QJM Advance Access originally published online on June 28, 2008
QJM 2008 101(8):667-668; doi:10.1093/qjmed/hcn073
© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Intravenous self administration of mercury
I. Marie,
J. Bernet,
G. Beduneau,
I. Auquit-Auckbur,
E. Houy-Durand and
H. Levesque
Department of Internal Medicine, Rouen University Hospital, 76031 Rouen Cedex, France.
email: isabelle.marie{at}chu-rouen.fr
A 24-year-old man attempted suicide by intravenous injection of elemental mercury. The exact quantity of injected elemental mercury was unknown. Five days later, the patient presented with painful erythema involving the anterior part of both forearms. On admission, laboratory findings disclosed the following: haemoglobin: 14.5 mmol/l, white blood cell count: 8.34 x 109/l, platelet count: 321 x 109/l, urea: 5.4 mmol/l, creatinine: 68 µmol/l; other tests, including liver tests, blood protein electrophoresis, proteinuria and urinalysis, were within normal limits. Urinary mercury was 371 µmol/l. Chest radiograph (Figures 1 and 2) showed multiple specks of mercury throughout both lung fields. Bone radiographs also revealed numerous aggregations of metallic mercury in subcutaneous tissues of the antecubital fossa as well as in the anterior part of forearms (Figures 3 and 4). Both thoracic and abdominal CT-scan demonstrated multiple specks of mercury throughout the lungs, heart, liver and within the soft tissues of forearms and arms (Figure 5). The patient was hydrated and chelation with 2,3-dimercaptosuccinic acid (DMSA) was administered. In addition, he underwent surgical removal of residual mercury at both forearm injection sites. The removal of residual subcutaneous mercury was successful in lowering urinary levels of mercury to about half that recorded on admission. At 7-month-follow-up after surgery, the patient was asymptomatic, with no evidence of renal, gastrointestinal or neurological effects related to the oxidation of mercury in both blood and other organs.
Clinical manifestations of mercury toxicity are determined by
its chemical form, route of exposure as well as amount absorbed.
Injection of elemental mercury is rare, as our literature search
using the Medline database identified only 79 previous cases.
Liquid mercury injected intravenously embolizes to the lungs
and other organs, and may be responsible for various manifestations
including: urticaria, excessive salivation and digestive signs
(diarrhoea, nausea/vomiting, stomatitis, gingivitis), as well
as renal and liver damage. To date, the optimal strategy for
management of mercury intoxication has not been defined. Nevertheless,
previous authors have suggested that DMSA may be an effective
antidote in active heavy metal intoxication; they have further
recommended that removal of mercury granulomas should also be
attempted. The present report also indicates that surgical removal
of residual mercury should be undertaken in patients exhibiting
elemental mercury injections, in association with DMSA therapy,
to control both blood and urinary mercury levels.
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