[Arterial hypertension due to mercury poisoning: diagnostic value of captopril]. / Hypertension artérielle par intoxication au mercure: intérêt diagnostique du captopril.

BACKGROUND: Mercury poisoning is a rare cause of hypertension in children. Urinary excretion sometimes remains low despite severe clinical intoxication. CASE REPORT: A 32 month-old girl was admitted with hypertension, tachycardia, apathy, irritability and excessive sweating. Erythromelalgia and neurologic symptoms permitted the diagnosis of acrodynia. Urine mercury remained normal until chelation. Captopril significantly increased urine mercury concentration but failed to improve clinical manifestations. Clinical improvement required infusions of BAL for 5 days then oral dimercaptosuccinic acid for 3 months. Metal vapors originated from the mercury which spilled from a broken thermometer onto the carpet. COMMENTS: Low basal urine mercury could be associated with real mercury poisoning. Small amounts of metal mercury held in a thermometer could produce a high level of mercury vapor leading to intoxication in young children. The binding capacity of metal ions by captopril could be used to increase urine mercury output. Nevertheless, captopril therapy fails to improve acrodynia. Total elimination of mercury requires long-term therapy with BAL or dimercaptosuccinic acid. CONCLUSIONS: An unexpected mode of intoxication and low basal urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.

[Nutritional investigations and dietetic note-book. An instrument to establish the diet of hyperlipidemic patients (author's transl)]. / Enquête alimentaire et cahier diététique. Un outil pour réaliser le régime des hyperlipidémiques.

Whenever an excess of blood lipoids is revealed by laboratory tests, investigations should be conducted along two lines: etiological, aimed at detecting an underlying disease amenable to treatment, and dietetic, aimed at determining the patient's calorie intake. In every case, dietetic measures should begin with a normal-lipid, alcohol-free diet providing a number of calories adapted to the patient's weight. Calorie restriction is achieved at the expense of carbohydrates. This adaptation phase usually lasts 2 months. It is made easier by dietetic note-books where the amounts of each food are expressed as parts containing either 10 g of lipids or 10 g of glucides, and where fats are divided into predominantly saturated and unsaturated and glucides into slowly and rapidly absorbed. The problem of adapting the diet to the various types of hyperlipaemias is discussed. In most cases serum lipoprotein levels return to normal after 2 months of adequate diet, but it is essential to reeducate the patients in their eating habits, since successful re-education may help to reduce cardiovascular morbidity and mortality.