MERCURY POISONING

MERCURY (QUICK SILVER)

 ‘Mercury’ was the name of the Roman’s

messengers of the gods who were believed
to be really fast moving.
MERCURY (QUICK SILVER)

 Mercury was named ‘Mercury’ because it, as

a liquid, flows quickly.
MERCURY (QUICK SILVER)

 It’s also called quicksilver because in addition

to its quick flowing property, it has a silvery
tinge.
MERCURY (QUICK SILVER)

 Since Mercury is liquid at standard

temperature and pressure, another name for
it, is Hydrargyrum.
(Hydr meaning Water, and Argyros meaning
Silver).
MERCURY (QUICK SILVER)
MERCURY (QUICK SILVER)
 Properties of Mercury (as a
transition metal):
 It has a Metallic taste.
 Since transition metals possess the shades of grey-
brown-white, mercury decolourizes the mucous
membranes (e.g gums) grey, and the lens of the eye
brown.
 It has a melting point of -38.83 °C and boiling point of
356.73°C.
 It forms complex ions with variable oxidative states.
 Metallic Mercury is insoluble in water, but its ions do
possess variable solubility in water.
MERCURY (QUICK SILVER)

 Liquid
Mercury is not poisonous
because:
 It has little to no solubility.
 It flows down the GI tract quickly (owing
to its quick flowing property).
MERCURY (QUICK SILVER)

 Although Mercury is liquid at room temperature,

it exhibits great tendency to vaporize even at
room temperature.
 However, the vapourized mercury itself is not so
much soluble.
MERCURY (QUICK SILVER)

 But vapourized mercury is toxic because instead

of going down the GI tract, it enters the
respiratory tract!! -- where it is easily diffused into
the blood simply by following diffusion gradient.
MERCURY (QUICK SILVER)

 Whatother forms of mercury

are poisonous?

 Mercurous ions, which have an oxidative state

of 1 e.g Mercury (I) oxide are less soluble and
less toxic.
 Mercuric ions, which have an oxidative state of
2, e.g Mercury (II) Oxide are more soluble and
hence more toxic.
MERCURY (QUICK SILVER)

 Things to remember:

 Metallic Mercury and Mercury (I) compounds

are not toxic.
 Vapourized Mercury and Mercury (II)
compounds are toxic.
MERCURY (QUICK SILVER)

 Effects
of Mercury toxicity on
the body:

 Hypersensitivity reaction.
 Characterised by generalised body rash.
Puffy, pinkish, painful, paraesthetic, perspiring & peeling
hands & feet.
MERCURY (QUICK SILVER)
 Effects of Mercury toxicity on the
body:

 Mercury binds to sulphydryl groups and inactivates

key enzymes involved in preventing oxidative
damage.

 So, typical signs of oxidative stress appear. Of all

the organs, kidneys are most affected by
oxidative stress, leading to Renal Failure.
 Oxidative stress also leads to brain damage,
producing many neurological symptoms.
MERCURY (QUICK SILVER)
 Effects
of Mercury toxicity on
the body:

 Mercuryirreversibly inactivates S-adenosyl-

methionine, which is necessary for
catecholamine metabolism by COMT.
MERCURY (QUICK SILVER)
 Effects
of Mercury toxicity on
the body:

 So, due to the body's inability to degrade catecholamines

(e.g. Epinephrine), a person suffering from mercury
poisoning may experience sympathomimetic effects:
nervousness, profuse sweating, tachycardia,
increased salivation, and hypertension.
MERCURY (QUICK SILVER)
 Effects
of Mercury toxicity on
the body:

 Mercury has a selective destructive effect on intestines,

especially large intestine, from where it passes on to be
excreted, leading to intestinal ulceration.
MERCURY (QUICK SILVER)
 Effects of Mercury toxicity on
the body:

 Abortion: Exposure to mercury can also lead to

abortion, as it can pass through the placental
circulation.
AN EASY WAY TO REMEMBER ORGAN EFFECTS
OF MERCURY POISONING

H (Acute+Chronic)– Hypersensitivity Reactions

A (Chronic) – Abortion

R (Acute+Chronic) – Renal Failure (with brain damage)

I (Chronic) – Intestinal ulceration

S (Acute+Chronic) – Sympathomimetic effects

ACUTE POISONING
 Effects appear soon if the vapourized poison is
inhaled, and slowly if mercury (II) compounds
are swallowed.
 It has a metallic taste, with a feeling of
constriction in the throat, a burning sensation
from mouth to stomach, and pain radiating over
the abdomen.
 The Mouth, tongue and fauces become
corroded and the mucous membrane appears
grayish white.
ACUTE POISONING

 Nausea, vomiting (long stringy masses of

white mucous, mixed with blood).
 Hypersensitivity reactions

 Sympathomimetic effects

 Collapse and Shock may ensue.

 Syncope and Convulsions may occur before

eventual death.
ACUTE POISONING

 If death is delayed, on the 2nd-3rd day,

salivation may further increase, the gums
become swollen, and the breath foul.
 Renal lesions soon appear due to
nephrotoxicity of mercury. The urine contains
albumin and blood, and death ensues from
renal failure (uraemia).
FATAL DOSE

 1-2 grams.
FATAL PERIOD

 Death may occur within a few hours, but is

usually delayed for 3-5 days. Delayed deaths
are usually due to renal failure (uraemia).
TREATMENT

 Stomach should be washed out with 250 ml

of a 5 percent solution of sodium
formaldehyde sulphoxylate.
 This substance reduces the Mercury (II)
perchlorate (more soluble) to Mercury (I)
chloride (less soluble).
TREATMENT

 Egg Albumin may be administered, which

forms mercury albuminate (which is
insoluble).
TREATMENT

 Medicinal Charcoal – Mercury adsorbs with

charcoal’s surface, and hence gets removed
without being absorbed by enterocytes.
TREATMENT

 If poison has been absorbed,

British Anti-Lewisite (BAL) and
penicillamine derivates (cuprimine)
are effective antidotes.
 If Kidneys show signs of damage,
alkaline fluids, peritoneal dialysis or
hemodialysis may be necessary.
 Treatment of shock and collapse
are also required.
POSTMORTEM APPEARANCE

 The tongue is white and sodden in

appearance, and the mouth generally has a
diffuse grayish white escharotic appearance.
 Mucous membranes of alimentary tract are
inflamed and corroded. The muscular coats
are softened, so that removing an organ
causes its entire rupture.
POSTMORTEM APPEARANCE

 Kidneys show toxic nephritis.

 Liver shows fatty degeneration.

 Subendocardial haemorrhages are present in

the heart.
CHRONIC POISONING (HYDRARGYRISM)

 This maybe the result of:

 The aftereffects of the acute attack, where
absorbed mercury accumulated in body organs.
 Continuous accidental absorption in those
working with the metal or its salts (as in the
manufacture of thermometers, mirrors, or in
police officers engaged in finger print detection
work where finger print powder contains
mercury).
SIGNS & SYMPTOMS OF CHRONIC POISONING

 Excessive salivation with metallic taste in

mouth.
 Loosening of teeth with painful inflamed gums.
 Hypersensitivity Reaction.
 Abortion.
 Nephritis, leading to renal failure (serious
complication).
 Intestinal ulceration, gangrene (especially of
large intestine).
 Sympathomimetic effects.
SIGNS & SYMPTOMS OF CHRONIC POISONING

 Neurological Symptoms:
 Hatter’s shake tremor:
 It is an intentional tremor, which affects the hands,
arms, tongue and later the legs.
 Erethism:
 Disturbance of personality, characterised by
shyness, irritability, tremors, loss of memory and
insomnia.
 Brown discoloration of the capsule of lens of the
eye due to deposition of mercury (mercuria
lentis) – It is observed through a slit lamp.
TREATMENT

 Removal of the patient from exposure to

mercury, and promoting elimination of
mercury by bowels and kidneys.
 Giving alkaline solution to the patient to fight
metabolic acidosis, which has resulted from
renal insufficiency.
POSTMORTEM APPEARANCE

 Drastic changes in the large intestine, with

spreading necrosis, which may even involve
whole of the large intestine.
 Renal damage, particularly tubular nephritis.

 Fatty degeneration of liver and cardiac

muscle.
MEDICOLEGAL ASPECTS OF MERCURY
POISONING
 Accidental poisoning:
 Accidental ingestion of antiseptic solutions
containing Mercury perchloride.
 Absorption of mercurial preparations applied to
skin.
 Intravenous administration of organic mercurials
as diuretics.
MEDICOLEGAL ASPECTS OF MERCURY
POISONING
 Accidental poisoning:
 In children, the use of ammoniated mercury in
some bleaching creams
 Swallowing the sulphocyanide of mercury stick
or tablet.
MEDICOLEGAL ASPECTS OF MERCURY
POISONING
 Homicidal, Suicidal cases of mercury
poisoning are rare to none.