Cloarec S, Deschênes G, Sagnier M, Rolland J C, Nivet H
Service de pédiatrie R, hôpital Gatien-de-Clocheville, Tours, France.
Arch Pediatr. 1995 Jan;2(1):43-6. doi: 10.1016/0929-693x(96)89808-3.
Mercury poisoning is a rare cause of hypertension in children. Urinary excretion sometimes remains low despite severe clinical intoxication.
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.
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.
An unexpected mode of intoxication and low basal urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.
汞中毒是儿童高血压的罕见病因。尽管临床中毒严重，但尿汞排泄有时仍较低。
一名32个月大的女孩因高血压、心动过速、冷漠、易怒和多汗入院。红斑性肢痛症和神经症状确诊为肢端痛症。螯合治疗前尿汞一直正常。卡托普利显著增加尿汞浓度，但未能改善临床表现。临床改善需要静脉输注二巯丙醇5天，然后口服二巯基丁二酸3个月。金属蒸汽源自一支破碎温度计中洒落在地毯上的汞。
基础尿汞水平低可能与真正汞中毒有关。温度计中少量的金属汞可产生高水平汞蒸汽，导致幼儿中毒。卡托普利对金属离子的结合能力可用于增加尿汞排出量。然而，卡托普利治疗未能改善肢端痛症。汞的完全清除需要用二巯丙醇或二巯基丁二酸进行长期治疗。
意外的中毒方式和基础尿汞水平低并非反对汞中毒的决定性论据，汞中毒是肢端痛症的唯一病因。
