphologically normal living fetus, (e) malformed living fetus, (f) number of MLF, (g) length of MNLF, and (h) weight of MNLF. LE3H caused 4 (50.00%), whereas HgCl₂ resulted in 7 (87.50%) parameters that were significantly different from those of the control, indicating that the teratogenicity of HgCl₂ was significantly higher than that of LE3H. HgCl₂ + LE3H showed two effects of LE3H on the teratogenicity of HgCl₂: increased 2 (25.00%), and decreased 6 (75.00%). Thus, LE3H decreased the teratogenic effects of HgCl₂ in M. musculus.

Mercuric chloride poisoning: symptoms, analysis, therapies, and autoptic findings. A review of the literature

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.

Neurochemical dysfunction in motor cortex and hippocampus impairs the behavioral performance of rats chronically exposed to inorganic mercury

Chronic exposure to mercury chloride (HgCl₂) has been shown to promote oxidative stress and cell death in the central nervous system of adult rats displaying motor and cognitive impairments. However, there are no investigations about neurochemical function after this type of exposure in rodents that may be associated with those behavioral changes already reported. Thus, the aim of this study was to analyze glutamatergic and GABAergic dysfunctions in the motor cortex and hippocampus of adult rats, in a model of chronic exposure to HgCl₂ in. Twenty rats were exposed to a daily dose of 0.375 mg/kg for 45 days. After this period, they were submitted to motor and cognitive functions tests and euthanized to collect the motor cortex and hippocampus for measurement of mercury (Hg) levels in the parenchyma and neurochemical assays for analysis of glutamatergic and GABAergic functions. It was observed that chronic exposure to HgCl₂ promoted increase in total Hg levels in these two brain areas, with changes in glutamatergic transport, but without changes in GABAergic transport. Functionally this model of exposure caused the decrease of the spontaneous motor locomotion and in the process of learning and memory. In this way, our results provide evidences that glutamatergic neurochemical dysfunction can be pointed out as a strong causal factor of motor and cognitive deficits observed in rats exposed to this HgCl₂.

Human exposure to mercury and its hematological effects: a systematic review

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.

Exposure to Inorganic Mercury Causes Oxidative Stress, Cell Death, and Functional Deficits in the Motor Cortex

Mercury is a toxic metal that can be found in the environment in three different forms – elemental, organic and inorganic. Inorganic mercury has a lower liposolubility, which results in a lower organism absorption and reduced passage through the blood–brain barrier. For this reason, exposure models that use inorganic mercury in rats in order to evaluate its effects on the central nervous system are rare, especially in adult subjects. This study investigated if a chronic exposure to low doses of mercury chloride (HgCl2), an inorganic form of mercury, is capable of promoting motor alterations and neurodegenerative in the motor cortex of adult rats. Forty animals were exposed to a dose of 0.375 mg/kg/day, for 45 days. They were then submitted to motor evaluation and euthanized to collect the motor cortex. Measurement of mercury deposited in the brain parenchyma, evaluation of oxidative balance, quantification of cellular cytotoxicity and apoptosis and density of mature neurons and astrocytes of the motor cortex were performed. It was observed that chronic exposure to inorganic mercury caused a decrease in balance and fine motor coordination, formation of mercury deposits and oxidative stress verified by the increase of lipoperoxidation and nitrite concentration and a decrease of the total antioxidant capacity. In addition, we found that this model of exposure to inorganic mercury caused cell death by cytotoxicity and induction of apoptosis with a decreased number of neurons and astrocytes in the motor cortex. Our results provide evidence that exposure to inorganic mercury in low doses, even in spite of its poor ability to cross biological barriers, is still capable of inducing motor deficits, cell death by cytotoxicity and apoptosis, and oxidative stress in the motor cortex of adult rats.

Acute mercury poisoning from occult ritual use

Mercury exposure is a serious environmental issue that concerns people worldwide. Industrial emissions containing mercury, some pharmaceutical and cosmetic products represent exposure sources. In Romania, as in many other countries, a supplementary cause for mercury exposure is represented by various occult rituals where liquids containing mercury are supposed to be ingested. We present the case of a 28 year old female who was admitted to the hospital for oral paresthesia, nausea, vertigo and sialorrhoea, after ingesting 100 ml diluted liquid mercury during an occult ritual. After the gastrointestinal decontamination, including gastric lavage, activated charcoal and cathartics, the outcome was favourable and 48 hours after admission the patient was discharged. This case report emphasizes the importance of an early digestive decontamination in mercury poisoning and the danger of mercury ingestion during various occult rituals.