Clinical Features

The clinical effects of mercury poisoning depend on the form and, in some cases, the route of administration. In general, the neurologic, gastrointestinal, and renal systems are predominantly affected. The short-chained alkyl compounds, methyl, dimethyl, and ethyl mercury, have the most devastating effects on the CNS, 24 followed by elemental mercury, whose primary toxicity is neurologic. Both forms of mercury produce erethism, a constellation of neuropsychiatric abnormalities including anxiety, depression, irritability, mania, sleep disturbances, excessive shyness, and memory loss. Tremor, either intention or nonintention, is a common physical finding.25 The short-chained alkyls produce paresthesias (early sign), ataxia, muscular rigidity or spasticity, and visual and hearing impairment and induce CNS teratogenic effects. Gastrointestinal effects of both elemental and short-chained alkyl compounds are mild. In cases of severe, chronic poisoning with elemental mercury, stomatitis, gingivitis, and excessive salivation are seen. Chronic toxicity of elemental and organic forms may cause renal glomerular and tubular damage. Acute mercury inhalation can produce pneumonitis, adult respiratory distress syndrome, and progressive pulmonary fibrosis with death. 26

In contrast, the mercury salts have little to no effect on the CNS but produce a severe corrosive gastroenteritis with abdominal pain that may be followed rapidly by cardiovascular collapse. Renal effects are typical, including acute tubular necrosis within 24 h. Children exposed to all forms of mercury except the short-chained alkyls can develop acrodynia, an immune-mediated condition characterized by a generalized rash, fever, irritability, splenomegaly, and generalized hypotonia with particular weakness of the pelvic and pectoral muscles. Further details of clinical findings are listed in Table 17.8-.5..

Swallowing mercury contained in a glass thermometer usually does not produce adverse effects because the mercury is not absorbed from the gastrointestinal tract unless the tract is damaged or contains fistulas.

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