Mercury poisoning

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Mercury is silver white liquid metal Evaporation occurs at normal temperature. Mercury poisoning is mainly chronic, mainly occurring in Production activities Medium and long-term inhalation of mercury vapor and mercury compound dust. With psycho neurological abnormalities Gingivitis Tremor is the main symptom. Acute mercury poisoning occurs when large doses of mercury vapor are inhaled or mercury compounds are ingested. People who are allergic to mercury may be poisoned even if they are locally coated with mercury oil based preparations.

The amount of mercury ingested into human body through food has now reached 20-30 μ g/day, and even up to 200-300 μ g/day in severely polluted areas, which poses a serious threat to human health. Therefore, the prevention and control of mercury poisoning has become an important issue facing all countries in the world.

Foreign name: mercurypoisoning
Visiting department: Emergency Department

Common causes: Long term inhalation of mercury vapor and mercury compound dust
common symptom: Psycho neurological disorders, gingivitis, tremor
Also called: Occupational mercury poisoning

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pathogeny

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Mercury poisoning is common because of its fluidity and easy evaporation at room temperature Occupational poisoning 。 It mainly occurs in long-term inhalation of mercury vapor or mercury compound dust in production. Productive poisoning See at Mercury ore Mining, amalgam smelting, gold and silver extraction, vacuum mercury, lamps, instruments thermometer , dental filling Fulminate mercury , pigment, pharmaceutical nuclear reactor coolant Hefang Atomic radiation Among the production workers of materials, etc.

Mercury widely exists in nature natural phenomena It can make mercury circulate continuously from the surface through the atmosphere, rain and snow, and can be absorbed by animals and plants. Anthropogenic Production activities It can obviously aggravate the environmental pollution caused by mercury. This Anthropogenic pollution Although the proportion is not large, the discharge is concentrated, so the harm is far more than Natural pollution Serious. The pollution of mercury containing sewage to rivers, lakes and seas can cause Public nuisance disease , such as Minamata disease 。

Inhalation of high concentration mercury vapor (>1.0mg/m) for a short time (>3-5 hours) three ）And oral administration of large amounts of inorganic mercury can cause acute mercury poisoning; Taking or smearing mercury containing folk prescription can cause Subacute Mercury poisoning; Occupational exposure to mercury vapor often causes chronic mercury poisoning.

clinical manifestation

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The clinical manifestations of mercury poisoning are closely related to the form, route, dose and time of mercury entering the human body.

1. Acute mercury poisoning

(1) Systemic symptoms Metallic taste in mouth headache , dizziness, nausea, vomiting abdominal pain , diarrhea, fatigue, body aches shiver 、 fever (38~39 ℃), in serious cases, they are excited, agitated, insomnia, even convulsions, coma or insane 。

(2) Respiratory manifestations Cough, expectoration, chest pain, dyspnea Cyanosis Auscultation can be used to hear dry and wet sounds in both lungs or Breath sound Weakening.

(3) Gastrointestinal manifestations Gingival swelling, pain, erosion, bleeding Oral mucosa Canker Loose teeth 、 Drooling , available“ Mercury line (mercurialine) ", lip and buccal mucosa ulcer , available Abnormal liver function And hepatomegaly. Oral poisoning may cause abdominal pain, diarrhea, mucus excretion or bloody stool. Severe cases may lead to generalized gastrointestinal perforation peritonitis , due to water loss Shock occurred due to other reasons, and liver damage occurred in individual cases.

(4) Toxicity Nephropathy: Due to necrosis of renal tubular epithelial cells, edema usually occurs after taking mercury salt orally for several hours and inhaling high concentration mercury vapor for 2-3 days Anuria 、 Azotemia 、 Hyperkalemia 、 Acidosis 、 uremia Until acute renal failure and life-threatening. People who are allergic to mercury may appear hematuria 、 Eosinophils Urine, with systemic allergic symptoms, some patients may have acute glomerulonephritis hematuria 、 proteinuria 、 hypertension And acute renal failure (ARF).

(5) Skin manifestations More than 2 to 3 days after poisoning red maculopapules 。 It appears in the extremities, head and face at the early stage, and then the whole body, which can be melted into flakes or ulcers, and infected with the whole body Lymph node enlargement 。 Exfoliative dermatitis may occur in severe cases.

2. Subacute mercury poisoning

It is commonly used for oral administration, application of mercury containing prescriptions and inhalation of mercury vapor with low concentration (0.5~1.0mg/m three ）The disease usually occurs 1 to 4 weeks after exposure to mercury. The clinical manifestation was similar to that of acute mercury poisoning, and the degree was mild. But hair loss, insomnia abnormal sweating , three tremors (eyelid, tongue, finger), etc. commonly disengage And can be cured after several weeks of treatment.

3. Chronic mercury poisoning

(1) Neuropsychiatric symptoms Have dizziness headache , insomnia, dreaminess, forgetfulness, fatigue Anorexia etc. Mental infirmity Performance, often palpitation 、 hyperhidrosis 、 Skin scratch test Positive Hypolibido , menstrual disorders (female), and then emotional and personality changes hotbed , moody, irritable, prone to cry, timid, shy, depressed, withdrawn, suspicious, inattentive, even hallucinations, delusions and other mental symptoms.

(2) Stomatitis Early gingival swelling, soreness, easy bleeding, oral mucosal ulcer salivary glands Swelling, increased saliva Halitosis , then gingival atrophy Loose teeth , falling off, oral hygiene The bad person may have "mercury line" (mercury secreted by salivary glands and decayed oral residue hydrogen sulfide Associative generation Mercuric sulfide A blue black line about 1mm is deposited under the gingival mucosa).

(3) Tremor At first, the hands trembled when threading, writing, and holding chopsticks inaccurate , Yes Intentionality , gradually develop to the limbs, the patient's diet, clothing, walking, cycling, climbing are affected, pronunciation and enunciation are impaired habituation The tremor is relatively reduced when working or not being noticed. Electromyography Available peripheral nerve injury 。

(4) Renal manifestations Generally, it is not obvious. A small number of patients may have low back pain, proteinuria, and red blood cells can be seen on uroscopy. Clinical cases of tubular nephritis, glomerulonephritis and nephrotic syndrome are rare. Generally, it can recover after getting rid of mercury and treatment. Some patients may have hepatomegaly and abnormal liver function.

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1. Urine mercury and Blood mercury determination

To some extent, it reflects the amount of mercury absorbed in the body, but it often has no parallel relationship with the clinical symptoms and severity of mercury poisoning.

2. Patients with chronic mercury poisoning

Available electroencephalogram amplitude And rhythmic electrical activity changes around nerve conduction velocity Slow down, a in blood two Globulin and Reduced glutathione Increase, and Lysosomal enzyme 、 red blood cell cholinesterase And serum Mercapto group And so on.

three X-ray Chest radiograph

Extensive irregular shadows can be seen in both lungs, most of which are fused into dots, patches, or Ground glass Like interstitial changes.

diagnosis

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According to the medical history and typical symptoms and signs, the diagnosis of acute mercury poisoning is usually not difficult; Urinary mercury The obvious increase has important diagnostic value. Chronic mercury poisoning The diagnosis must have a clear long-term mercury exposure history; Can be based on diagnostic criteria It is divided into three levels: light, medium and heavy. Mild poisoning It has typical clinical characteristics of mercury poisoning, such as Neurasthenia ﹑ Stomatitis , tremor, etc., to a lesser extent; If the above symptoms are aggravated and have mental and personality changes, it can be diagnosed as moderate poisoning; If there is Toxic encephalopathy , which can be diagnosed as severe poisoning. Urine mercury is not parallel to symptoms and signs, and can only be used as the basis for excessive mercury exposure; If the urine mercury is not high, it is feasible to conduct mercury elimination test to facilitate diagnosis.

differential diagnosis

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Acute mercury poisoning should be associated with acute upper respiratory tract infection Infectivity Pneumonia Drug allergy 、 Infectious diseases Isophase identification; Attention to chronic mercury poisoning Neurasthenia 、 Parkinson , chronic alcoholism, etc.

treatment

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one First aid treatment

Oral Poisoning by mercury and its compounds Should be used immediately sodium bicarbonate Or warm water is used for gastric lavage to induce vomiting, and then raw egg white, milk or Soybean Milk , absorb poisons and reuse magnesium sulphate catharsis. Those poisoned by inhalation of mercury should leave the site immediately and change clothes.

2. Mercury elimination treatment

5% available for acute mercury poisoning Sodium dimercaptopropane sulfonate Solution, Intramuscular injection ； After that, once every 4-6 hours, once a day after 1-2 days, General treatment About 1 week. Optional Dimercaptobutylene disodium or Dimercaptopropanol 。 If the patient appears during the treatment Acute renal failure , then mercury removal should be postponed, and Renal failure First aid; Or on Hemodialysis The patients were treated with small dose of mercury elimination. The commonly used drug for the treatment of chronic mercury poisoning is 5% sodium dimercaptopropane sulfonate solution, intramuscular injection , once a day for 3 days, and 4 days after stopping the drug as a course of treatment. The number of courses of treatment shall be determined according to the condition and mercury elimination.

3. Symptomatic support treatment

fluid infusion , correct water Electrolyte disorder ， Oral Care , and can be applied Glucocorticoid , improve the condition. In case of contact dermatitis, 3% boric acid can be used Wet compress 。

Once the exposure history of organic mercury is determined, mercury elimination treatment should be carried out regardless of symptoms. Methods The same as chronic mercury poisoning, but the first week should be treated as acute mercury poisoning; Patients with oral poisoning should be given gastric lavage in time. Symptomatic support therapy is particularly important for organic mercury poisoning, which is mainly used to protect important organs, especially nervous system The function of Neuropsychiatric symptoms Development of.

prevention

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1. Substitute non-toxic or low toxic raw materials for mercury, such as Electronic instruments Instead of mercury meters, use Alcohol thermometer Instead of metal mercury thermometers.

2. When smelting or injecting mercury Exhaust hood Or close the device to prevent mercury vapor from escaping, and regularly measure the mercury concentration in the air of the workshop. Walls, floors and Operation console The surface of shall be smooth and free of cracks for easy cleaning and detoxification. The workshop temperature should not exceed 15~16 ℃. Mercury in the air of workplace Maximum allowable concentration 0.001mg/m three 。

3. Workers working on mercury should have a physical examination once a year to find patients with mercury absorption and early mercury poisoning in time for early treatment. Waste gas, waste water and waste residue containing mercury should be discharged after treatment.

4. The treatment method for household mercury leakage is: if there is still liquid, sulfur powder should be sprinkled on it for reaction; If it has volatilized, pay attention to indoor ventilation and do not use hands direct contact Mercury, to avoid skin sensibility 。

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