mercury poisoning. occupational sources manufacture of electric equipment, ammunitions, amalgams,...
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Occupational Sources Manufacture of electric equipment,
ammunitions, amalgams, felt making, disinfectants
coal plants - emit approximately half
of atmospheric mercury gold production, non-ferrous
metal production, cement production, waste disposal, crematoria, caustic soda production, pig iron and steel production, mercury production (mostly for batteries)
Mercury and its compounds are commonly Mercury and its compounds are commonly used in chemical laboratories, hospitals, used in chemical laboratories, hospitals, dental clinics, and facilities involved in the dental clinics, and facilities involved in the production of items such as fluorescent production of items such as fluorescent light bulbs, batteries, and explosives.light bulbs, batteries, and explosives.
Common items that may contain mercuryCommon items that may contain mercury Flourescent bulbsFlourescent bulbs Mercury thermometersMercury thermometers Watch batteriesWatch batteries thermostatsthermostats
Exposure Inhalation of Mercury Vapors - 80%
Most dangerous (lungs-blood- kidneys&brain) Oral ingestion of liquid metallic mercury,
subcutaneous routes Urinary and fecal routes - excretory pathways
Toxic Dose World Health Organization reports that the
amount of mercury-absorbed daily by the average human body is 0.3 - 0.05 ug
Uptake of >100ug can be extremely lethal
Mechanism of Toxicity Severe imbalance in the ratio of active to
inactive glutathione, the body's most important tool for detoxifying and excreting metals
Causes Neurological impairments particularly CNS affectation
Fulminant Symptoms
Acute /sudden/ may be intense Rarely causes systemic poisoning
Dermatitis Sensitization Stomatitis Conjunctivitis
Initial Exposure to High Concentrations
Metal Fume Fever Fatigue Fever Chills Respiratory: cough,
SOB, tightness, burning of chest and lung inflammation
Mercury splashes
Occupational Exposure
levels: 1-44 mg/m3 (4 to 8 hours) Chest pain Cough Hemoptysis impaired lung function Lung inflammation Pulmonary edema
Chronic Symptoms
Insidious/Gradual onset Classic triad of elementary mercury poisoning
Oral manifestations: gingivitis, salivation, stomatitis
Intentional tremors Erethism (neurobehavioral changes characterized
by anxiety, depression, irritability, emotional instability and regressive behavior; abnormal irritability or sensitivity of an organ upon stimulation)
Other Signs
Blue line in gums Metallic fetid breath Metallic or sweet taste Tremors of facial and hand muscles Loss of memory Depression Insomnia Hyperactive knee jerks Anxiety and irritability
Confirmatory Diagnostic Test
1. Urine Mercury level is above 50 mcg/dL – tentative maximum permissible concentration
2. Whole blood levels: 10 mcg/dL (methylmercury) 2 mcg/dL (inorganic Hg)
Specific Management Decontamination requires removal of
clothes, washing skin with soap and water, and flushing the eyes with saline solution as needed.
Inorganic ingestion such as mercuric chloride should be approached as the ingestion of any other serious substance that causes corosion.
Immediate chelation therapy is the standard of care
Treatment/Antidotes DMSA
Forms an inactive complex with mercury Chelation for acute inorganic mercury poisoning to
be excreted Penicillamine
Increases the excretion of mercury after acute exposure to mercury vapor
Primary prevention
Personal Protective Equipment Use masks, respirators, and gloves
Engineering controls Proper ventilation via exhaust systems Good housekeeping Handle under fume hood to eliminate vapors Proper container Avoid spillage, proper waste disposal
Proper hygiene
Primary Prevention
Engineering Controls Proper ventilation via exhaust systems Handle under fume hood to eliminate vapors Proper container (airtight)
Administrative Controls Good housekeeping proper waste disposal Health education and Proper hygiene
Personal Protective Equipment Mask, respirators, gloves
Secondary Prevention
Recognize early clinical manifestations to avoid serious developments
Application of physiological methods of measurement
Pre-employment and periodic examination and records
Regular monthly medical evaluations with emphasis to blood level monitoring
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