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Lessons learned from a fatal case of mercury intoxication

  • Nephrology – Case Report
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Context

While many cases of metallic mercury poisoning have been reported, cases of metallic mercury poisoning from multiple exposure routes are rare.

Case presentation

We report the case of a 36-year-old Latin American male who presented with rash, sore throat, fever, chills, cough, and diarrhea after chronic mercury vapor exposure and likely intravenous injection. Despite chelation treatment with meso-2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercaptopropanesulfonic acid (DMPS), the patient’s clinical course was complicated by renal failure and he passed away after 18 days.

Discussion

The most striking aspect of this case is that despite use of chelators, a dramatic increase in blood mercury level occurred. We discuss the rationale for combined use of chelators with hemodialysis and other treatments such as plasma exchange in the setting of acute mercury poisoning. This case also illustrated the potentially serious side effects of the chelation drug DMSA, and we discuss the potential relevance of dosing frequency to the occurrence rates of such side effects.

Relevance to clinical practice

Despite the tragic outcome, on review of case literature, we believe this case provides valuable lessons concerning the use of DMSA and DMPS to treat mercury toxicity, particularly with regard to the combined use of chelation agents and hemodialysis.

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Fig. 1
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Abbreviations

DMSA:

Meso-2,3-dimercaptosuccinic acid

DMPS:

2,3-Dimercaptopropanesulfonic acid

ECG:

Electrocardiogram

BAL:

British anti-lewisite

CT:

Computed tomography

PT:

Prothrombin time

CK:

Creatine kinase

ICU:

Intensive care unit

CVVHD:

Continuous veno-venous hemodialysis

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Conflict of interest

We declare no competing financial interests.

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Authors and Affiliations

  1. Internal Medicine Department, Paul Foster School of Medicine, Texas Tech University Health Science Center at El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA

    Tarek Alhamad, Azikiwe Nwosu, Young-sik Kim & Vani Shukla

  2. Department of Pharmaceutical and Medicinal Chemistry, Royal College of Surgeons in Ireland, Dublin 2, Ireland

    James Rooney

  3. Emergency Medicine Department, Paul Foster School of Medicine Texas Tech University Health Science Center at El Paso, El Paso, TX, USA

    Jay MacCombs

Authors
  1. Tarek Alhamad
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  2. James Rooney
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  3. Azikiwe Nwosu
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  4. Jay MacCombs
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  5. Young-sik Kim
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  6. Vani Shukla
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Corresponding author

Correspondence to Tarek Alhamad.

Additional information

Tarek Alhamad and James Rooney—Joint first authors.

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Alhamad, T., Rooney, J., Nwosu, A. et al. Lessons learned from a fatal case of mercury intoxication. Int Urol Nephrol 44, 647–651 (2012). https://doi.org/10.1007/s11255-010-9896-3

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  • DOI: https://doi.org/10.1007/s11255-010-9896-3

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