Winker R, Schaffer A W, Konnaris C, Barth A, Giovanoli P, Osterode W, Rüdiger H W, Wolf C
Division of Occupational Medicine, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Int Arch Occup Environ Health. 2002 Oct;75(8):581-6. doi: 10.1007/s00420-002-0363-z. Epub 2002 Jul 6.
Mercury poisoning presents a variety of clinical pictures depending on chemical structure, the route of exposure, amount absorbed and individual factors. Thus, an injection of metallic mercury can be considered relatively harmless in contrast to inhalation of mercury vapor. Injection of elemental mercury is rare, and a total of only 78 cases have been reported in the literature over the period 1923-2000.
We report a suicide attempt by intravenous injection of approximately 8 g metallic mercury. By X-ray examination widespread multiple mercury shadows were visible in the whole lung and also in the subcutaneous region of the cubital fossa, the small pelvis and the right hypogastrium. Mercury excretion after treatment with 2,3-dimercaptopropane-1-sulfonate (DMPS) was significantly higher than in occupationally exposed workers.
The patient showed symptoms typical of acute mercury intoxication, including gastroenteritis, ulceromembranous colitis and stomatitis mercuralis. No biochemical abnormalities in hepatic or renal function occurred, despite the persistence of metallic densities in the body. The patient's lung function was normal. The patient transitionally developed erethismus and tremor mercuralis. After 1 month of DMPS treatment, the mercury levels in blood were still high and the tremor was persistent. Three years after the suicide attempt the surgical removal of residual mercury in the left fossa cubitalis was performed. The extirpation of residual mercury was successful in cutting the mercury levels to almost half. After the operation the patient showed no symptoms of chronic mercury intoxication.
Since only 1 mg of mercury per day could be removed with DMPS treatment, it can be calculated, that it would take about 8,000 daily treatments to remove a total of 8 g solely by DMPS. Although DMPS itself does not dissolve the metallic deposits, it may considerably reduce the blood level of mercury and may therefore mitigate clinical symptoms, albeit transitorily. We therefore recommend that in cases of symptomatic metallic mercury injections, where the mercury cannot be removed by surgery, the patient's condition should be managed by repeated long-term DMPS treatment in order to control blood mercury levels.
汞中毒会呈现出各种各样的临床表现，这取决于汞的化学结构、接触途径、吸收量以及个体因素。因此，与吸入汞蒸气相比，注射金属汞可被认为相对无害。注射元素汞的情况较为罕见，在1923年至2000年期间，文献中总共仅报道了78例。
我们报告了一例通过静脉注射约8克金属汞自杀未遂的病例。通过X线检查，在全肺以及肘窝、小骨盆和右下腹的皮下区域可见广泛的多个汞影。用2,3 -二巯基丙烷 - 1 -磺酸钠（DMPS）治疗后的汞排泄量明显高于职业性接触汞的工人。
该患者表现出急性汞中毒的典型症状，包括肠胃炎、溃疡性膜性结肠炎和汞毒性口炎。尽管体内金属密度持续存在，但肝肾功能未出现生化异常。患者的肺功能正常。患者暂时出现了易兴奋症和汞毒性震颤。经过1个月的DMPS治疗后，血液中的汞水平仍然很高，震颤持续存在。自杀未遂三年后，对左肘窝的残留汞进行了手术切除。残留汞的切除成功地将汞水平降低了近一半。手术后，患者未表现出慢性汞中毒的症状。
由于用DMPS治疗每天只能排出1毫克汞，可以计算出仅通过DMPS排出总共8克汞大约需要8000次每日治疗。尽管DMPS本身并不能溶解金属沉积物，但它可能会显著降低血液中的汞水平，从而可能减轻临床症状，尽管只是暂时的。因此，我们建议，对于有症状的金属汞注射病例，如果汞无法通过手术清除，应通过反复长期的DMPS治疗来控制患者的病情，以控制血液中的汞水平。
