General therapeutic measures include removal from exposure and supportive therapy. Ingestion of mercury salts should be treated with aggressive gastrointestinal decontamination, including instillation of milk or egg whites to bind the mercury, lavage, and activated charcoal. Given the profuse diarrhea that may ensue, a cathartic may not be indicated. A polythiolated resin (commercially unavailable) has been used to bind intestinal methyl mercury and interrupt the enterohepatic circulation. Neostigmine may improve motor function in methyl mercury-poisoned patients by improving acetylcholine levels.
BAL is the preferred chelator for mercury salts and is administered in a regimen of 3 to 5 mg/kg per dose intramuscularly every 4 h for 2 days and then every 6 h for 2 days, followed by every 12 h for 7 days. BAL is contraindicated in methyl mercury poisoning owing to exacerbation of CNS symptoms. The BAL-mercury complex is dialyzable, and hemodialysis may be helpful in patients receiving BAL who have diminished renal function. Plasma exchange transfusion also was beneficial in a case of mercuric chloride ingestion.28 D-Penicillamine is used in elemental mercury and less severe cases of mercury salt toxicities. The dose is 100 mg/kg per day, to a maximum of 1 g in four divided doses for 3 to 10 days. D-Penicillamine has been used with variable results in organic mercury poisoning. DMSA has demonstrated efficacy in binding mercury, including organic forms and may become the treatment of choice for the short-chained alkyl compounds. 29
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