Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning.

Public awareness of the potential for mercury to cause health problems has increased dramatically in the last 15 years. It is now widely recognized that significant exposure to all forms of mercury (elemental/metallic and both inorganic and organic compounds) can result in a variety of adverse health effects, including neurological, renal, respiratory, immune, dermatologic, reproductive, and developmental sequellae. And while the various media have made the general population cognizant of the need to avoid unnecessary exposure to this naturally occurring element, there has also evolved a growing tendency to attribute unexplainable neurologic, as well as other, signs and symptoms to mercury, whether or not significant exposure to mercury has actually occurred. For the physician, making a diagnosis of mercury intoxication can be difficult, because many of the clinical signs and symptoms of mercury exposure can also be attributed to any number of causes, including undiagnosed neurological diseases, pharmacotherapy, vitamin or mineral deficiencies, and psychological stress. The physician must be able to recognize the clinical manifestations of mercury intoxication, and understand the importance of biological markers in making a definitive diagnosis of mercury poisoning. In a desire to treat the patient complaining of symptoms similar to some that can be caused by mercury, a growing number of physicians, particularly those in alternative medicine fields, result to chelation to "rid" the body of the mercury, believed to be the cause of the ailments. And although the use of chelation is increasing, controlled studies showing that this procedure actually improves outcome are lacking. If chelation therapy is considered to be indicated, the attending physician should communicate the risks of chelation to the patient before beginning treatment with metal-chelating drugs.

Elemental mercury poisoning in occupational and residential settings.

In its elemental form, mercury is the only metal that is in a liquid state at room temperature. It readily volatilizes at standard temperature and pressure, and its presence in open containers can result in biologically significant air concentrations in unventilated or poorly ventilated spaces. In recent years, elemental mercury has proven to be a potential source of toxicosis through either unintentional exposure or exposure resulting from inappropriate handling of liquid mercury acquired from school science laboratories or abandoned industrial facilities or warehouses. The shiny, silvery appearance of mercury in its liquid form makes it particularly enticing to children, and its insolubility in water and tendency to form beads when disturbed add to its mystique. This paper presents two case studies in which excessive exposure to elemental mercury vapor has resulted in adverse health effects in the exposed individuals: one in the workplace and one in a residential setting. These case studies serve to emphasize that primary care physicians, public health officials, and science educators need to recognize the potential risk posed by inhalation exposure to mercury vapors, and health practitioners need to be able to recognize the health signs and symptoms of such exposure. Public health professionals and those in charge of public and private education facilities should also be keenly aware of the necessity of prompt mitigation of human exposure should a spill or other mercury exposure scenario occur.