Case report: severe mercuric sulphate poisoning treated with 2,3-dimercaptopropane-1-sulphonate and haemodiafiltration.
BACKGROUND
Inorganic mercury poisoning is uncommon, but when it occurs it can result in severe, life-threatening features and acute renal failure. Previous reports on the use of extracorporeal procedures such as haemodialysis and haemoperfusion have shown no significant removal of mercury. We report here the successful use of the chelating agent 2,3-dimercaptopropane-1-sulphonate (DMPS), together with continuous veno-venous haemodiafiltration (CVVHDF), in a patient with severe inorganic mercury poisoning.


METHODS
A 40-year-old man presented with haematemesis after ingestion of 1 g mercuric sulphate and rapidly deteriorated in the emergency department, requiring intubation and ventilation. His initial blood mercury was 15 580 microg/l. At 4.5 hours after ingestion he was started on DMPS. He rapidly developed acute renal failure and so he was started on CVVHDF for renal support and in an attempt to improve mercury clearance; CVVHDF was continued for 14 days.


METHODS
Regular ultradialysate and pre- and post-filtrate blood samples were taken and in addition all ultradialysate generated was collected to determine its mercury content.


RESULTS
The total amount of mercury in the ultrafiltrate was 127 mg (12.7% of the ingested dose). The sieving coefficient ranged from 0.13 at 30-hours to 0.02 at 210-hours after ingestion. He developed no neurological features and was discharged from hospital on day 50. Five months after discharge from hospital he remained asymptomatic, with normal creatinine clearance.


CONCLUSIONS
We describe a patient with severe inorganic mercury poisoning in whom full recovery occurred with the early use of the chelating agent DMPS and CVVHDF. There was removal of a significant amount of mercury by CVVHDF.


CONCLUSIONS
We feel that CVVHDF should be considered in patients with inorganic mercury poisoning, particularly those who develop acute renal failure, together with meticulous supportive care and adequate doses of chelation therapy with DMPS.
Dargan
Paul I
PI
National Poisons Information Service (London), Guy's and St Thomas' NHS Trust, London, UK. paul.dargan@gstt.sthmaes.nhs.uk
Giles
Lucy J
LJ
Wallace
Craig I
CI
House
Ivan M
IM
Thomson
Alison H
AH
Beale
Richard J
RJ
Jones
Alison L
AL
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy; D000328:Adult; D005500:Follow-Up Studies; D005756:Gastritis / Q000139:chemically induced / Q000628:therapy; D006396:Hematemesis / Q000139:chemically induced / Q000628:therapy; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D008297:Male; D017669:Mercury Compounds / Q000493:pharmacokinetics / Q000506:poisoning*; D008630:Mercury Poisoning / Q000628:therapy*; D008657:Metabolic Clearance Rate; D013276:Stomach Ulcer / Q000139:chemically induced / Q000628:therapy; D013406:Suicide, Attempted; D013431:Sulfates / Q000493:pharmacokinetics / Q000506:poisoning*; D016896:Treatment Outcome; D014494:Unithiol / Q000627:therapeutic use*
D017669:Mercury Compounds; D013431:Sulfates; D014494:Unithiol; C028430:mercuric sulfate