2. Introduction:
• Mercury exists in various forms as follows: elemental (or
metallic) and
• inorganic (people may be exposed to it in the course of their
occupations).
• organic (such as methyl mercury that people may be exposed
to through their diet).
• These forms of mercury vary in their degree of toxicity and
their effect on the nervous, digestive and immune systems,
and on the lungs, kidneys, skin and eyes
3. Calomel (mercurous chloride):
A form of inorganic mercury
• An uncommon source of mercury exposure
(compared to organic methylmercury, found in fish)
• Used in the past for a variety of medicinal/personal
care products (laxatives, skin lightening creams,
diuretics, antiseptics), and still found in unregulated
markets or privately imported items
4. • Manufactured in many countries and areas,
• including Bangladesh, China, Mexico,
• Pakistan, Philippines, Korea, Thailand, and the USA May be
marketed as a soap or antiseptic soap, product labels may
note mercury or its forms
• Other mercury-containing cosmetics may include mascara,
eye makeup, or eye makeup cleansers
5. Signs and symptoms :
Inorganic mercury can be absorbed by inhalation or dermal
contact; ingestion is minimal (unlike for methylmercury)
• Signs and symptoms of significant exposure include:
• Neurotoxicity: Tremor, erythism, numbness
• Vascular: Gingivostomatitis, acrodynia
• Hypertension and tachycardia
• Nephrotoxicity: Reduced eGFR, reduced kidney function
• Respiratory tract irritation (cough, shortness of breath)
• GI tract irritation (nausea, vomiting, pain)
• Teratogenic
6. Testing:
The biomarker of choice for inorganic (and elemental) mercury
is a urine mercury level
• The biomarker of choice for organic mercury is a blood
mercury level
• Blood mercury ULN is 18.4nmol/L; toxicity does not occur
until 500-1000nmol/L
• Urine mercury ULN is 3µg/L; toxicity does not occur until 20-
100 µg/L
7. Sources of exposure:
• Inorganic/Elemental mercury: Broken thermometers/
sphygmomanometers, fluorescent and dental amalgam.
light bulbs, paints, fungicides, chemistry sets, pigments,
solvents, traditional/herbal medicines
• Organic mercury: Fish and food consumption
9. Treatment:
• The most frequently used agent for acute inorganic mercury
exposures is dimercaprol (also known as BAL).
• The standard dosage regiment of BAL for inorganic mercury
poisoning is 3 mg/kg IM every 4 hours for 2 days, and every
12 hours thereafter for 7 to 10 days or until 24-hour urinary
excretion levels are less than 50 µg/L.
• Oral agents such as dimercaptosuccinic acid (DMSA) or D-
penicillamine have been used as alternatives when
dimercaprol toxicity or intolerance develops
