Mercury (Hydrargyrum (Hg), Mercurius) is an element from the group of heavy metals.Mercury is found in many areas of daily life (e.g. amalgam fillings). In addition, we ingest mercury with our food (fish and seafood can be contaminated with mercury (methylmercury) – especially predatory fish species: swordfish, tuna; sometimes also buttermackerel, trout, halibut, carp). Mercury occurs in various inorganic and organic compounds. Acute mercury poisoning can be distinguished from subacute and chronic mercury poisoning (mercurialism). Signs of chronic mercury poisoning are expected only after at least one year of exposure to more than 50 μg/m³. In acute mercury poisoning, the following symptoms may occur:
- Burning pain in the esophagus
- Renal dysfunction due to destruction of renal tubules leading to uremia (kidney failure)
- Nausea (nausea)/vomiting
- Inhalation of larger amounts of mercury causes respiratory irritation and central nervous system damage
In subacute mercury poisoning, the following symptoms may occur:
- Gingivitis (inflammation of the gums), which can lead to the formation of a dark bluish-purple fringe on the gums and lips
- Nephropathy (kidney disease), unspecified.
- Intestinal damage, unspecified, associated with diarrhea (diarrhea).
- Increased saliva production
- Stomatitis (mercurialis) (inflammation of the oral mucosa).
- Tooth loss
Chronic mercury poisoning may cause the following symptoms:
- Dermatitis mercurialis – form of inflammatory skin reaction.
- Diarrhea (diarrhea)
- Gingivitis (inflammation of the gums) – z. T. bluish-purple “mercury fringe”.
- Limb pain
- Hearing disorders
- Insomnia (sleep disorders)
- Cachexia
- Concentration disorders
- Headaches
- Paralysis
- Faintness
- Psellismus mercurialis – stuttering speech.
- Redness of the pharyngeal ring (so-called “mercury throat”).
- Visual disturbances
- Stomatitis (mercurialis) with increased salivation, z. T. also dry mouth.
- Tremor mercurialis – involuntary tremor.
- Tooth loosening and loss
- CNS symptoms such as:
- Ataxia (gait disturbances)
- Erethismus mercurialis – greatly increased excitability (jumpiness) and with a strong urge to move as well as anxious self-consciousness, sensitivity, shyness and mood lability.
- Memory disorders and personality degradation
- Mercurial tremor (tremor mercurialis)
- Sensory and motor paresis (paralysis).
- Speech disorders (psellismus mercurialis – stuttering speech/washy with sibilants).
- Sensory disturbances
Chronic mercury poisoning by oral ingestion is known as Minamata disease in Japan.
The procedure
Material needed
- EDTA blood
- Urine
- 24h collection urine (before/basal and after DMPS administration).
- (Saliva samples; before and after gum chewing).
Preparation of the patient
- Not necessary
- Collect 24h urine (basal value); next morning DMPS administration (3 tablets = 300 mg DMPS orally with 300 ml water) and again 24h urine (loading value).
Interfering factors
- Not known
Normal values – blood
| Normal value | <7.2 μg/l |
| BAT value | 50 μg/l (alkyl Hg compounds)100 μg/l ((in)organic compounds) |
Normal values – urine
| Normal value | <24.6 μg/l<38.9 μg/g creatinine |
| After DMPS administration | <50 μg/l |
| BAT value | 200 μg/l |
Normal values – saliva
| Normal value | <5 μg/l |
BAT value: biological agent tolerance value.
Indications
- Suspected mercury poisoning
Interpretation
Interpretation of lowered values
- Not relevant to disease
Interpretation of elevated values
- Occupational exposure (recognition as occupational disease).
- Agriculture: fungicides, seed dressings.
- Pyrotechnic and explosives industry
- Production of wood preservatives
- Chemical and pharmaceutical industry
- Dentistry – alloys with mercury (amalgam).
Caution. Organic mercury compounds are more toxic than inorganic compounds! Further notes
- The chewing gum test according to Daunderer (saliva sample!) – for estimating mercury exposure from amalgam fillings – cannot be recommended
- If symptoms of poisoning, you can try with DMPS (2,3-dimercaptopropane-1-sulfonic acid) to eliminate that mercury.
