title: Mercuric oxide poisoning treated with whole-bowel irrigation and chelation therapy.
abstract: Most reported cases of inorganic mercury poisoning are from mercuric chloride. We report a case of mercuric oxide (HgO) powder ingestion. A 31-year-old man presented to an emergency department after ingestion of approximately 40 g of HgO. Soon after ingestion, he developed nausea, vomiting, and abdominal cramping. Abdominal radiograph revealed densely radiopaque material in the stomach. Gastrointestinal decontamination was accomplished with activated charcoal and whole-bowel irrigation with polyethylene glycol solution (Golytely) for 24 hours until repeat abdominal radiographs no longer demonstrated the substance in the gastrointestinal tract. He was also chelated with British anti-Lewisite for 5 days, followed by succimer for 10 days. He had markedly elevated urine and blood mercury levels after ingestion, but except for a mildly depressed serum bicarbonate (19 mEq/L), his chemistry results remained normal including blood urea nitrogen and creatinine. He had an uncomplicated hospital course and remained asymptomatic at 6 months postingestion. Despite elevated urine and blood mercury levels after ingestion of HgO, our patient did not develop the end-organ toxicity typical of inorganic mercury poisoning.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego Medical Center, San Diego Division, San Diego, CA 92103, USA. bly@ucsd.edu
authors.forename: Binh T
authors.initials: BT
authors.lastname: Ly
authors.forename: Saralyn R
authors.initials: SR
authors.lastname: Williams
authors.forename: Richard F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D000328:Adult; D002606:Charcoal / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use*; D004112:Dimercaprol / Q000627:therapeutic use; D004573:Electrolytes / Q000627:therapeutic use; D006801:Humans; D007422:Intestines; D008297:Male; D008630:Mercury Poisoning / Q000628:therapy*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D004113:Succimer / Q000627:therapeutic use; D013406:Suicide, Attempted; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D002614:Chelating Agents; D004573:Electrolytes; C033608:Golytely; D004112:Dimercaprol; D002606:Charcoal; D011092:Polyethylene Glycols; D004113:Succimer