Mercury poisoning symptoms
Mercury ions is a strong protoplasmic poison deposited in the liver and kidneys. Particularly toxic are inorganic mercury compounds: mercuric dichloride, cinnabar( mercury sulfide), calomel( mercury monochloride), mercury nitrate, mercury amido chloride, mercury hydroxyanide, mercury salicylate, mercury diiodide, etc.; organic compounds: insectofungicides - ethyl mercuric chloride, granozane, mercurane;medicines: merkuzal, promeran, novorit, diocid. Toxic dose of mercury of dioxide -0,1-0,2 g. Lethal doses of mercuric chloride, diocid and diodiodide for oral administration are for adults 0.5-4 g.
Mercury and its compounds are widely used in various branches of the national economy: metallurgical andmetalworking enterprises, instrumentation plants, in the electrical industry, in the production of X-ray and quartz lamps, the extraction of silver and gold from copper ores, in the etching of steel, in the production of batteries, for impregnating wood, in the chemical industry,economy, as well as in medical practice.
Mercury and its compounds come through respiratory system, digestive apparatus, skin and mucous membranes. Acute poisoning can result from the inhalation of fumes of metallic mercury or dust of mercury containing pesticides. Ingestion of metallic mercury usually does not lead to intoxication. Salts of mercury, and especially of mercury, can cause acute poisoning also when absorbed from undamaged mucous membranes and skin.
In the body, mercury is retained for a long time, accumulating in the form of compounds with protein( albumins) in various organs, mainly in the liver and kidneys. From the body, mercury is excreted mainly by the kidneys, and part by the glands of the digestive apparatus( salivary glands, liver, mucous membrane of the large intestine), and also other glands, including dairy.
Mercury and its compounds are very toxic. Organic compounds are more toxic than inorganic compounds. The toxicity of the latter depends on the degree of their solubility in water. Thus, mercury dichloride and nitrate are more toxic than mercury chloride and sulfide.
Salivation, metallic taste in the mouth. Unpleasant, specific odor from the mouth. White-gray necrotic attacks on the mucous membrane of the tongue, gums, throat and pharynx. Edema of the larynx.
Burning pain in the mouth, pharynx, esophagus, stomach( in the epigastric region), large intestine.
Nausea. Abundant salivation( up to 1 liter of saliva per day with an unpleasant odor).Vomiting persistent, prolonged;vomit often with an admixture of blood. Diarrhea, the stool is liquid, foul-smelling, with mucus and blood. Tenesmus.
Progressive drop in cardiac activity, heart sounds are deaf. Bradycardia. Hypertensive syndrome in acute renal failure. Kidney - necronemphrosis. Oliguria, coming through the phase of polyuria. Hypostenuria. Albuminuria. Hematuria. Progression of oliguria to anuria. The early onset of anuria is most unfavorable, it is a sign of the development of the syndrome of the kidney soup.
Blood - thickening;azotemia;hypochlorism, hypochromic anemia.
Cold sweat. Increase in blood pressure. Uremia. Mercury dermatitis, toxicormy of neurovascular origin.
Fainting. Convulsions. Death from uremia.
It should be taken into account that sodium chloride, taken per os when mercury is poisoned with dichloride, significantly increases its solubility!
Contraindicated: taking per os of acids, salty foods, castor oil( and fats), ethanol. Do not smoke - nicotine dramatically worsens the course of poisoning
Inhalation of mercury vapor leads to prevailing changes in the central and autonomic nervous system.
Headache, weakness. Stomatitis. Necrosis of the nasal mucosa. There may be gangrene or necrosis of the lower jaw. Changes in the kidneys are necronemphrosis. Mercury Fever. Polyneuritis.
Mercurial stomatitis. The lacquer of Kussmaul is a varnish-copper coloration of the soft palate and tongue.
Excitement, violence, attacks of rabies. Encephalopathy. Cerebrospinal tremor of fingers. Writing cramp. The color reflex of Atkins - the luminescence of the lens in the light of the slit lamp copper-red-brown color.
Detection of mercury - from the color reaction of urine: with the addition of potassium iodide appears yellow, then red.
Skin - eczema, exanthema, urticaria, exfoliative dermatitis. Stomatitis. Fever. Serum sickness. Shock.
1. Lay the patient, remove the poison. The most radical and really active way of treating poisoning with salts of mercury is possibly an early application of extracorporeal detoxification - hemosorption( it can be started even at the prehospital stage), hemodialysis, peritoneal dialysis, lymphosorption.
2. Antidotes.
3. Gastric lavage through the probe with a large amount of water with the addition of either egg protein( 2 protein per 1 liter of water) or 30-50 g sodium thiosulfate, or 30-40 g magnesium sulfate or magnesium oxide, or an antidote solution against metals( 100: 4000) with a suspension of activated carbon( 2 tablespoons per 1 liter of water), or skimmed milk.
4. After washing, insert through the probe 0.25 l of water with 2-3 tablespoons of magnesium sulfate and activated carbon.
5. Abundant liquids drink( hips infusion, 5% glucose solution).Slimy unsalted soups.
6. High siphon enema( water with a 0.1% solution of tannin or a suspension of activated carbon or a decoction of chamomile with magnesium oxide).
7. Continue to inject intravenously isotonic sodium chloride solution, polyglucin, 5% glucose solution, dropwise, up to 4-5.5 l / day;to force diuresis by intravenous injection up to 200 mg of lazix per day.
8. At the same time, intravenously inject ascorbic acid( up to 1 g / day) and thiamine bromohydrate( up to 0.025 g / day).When bleeding - vitamin K( Vikasol) 1 ml of a 1% solution intramuscularly or in tablets of 0.015 g 2-3 times a day. Permanent intake of rutoside( vitamin P) at 0.02 g.
9. For severe hypochloremia, sodium chloride( 10-15 ml 10% solution 1-2 times a day intravenously).
10. Active struggle with acute renal failure and uremia!
Activation of kidneys:
11. Repeated massive bleeding with exchange transfusions of single-group fresh citrated blood( up to 1 liter per session).
12. If necessary - cardiac funds intravenous - strophanthin or korglikon.
13. Analeptics, vascular agents - caffeine( 2 ml of 10% solution subcutaneously), cordiamine( 1-2 ml), sulphocamphocaine;mezaton;Norepinephrine in a 5% solution of glucose is intravenously drip during collapse.
14. Tracheostomy for edema of the larynx, intubation of the trachea;by indications - controlled breathing.
15. With stomatitis - cauterization of ulcers with 10% solution of chromic acid or silver nitrate. Rinse mouth with potassium permanganate solutions( 1: 5000) or hydrogen peroxide( 1: 500).
16. Hydrocortisone( 125 mg intramuscularly), prednisone( 0,005 g 4-6 times a day).Dimedrol( 0.05 g per os or in injections).
17. Syndrome therapy:
18. Urgent admission to the hemodialysis department. Transportation by ambulance on stretchers. During the evacuation, continue to provide medical care.
Granosan( ethylmercurychloride) pesticides, ceresan, abavit, phalizan and similar representatives of organomercury compounds are more toxic than mercury dichloride( sulma) and other inorganic mercury compounds. These poisons affect enzyme systems, blocking the activity of sulfhydryl groups of proteins. They are deposited in the brain and spinal cord, lungs, liver, kidneys, the wall of the stomach and intestines, the red bone marrow.
The defeat of the nervous system is made up of a consistent combination of asthenic syndrome, polyneuric syndrome and encephalopathy with a polyneuric syndrome.
The transition from one syndrome to another takes place according to the severity of poisoning in the 3rd stage:
. At first, patients complain of headache, dizziness, weakness, fatigue, apathy, insomnia, unstable mood, impaired performance, impotence.
Later, on the background of further progression of symptoms or at the same time, lumping, aching leg pains, crawling sensations, stiffness in the body, lumbosacral neuralgia, hyperesthesia of the skin occur. There are red dermographism, hyperhidrosis( sweating) of the palms and in the skin folds;marbling of the skin. Tremor of fingers.
In the most severe cases, speech and swallowing, thirst develop. Shaky gait, nystagmus, pathological reflexes, paresis.
Body temperature goes down.
Skin - dermatitis may occur, even a burn( prolonged, poorly healing).
Progressive emaciation.
Mucous membranes are inflamed, but in contrast to poisoning with inorganic compounds of mercury, stomatitis and gingivitis are not expressed.
Gastrointestinal tract - thirst, drooling, peculiar metallic taste in the mouth, nausea, vomiting of mucus with an admixture of blood. Approximately one-third of cases lead to diarrhea;feces mucous with blood.
Pain in the epigastric region and around the navel. Weakness of sphincters;involuntary urination and defecation. Hepatomegaly, a decrease in the antitoxic function of the liver.
Heart - complaints of constrictive, stitching pains behind the sternum, palpitations, dyspnea with walking and physical exertion. Tones of the heart are deaf( typical stiff muffled tones!), Occasionally a systolic murmur at the top is heard.
Bradycardia, pulse lability. Asymmetry of blood pressure. Arterial hypotension. Capillaroscopic changes in the tone of capillaries are noted. Dystonic type of reaction of pulse and arterial pressure in response to the load.
Electrocardiogram - decrease in voltage of tooth T, alteration of QRS complex, increase in systolic index, slowing of intraventricular conduction.
Urine - initially polyuria with iso- and hyposthenuria, then oliguria. Microalbuminuria, microhematuria, microleuko-Cyguria. In daily urine a large amount of mercury is detected - 100-500 mg.
Blood - leukocytosis, small monocytes, neutrophilia, increased ESR.
1. Full rest, warming of the patient. Remove the poison, enter antidotes.
2. Rinsing the stomach with a large amount of water( up to 10-12 liters) with the addition of activated charcoal( 2 tablespoons per 1 liter of water) or 100-150 ml of a 5% solution of unithiol or with Strozhevsky's antidote. Then, introduce a salt laxative-30 g of magnesium sulfate, dissolved in 150 ml of water.
3. Antidotes.
4. The most effective is the combination of extracorporal detoxification( hemodialysis) with antidote therapy( especially in oligo-anuria).
5. Forced diuresis - intravenous drip injection of 1-1.5 liters of isotonic sodium chloride solution, 1-1.5 liters of 5% glucose solution, 500 ml of polyglucin, hemodeza and simultaneous intravenous injection of 80-160 mg of lasix or 80-100 gmannitol.
6. Proserin - 1 ml of 0.05% solution subcutaneously 3-4 times a day. Injections of vitamins B1, B12, cocarboxylases. Introduction of lipoic acid.
7. Syndrome therapy of nephropathy, hepatopathy, cardiac and vascular insufficiency.
8. Urgent hospitalization in the toxicology department or in the therapeutic department - in the intensive care and reanimation room.