Toxicokinetics and toxicodynamics of elemental mercury following self-administration.
BACKGROUND
Intravenous injection of mercury has seldom been reported, especially in cases of attempted suicide, and is associated with variable clinical outcomes.


METHODS
A young woman came to our attention after self-injecting and ingesting mercury drawn from 37 thermometers. The patient suffered lung embolization complicated by adult respiratory distress syndrome (ARDS), toxic dermatitis, anemia, mild hepato-renal impairment, and died after 30 days. Mercury was monitored in biological fluids (blood, plasma, urine, and bronchoalveolar fluid) to study its toxicokinetics and to evaluate dose-effect relationships. Its urinary clearance significantly increased after a chelation challenge test with meso-2,3-dimercaptosuccinic acid (DMSA) (median values of 2.48 and 8.85 before and after the test, respectively, p < 0.05).


CONCLUSIONS
Mercury poisoning by intravenous injection is a clinical emergency, potentially leading to death. When injected, the element has a very slow clearance, mainly renal. Our data do not allow any conclusion about the effectiveness of chelation therapy.
De Palma
Giuseppe
G
Department of Experimental and Applied Medicine, Section of Industrial Hygiene, University of Brescia, Brescia, Italy. depalma@med.unibs.it
Mariotti
Orietta
O
Lonati
Davide
D
Goldoni
Matteo
M
Catalani
Simona
S
Mutti
Antonio
A
Locatelli
Carlo
C
Apostoli
Pietro
P
D000328:Adult; D002614:Chelating Agents / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008628:Mercury / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000633:toxicity*; D008630:Mercury Poisoning / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000139:chemically induced; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*; D004113:Succimer / Q000627:therapeutic use; D013405:Suicide; D013821:Thermometers
D002614:Chelating Agents; D004113:Succimer; D008628:Mercury