Mercury

Types of Mercury:- 1) Elemental 2) Organic 3) Inorganic Metabolism:- 1) Inhalation:- Uptake through inhalation, vapours & compounds are absorbed through inhalation. 2) Ingestion:- Organic & Inorganic forms are absorbed through this route, but organic forms are absorbed more through this route. 3) Skin:- Both Organic & Inorganic has same route of absorption. Distribution:- It has great affinity for Ethyl Group & distributed to sulphur containing ligands( ion or a molecule which binds to central metal atom). It is able to combine with & inhibit the action of enzymes containing SH Group. In the blood inorganic mercury is distributed almost equally between RBCs & Plasma, whereas the compounds like Methyl Mercury is concentrated 10 to 20 folds in RBCs. Principle target organs are CNS & Kidneys. It can cross rapidly the blood brain barrier. Excretion:- It is excreted into urine & faeces & may also found in sweat, saliva & breast milk. Organo mercury are excreted in the bile & then reabsorbed from the gut. Toxity:- A) Acute Toxicity:- Accidental or deliberate ingestion. Effects:- 1) Pain, inflammation, oedema & necrosis of oropharyngeal mucosa. 2) Nausea, Vomiting, Severe Abdominal Pain 3) Renal Damage with a) Albuminurea, b) Hematurea d) Oligourea, e) Excretion of casts 4) Acute papillary Necrosis in severe cases 5) Chemical Collitisnwith bloody diarrhoea 6) Tremors 7) Ataxia 8) Cerebral Oedema 9) Shock 10)Death 11) Chemical Pneumonitis:- If plenty of Mercury vapours are inhaled it causes Chemical Pneumonitis characterised by cough, dyspnoea, retrosternal pain, basal late inspiratory crackles, patchy shadows on X-Ray Chest, Haemoptysis & pulmonary Oedema. B) Chronic Poisoning:I) GIT:- 1) Gingivitis:- Most common in people with poor oral hygiene, which may cause loosening or loss of teeth. 2) Hypersalivation known as Mercury Ptyalism 3) Unpleasant bitter metallic taste in mouth. 4) A slate gray or reddish, punctuate Pigmentation of buccal mucosa. 5) Blueish line on the dental margins of gum. H2S reacts with Sulphates of Mercury. 6) Glossitis 7) pharyngitis 8) Gastritis II)CNS:- 1) Tremors:- Mainly in hands known as Mercuria Micro Parkinsonism, Haters Shake Head shaking, Mad Haters Syndrome 2) Ataxia:- Resulting in walking diffilculties. 3) Speech Defects 4) Peripheral Neuropathy mainly due to Organic Mercury. 5) Parasthesia of the extremities & Around the Mouth 6) In fatal cases the ventral & dorsal roots of spinal cord have been found to have undergone axonal degeneration & have loss of Mylin Sheath. So the clinical picture will be of, Parkinsonism, Multiple Sclerosis or Cerebrellar Disease but there is no nystagmus. III) Eyes:-1) Haemorrhages in the lens known as Mercuria Lentis. IV) Kidneys:- 1) Usual effect is Tubular Damage, more in case of Inorganic than Organic Mercury. 2) Glomerulus may also be damaged leading to albuminurea. 3) Nephrotic Syndrome may develop mainly in Inorganic. V) Erythysm:- It is a form of Organic Psychosis characterised by

1) Morbid Irritability 2) Mental Hyperactivity 3) Outburst of temper. 4) Memory impairment 5) Difficulty in Concentration 6) Depression 7) Somnolence VI) Minamatas Disease:- First noted at the end of 1953, when as unusual neurological disorder began to affect the villagers living on Minamata Bay on the southern coast of most southern of the main island of Japan. It was commonly referred to as Kibyo i.e. Mistry Illness. Both the sexes and all ages are equally affected. Signs & Symptoms were those of Polyneuropathy with Cerebellar Ataxia, Dysarthria, Deafness & Disturbance of Vision (Tubular Vision, loss of Peripheral Vision). Prognosis is Poor, Case Fatality Rate was 40%. Treatment:- A) Acute Poisoning:- It is a Medical Emergency. Purpose of the treatment is to Eliminate the Mercury from the Body & Resuscitation. 1) First Aid:- To Administer 4 Glasses of Milk as an emulsant. 2) Emergency Tracheostomy if needed. 3) Gastric Lavage with 10% Soda Bi Carb Worm Solution. 4) If Organo Mercury is involved 3 to 6 Sachets of the Basic Anion Exchange Resin Known as Cholesteramine should be administered before the Gastric Lavage tube is withdrawn, as sequestration of bile salts increases faecal excretion of the compound. 5) Chelating Agents:- a) IV Infusion of Na-Ca Edtate or Oral Penicillamine 1 to 4Gms daily in 4 divided doses. b) IM Injection of Dimercaprol (BAL) is extremely effective for Inorganic Mercury. Dose 2.5 Mg./Kg body weight, repeated at 4 hours of interval for 2 days, then twice daily for 10 days or till recovery. It is contraindicated in case of Organic Mercury, as it enhances its passage through blood brain barrier. c) If these drugs are not available then give 100 Ml of 5% Sodium Sulphate, 500-1000 Ml Ringer Lactate solution. 6) Alkaline Diuretics with physiological Saline i.e. 5% Dextrose with 1.26% Bicarbonate solution. 7) In case of Acute Inhalation:- a) Moist Oxygen inhalation b) Bronchodilators c) Antibiotics d) Mechanical Ventilation e) Steroids if needed B) Chronic Poisoning:- There is no effective treatment for chronic mercury poisoning. But we can use 1) Penicillamine 2) BAL 3) Mercapto Propio Glycene for organic mercury to induce urinary excretion. Close supervision of the person recovering from poisoning is required. Biological Monitoring of Mercury levels is done all over the world.