Intravenous injection of elemental mercury: A report of two cases

Elemental Mercury Poisoning by Self-Injection - A Report of Two Cases

Injection of mercury into the upper limb is a rare method of self-harm. We report two patients with varied clinical presentations - a 19-year-old male student who injected himself with mercury extracted from a sphygmomanometer bulb and reported to our emergency department 24 hours after the event and a 34-year-old industry worker who presented 2 years after injecting himself with elemental mercury. The management of mercury poisoning is described along with a brief review of literature. Mercury is a toxic element and adequate safety precautions must be taken by the surgical team in the management of such patients. Level of Evidence: Level V (Therapeutic).

Liposuction Technique Used as a Treatment Modality for Suicide Attempt by Injection of Mercury

Elemental mercury poisoning commonly occurs through vapour inhalation as it is well absorbed through the lungs. Administering subcutaneous and intravenous elemental mercury is very uncommon with only a few isolated case reports in literature. We present a case of attempted suicide by subcutaneous injection of elemental mercury, an unusual substance used for suicide. As the attempt at self-injury was not confessed by the patient, diagnosis was challenging. Patient was treated with an initial diagnosis of cellulitis, but with repeated and persistent questioning, a history of self-injection of mercury into the arm was revealed. On confirmation, mercury was aspirated from subcutaneous space similar to liposuction technique under X-ray guidance. Management of subcutaneous injection of elemental mercury with particular emphasis on the need for surgical removal of all available mercury is discussed.

A rare case of self-injection of elemental mercury

Background

Self-injection of elemental mercury is a rare finding especially in healthy people who are mentally sound. Early detection and removal of mercury from the body by chelation and physical removal of a stored injected site is required to prevent long term toxicity.

Case presentation

A 15 year old previously healthy girl presented with an acute febrile illness with a generalized maculopapular skin rash for 3 days with a preceding history of self-injection of mercury to both her forearms. This was an imitating experimental act influenced by a movie and she was mentally sound. Very high whole blood mercury levels, x-rays of the forearms and histology confirmed mercury poisoning.

Conclusion

Self-injection of elemental mercury can also occur in mentally sound people and rapid diagnosis and decontamination is required. This also signifies the importance of imposing limitations for visual media which could misguide minors and lead those to imitate and cause serious self-harm.

Aplastic anemia and membranous nephropathy induced by intravenous mercury

Self-injection of mercury can be life-threatening. We report a case of attempted suicide by self-intravenous injection of elemental mercury. The patient suffered from two side effects : membranous nephropathy and aplastic anemia. She was treated and the systemic effects of mercury were reversed after 4 years. The toxicology of mercury, mechanisms of renal and systemic toxicities, and the various therapeutic measures for mercury poisoning are discussed.