DOCTOR OF PHARMACY CANDIDATES

Ortiz, J and Hobby, R

 OBJECTIVES

DESCRIBE MERCURY
EXPLAIN THE MECHANISM OF TOXICITY
DESCRIBE CLINICAL DIAGNOSIS STRATEGIES
LIST MOST POSSIBLE SOURCES OF EXPOSURE
REVIEW MANAGEMENT STRATEGIES AND TREATMENT
DISCUSS APPLICABLE MONITORING PARAMETERS
 WHAT IS MERCURY?
GREEK NAME, HYDRARGYRUM, WHICH MEANS LIQUID SILVER,
AND IS ALSO NAMED QUICK SILVER DUE TO ITS FAST MOVING
NATURE

MERCURY ( Hg) IS A TOXIC HEAVY METAL WHICH IS WIDELY

DISPERSED IN NATURE

VAPORIZATION OF LIQUID MERCURY YIELD A TOXIC GAS THAT

CAN STAY IN THE ATMOSPHERE FOR UP TO A YEAR

BECAUSE OF ITS TOXICITY, THE CLINICAL USE OF MERCURY

HAS DIMINISHED
 TYPES OF MERCURY
Elemental Mercury Inorganic Mercury Organic Mercury

-Liquid at room temperature
-Vaporizes easily
-Bioaccumulates
-Fat Soluble
-Solid state is not well
absorbed in the
gastrointestinal tract
-Vapor form easily crosses
pulmonary alveolar
membranes to the circulatory
system
-Water soluble salts
-Primarily Mercuric Chloride
-About 10% of mercury salt
is absorbed
- Very caustic to the GI tract
- Half live is about 40 days
- Toxic to kidney and CNS
-The main organic forms are
methyl, ethyl and
phenylmercury
-Methylmercury has a half-
life in blood of 40-50 days
-extremely neurotoxic
(Most common mercury
toxicity).

Forms of Mercury: Beyond the silver liquid

http://mercurypolicy.scripts.mit.edu/blog/?p=435 January, 2013
http://mercurytox.weebly.com/life-cycle-and-exposure.html
 MECHANISM OF TOXICITY
Different types of mercury affect people in different ways.
Organic mercury is more dangerous than inorganic mercury, but
many inorganic mercury compounds can be converted to the
organic type
Elemental mercury is absorbed by the body through vapors
organic mercury is soluble in lipids and cross the blood brain
barrier and placenta easily.
In the central nervous system mercury can damage the blood brain
barrier and it facilitates penetration of the brain by other toxic metals
and substances

Mercury exposure and childrens Health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096006/ May, 2011
 MECHANISM OF TOXICITY
Methylmercury targets and kills neurons in specific
areas of the nervous system through:
1. Protein inhibition
2. Disruption of the mitochondrial function
3. Direct effect on ion exchange in a neuron
4. Disruption of neurotransmitters
5. Destruction of the structural framework of neurons

The effects of Mercury on the nervous system

https://faculty.washington.edu/chudler/merc.html
 MECHANISM OF TOXICITY
It is thought that mercury causes
neuronal problems through blockage
of the P-450 enzymatic process .
Mercury is associated with increased
tissue oxidative damage

Circulating organic mercury can be

taken up into the nerve terminals
where it can impair the synthesis of
tubulin and actin which are important
constituents of neuronal cell
structure and detoxification
processes

Environmental mercury and its toxic effects

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988285/ March 2014
 Uses of Mercury
Mercury was used as a common treatment for the sexually
transmitted disease Syphilis.

The mercury was administered by mouth, by rubbing it on the

skin, and by injection.

Mercury is used in thermometers and barometers, It is

also used in batteries, lamps, and dental amalgams.

Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound.

https://www.epa.gov/haps/health-effects-notebook-hazardous-air-pollutants October 4, 2016
 Sources of Exposure to Toxicity
List of common consumer products that contains Mercury

**Inhalation in Fish
occupational settings Vaccines
Mercury released from Batteries
Dental Amalgams Light bulbs
fillings Pesticides (rat poisoning)
Blood Pressure gauges Skin-lightening creams and
Thermometers soap
Old cans of latex paints

Exposure to Liquid Mercury. http://www.liquidmercury.net. June 7, 2013

Mercury in consumer products. https://www.epa.gov/mercury/mercury-consumer-products. July 7, 2016
Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound. https://www.epa.gov/haps/health-effects-notebook-
hazardous-air-pollutants October 4, 2016
The naked scientists, University of Cambridge. Are Heavy Metals in Vaccines Safe ? -Metal Levels TESTED for 1st
Time Influenza-Virus-Vaccine-Flulaval-Box-Mercury-Preservative-600.jpg.
http://www.thenakedscientists.com/forum/index.php?topic=51523.0. March 6, 2014
The Mercury Problem. http://www.vce.org/mercury/problem.html
 Mercury Absorption Pathways
Ingestion (GI tract)
Does not normally result in systemic toxicity but may cause
effects such as metallic taste, N/V/D, and abdominal pain.
CNS effects are common (HA, weakness and vision changes)

Inhalation (Lungs)
Acute exposure to high levels of elemental mercury vapor may
result in systemic toxicite causing inflammation of the lungs,
difficulty breathing, SOB, chest pain, and dry cough

Dermal (Skin)
Rash or inflammation of the skin (contact dermatitis)
Acute contact with the skin does not normally result in systemic
toxicity.
Center for Disease Control and Prevention. The National Institute for Occupational Safety and Health. Mercury (Lung Damaging Agent)
http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750021.html MAy 26, 2015
 Signs/Symptoms
Neurologic Inhalation
Brain damage Dyspnea
Impaired cognitive skills SOB
Movement Disorders / Muscle Tremors Chemical Pneumonitis
Mental Deterioration Chest Pain
Visual disturbances Dry cough
Speech and hearing problems Dermal
Sympathomimetic Effects Hypersensitivity
(Diaphoresis, HR, Bronchodilation) reactions
GI Tract Bloodstream
N/V/D Renal Failure
Abdominal Pain Abortion
Metallic taste
intestinal Ulceration
Center for Disease Control and Prevention. The National Institute for Occupational Safety and Health. Mercury (Lung Damaging Agent)
http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750021.html MAy 26, 2015
Mercury Toxicity Clinical Presentation. David A Olson. Medscape http://emedicine.medscape.com/article/1175560-clinical October 23, 2015
Hypersensitivity reaction
body rash
Puffy skin
Pinkish skin
painful area
perspiring area
peeling hands and feet

Intechopen.Hypersensitivity Reactions related to Mercury poisoning . http://www.intechopen.com/books/confocal-laser-microscopy-principles-

and-applications-in-medicine-biology-and-the-food-sciences/hypersensitive-reaction-mercurypoisoning
 An easy way to remember organ
effects of mercury poisoning

H HYPERSENSITIVITY REACTIONS
A ABORTION
R RENAL FAILURE (WITH BRAIN DAMAGE)
I INTESTINAL ULCERATION
S SYMPATHOMIMETIC EFFECTS

Center for Disease Control and Prevention. The National Institute for Occupational Safety and Health. Mercury (Lung Damaging Agent)
http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750021.html MAy 26, 2015
Mercury Toxicity Clinical Presentation. David A Olson. Medscape
 FATAL PERIOD

The lethal dose for an adult is 1 to 4 grams (g) or

14 to 57 mg/kg body weight for a 70-kg person.

Death may occur within a few hours, or it can be

delayed up to 5 days.

Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound.

https://www.epa.gov/haps/health-effects-notebook-hazardous-air-pollutants October 4, 2016
 Diagnosis of Hg Poisoning
History of Exposure
Symptoms
Laboratory testing:
Direct test for metals:
Urinalysis (Normal <10 mcg/L)
Poisoning (100 - 150 mcg/L
Blood (Normal <10 mcg/L)
Poisoning (>150-200 mcg/L)
Hair
Stool
Radiology: for elemental ingestion/aspiration/inhalation

Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound.

https://www.epa.gov/haps/health-effects-notebook-hazardous-air-pollutants October 4, 2016
 Treatment
Remove from source
Decontamination requires removal of clothes, washing skin
with soap and water, and flushing the eyes with saline solution
as needed.
Supportive care/Symptoms Management
Respiratory Support
Chelation with DMPS (2,3-Dimercapto-1-propanesulphonate)
therapy of choice for all forms of Mercury poisoning
Indications: 3-5 mg/kg once a month IV injected slowly over
five minutes

*** DMPS eliminates Mercury Systemically ***

Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound.

https://www.epa.gov/haps/health-effects-notebook-hazardous-air-pollutants October 4, 2016
 TREATMENT
Medicinal Charcoal Mercury absorbs with Charcoals
Surface, and hence gets removed without being absorbed by
enterocytes.
Stomach should be washed out with 250 ml of a 5 % solution of
sodium formaldehyde sulfoxylate

Antidote
If poison has been absorbed,
British Anti-Lewisite (BAL)
and Penicillamine derivates (Cuprimine)
are effective antidotes.
Health Effect Notebook for Hazardous Air Pollutants: Mercury Compound. https://www.epa.gov/haps/health-effects-notebook-
hazardous-air-pollutants October 4, 2016
 Monitoring/Follow UP
Follow-up to make sure that the mercury source of
poisoning is completely removed.

In cases of mercuric salt ingestion, carefully monitor the

patient's renal function.

If the patient develop neurological deficits, refer to a

neurologist for additional follow-up care and
rehabilitation.

Mercury Toxicity Treatment and Management. Aproach considerations

http://emedicine.medscape.com/article/1175560-treatment October 23, 2015
FUN FACTS
 The Mad Hatters
In the 17th century Hatters used a process called carroting.
Carroting uses mercuric nitrate to turn fur into felt
The hatters would breathe in fumes of this highly toxic metal
during this process
The symptoms that hatters displayed gave rise to the phrase
mad as a hatter.
 Pharaoh's serpent

Mercury(II) thiocyanate (Hg(SCN)2) in the presence of a

strong enough heat source, a rapid exothermic reaction is
started which produces a large mass of coiling serpent-like
solid.
 SUMMARY
Mercury (Hg) is a toxic heavy metal which is widely dispersed in
nature
There are three types of Mercury:
Elemental, Organic, and Inorganic
Mercury is a known neurotoxin and can damage all cells in the
human body
Mercury passes through the placental wall of pregnant women
and through the milk of nursing mothers to the infant leading to
health and neurological risk.
Dental Amalgam is a major contributor to wastewater pollution.
Treatment of choice is Chelation 3-5 mg/kg IV
Important follow-up for al people exposed to mercury poisoning is
to make sure that the mercury source of poisoning is completely
removed.
QUESTIONS?