Mercury

Classification:

Mercury is a chemical element, which is found in nature as HgS (cinnabar). Physically, mercury is a fluid at room temperature.

Cas:

7439-97-6

Synonyms/Trade Names:

Kwik (dutch), NCI-C 60399, Quick Silver, RCRA Waste Number U 151, RTEC (polish); Hydrargismus, Merkurialismus, Minamata Disease.

Natural Sources:

Mined in China, Germany, Italy, Yugoslavia, and the USA (California).

Medical Importance:

Key Hazards:

Intoxication, slowly progressive respiratory failure.

Involved Organs:

Lung, gastrointestinal tract, central nervous system.

Exposure/Epidemiology:

Exposure may occur during mining and processing, by dental amalgam filling, in the drinking water, fish meals, in metallurgy and chemical industry. In mercury workers, an increased rate of nonspecific respiratory infectious diseases is seen. Intoxication (mostly induced by organic molecules) is one of the oldest known occupational diseases.

Thresholds:

 TWA STEL
mg/m3 mg/m3
Australia 0.05
Belgium 0.05
Czechoslovakia 0.05 0.15
Denmark 0.05
Finland 0.05
Germany 0.01 0.1
Great Britain 0.05
Russia 0.005 0.01
Hungary 0.02 0.04
Japan 0.05
Poland 0.01
Sweden 0.05
Switzerland 0.005 0.005
United States: ACGIH 0.05
United States: NIOSH/OSHA 0.05

Etiology/Pathophysiology:

Mercury may be absorbed by the lungs (80% of mercury fumes), skin, gastrointestinal tract, or urinary bladder. In the blood, Hg binds to ?-globulin, albumin, and erythrocytes, reacting with the sulfhydryle groups of proteins. It is stored in the kidneys, (about 50%), liver, pancreas, and hair. Excretion is performed via the gall-bladder, feces, and urine. The biologic half-life is 40-70 days, that of the brain-stored mercury measured in years. Hg may cross the placenta and can intoxicate the fetus, without causing symptoms in the mother.

Lung Diseases:

Diffuse alveolar damage (acute respiratory distress syndrome, ARDS), followed by progressive respiratory failure in severe acute intoxication. Pulmonary embolus (after intravenous injection), granulomas (after skin lesions), and allergic reactions have been described.

Clinical Presentation:

Acute intoxications induce nausea, vomiting, gastric pain, dyspnea, cough, fever, anuria, uremia, proteinuria, stomatitis mercuralis, and CNS symptoms; chronic intoxications headache, disruptions of teeth, rhinitis, anaemia, erethrism mercuralis, tremor mercuralis, and psychic disorders. The symptoms of the central nervous system are related to the total amount of Hg absorbed as follows:

Symtoms Absorbed Hg
in the body (mg)
Paresthesias 25-40
Ataxia 50-80
Language faults >100
Deafness >200
Mesolite 214

Radiology:

Chest radiographs show diffuse irregular densities which may develop into consolidated areas with fibrotic changes.

Lung Function:

Disturbances of pulmonary diffusion may be followed by obstructive changes.

Bronchoalveolar Lavage:

The lavage fluid contains increased number of inflammatory cells, especially granulocytes and macrophages.

Pathology:

Gross:

The lungs are soft in consistency, heavy and wet in acute intoxication, and display focal fibrosis in chronic exposure.

Histology:

A marked interstitial and intra-alveolar edema, bronchiolar necrosis, and desquamation of the cells of the alveolar lining are seen in severe acute intoxication, followed by the formation of hyaline membranes, fibrinous plugs in the distant airways, and invasion of macrophages. Partial resolution is common after several days; however, remnants usually proceed to focal honeycombing.

Prognosis:

Fair, and dependent upon the amount of inhaled Hg, slow progressive respiratory failure is often seen in survivors of severe intoxication.

Additional Diseases:

Nervous System:

Erethrism, ataxia, polyneuropathia.

Skin:

Dermatitis.

Gastrointestinal Tract:

Vomitus and gastric pain. Remarks: Amalgams are Hg-containing alloys mixed with silver, gold, lead, copper, and other metals.

References:

search Pubmed for Mercury


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