Shin Sae-Ron, Han A-Lum
Department of Family Medicine, Wonkwang University College of Medicine, Iksan, Korea.
Korean J Fam Med. 2012 Sep;33(5):320-5. doi: 10.4082/kjfm.2012.33.5.320. Epub 2012 Sep 27.
Clinical manifestations of chronic exposure to organic mercury usually have a gradual onset. As the primary target is the nervous system, chronic mercury exposure can cause symptoms such as fatigue, weakness, headache, and poor recall and concentration. In severe cases chronic exposure leads to intellectual deterioration and neurologic abnormality. Recent outbreaks of bovine spongiform encephalopathy and pathogenic avian influenza have increased fish consumption in Korea. Methyl-mercury, a type of organic mercury, is present in higher than normal ranges in the general Korean population. When we examine a patient with chronic fatigue, we assess his/her methyl-mercury concentrations in the body if environmental exposure such as excessive fish consumption is suspected. In the current case, we learned the patient had consumed many slices of raw tuna and was initially diagnosed with chronic fatigue syndrome. Therefore, we suspected that he was exposured to methyl-mercury and that the mercury concentration in his hair would be below the poisoning level identified by World Health Organization but above the normal range according to hair toxic mineral assay. Our patient's toxic chronic fatigue symptoms improved after he was given mercury removal therapy, indicating that he was correctly diagnosed with chronic exposure to organic mercury.
长期接触有机汞的临床表现通常起病缓慢。由于主要靶器官是神经系统，长期接触汞可导致疲劳、乏力、头痛、记忆力减退和注意力不集中等症状。严重的长期接触会导致智力衰退和神经异常。最近爆发的牛海绵状脑病和致病性禽流感增加了韩国的鱼类消费量。甲基汞是有机汞的一种，在韩国普通人群中的含量高于正常范围。当我们检查一名患有慢性疲劳的患者时，如果怀疑存在如过量食用鱼类等环境暴露情况，我们会评估其体内的甲基汞浓度。在当前病例中，我们了解到该患者食用了许多片生金枪鱼，最初被诊断为慢性疲劳综合征。因此，我们怀疑他接触了甲基汞，并且根据头发有毒矿物质检测，他头发中的汞浓度将低于世界卫生组织确定的中毒水平，但高于正常范围。给予该患者驱汞治疗后，其慢性疲劳的中毒症状有所改善，这表明他被正确诊断为长期接触有机汞。
