title: Is Chelation Therapy Efficient for the Treatment of Intravenous Metallic Mercury Intoxication?
abstract: The efficacy of treatment for intravenous elemental mercury intoxication has not been fully studied with regard to clinical outcome, and treatment recommendations vary. We treated a 41-year-old man with a history of drug abuse and depression who attempted suicide using 1 mL (13.53 g) metallic Hg i.v. He was admitted to the hospital 2 months later for dyspnoea and thoracic pain and was diagnosed with pneumonia. Hg deposits were seen in the lungs and extra-pulmonary organs. His blood level (372 μg/L) exceeded the population level of 5 μg/L by more than 70 times. Dimercaptopropane sulphonate sodium (DMPS; 600 mg/day orally) was administered for 14 days. One year later, the patient presented with dyspnoea on exertion, fatigue, depression and impaired sleep. His chest X-ray showed multiple opacities (size up to 2.8 cm), and psychological testing revealed a selective cognitive deficit in the area of visual attentiveness, flexibility, source memory and impairment of the motor speed of the dominant upper extremity. Mercury blood level was 158 μg/L and mercury urine output was 1380 μg/24 hr. DMPS (800 mg/day orally) was administered for 40 days; the patient eliminated up to 18 mg Hg/day. His Hg blood level and Hg urine output belong to the highest among reported cases. In spite of the therapy, the patient's blood Hg, complaints and psychological tests showed no improvement. This case report confirms that DMPS does not effectively remove intravenous deposits of metallic Hg.
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pelclova
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Stepanka
authors.initials: S
authors.lastname: Vlckova
authors.affiliation: Department of Neurology Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Bezdicek
authors.affiliation: MR Unit, Department of Radiodiagnostics, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Manuela
authors.initials: M
authors.lastname: Vaneckova
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.|National Institute of Public Health, Centre for Industrial Hygiene and Occupational Medicine, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Urban
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Ridzon
authors.affiliation: Department of Ophthalmology, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Diblik
authors.affiliation: J. Heyrovský Institute of Physical Chemistry of the CAS, CR v.v.i., Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Navratil
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Pavlina
authors.initials: P
authors.lastname: Klusackova
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Kamil
authors.initials: K
authors.lastname: Vlcek
authors.affiliation: Department of Internal Medicine, Hospital Kromeriz, Kromeriz, Czech Republic.
authors.forename: Olga
authors.initials: O
authors.lastname: Benesova
authors.affiliation: Department of Internal Medicine, Hospital Kromeriz, Kromeriz, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Trestik
authors.affiliation: 1st Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Homolka
authors.affiliation: Department of Occupational Medicine, Charles University, First Medical Faculty and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zakharov
mesh_terms: D000328:Adult; D015913:Chelation Therapy; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008630:Mercury Poisoning / Q000188:drug therapy*; D013406:Suicide, Attempted; D014494:Unithiol / Q000627:therapeutic use*
chemical_list: D014494:Unithiol