Extracorporeal Regional Complexing Haemodialysis Treatment of Acute Inorganic Mercury Intoxication

Abstract

A 70-year-old white female presented approximately 24 h after ingesting three 475 mg tablets (1.425 g) of mercuric chloride in a suicide attempt. Acute renal failure necessitated the initiation of haemodialysis approximately 4 d after the ingestion. Treatment with BAL (2,3-dimercaptopropanol) resulted in only small increases in mercury output into dialysate. A new procedure involving the extracorporeal infusion of the chelating agent dimercaptosuccinic acid (DMSA) into the arterial blood line during haemodialysis was initiated. This procedure of Extracorporeal Regional Complexing Haemodialysis (ERCH) had been effective in increasing methylmercury removal in patients poisoned by contaminated grain. The first DMSA-ERCH procedure was performed 6 d after poisoning. There was a dramatic increase in mercury output into the dialysate. During three treatment sessions of 80 min each, 1189 μg of mercury were removed from the patient. The dialysed mercury represented the only mercury output since the patient was anuric and not producing faeces. DMSA-ERCH appears to be much more effective than BAL and haemodialysis in the treatment of acute inorganic mercury poisoning. The long interval between poisoning and initiation of treatment probably contributed to the patients ultimate demise, 28 d after poisoning. Efficacy of the DMSA-ERCH procedure for inorganic mercury poisoning is likely to be improved as the interval between exposure and treatment is reduced.

Get full access to this article

View all access options for this article.

References

' Clarkson TW , Hursh JB , Sager PR & Syverson Tlm. Mercury. In: Biological Monitoring of Toxic Metals , eds Clarkson, TW , Friberg, L. Nordberg, GF and Sager, PR , pp. 199-246. New York: Plenum Press, 1988.

Kostyniak PJ & Soiefer AI A methylmercury toxicity model to test for possible adverse effects resulting from chelating agent therapy . Journal of Applied Toxicology 1984; 4: 206-10.

Berlin M. , Jerksell L-G. & Nordberg GF Accelerated uptake of mercury by brain caused by 2,3-dimercaptopropanol (BAL) after injection into the mouse of a methylmercuric compound. Acta Pharmacology Toxicology 1965; 23: 312-20.

Kostyniak PJ , Clarkson TW , Cestero RV , Freeman RB & Abbasi AH An extracorporeal complexing haemodialysis system for the treatment of Methylmercury poisoning. I. In Vitro studies of the effects of four complexing agents on the distribution and dialyzability of methylmercury in human blood. Journal of Pharmacology and Experimental Therapeutics 1975 ; 192: 260-9.

Kostyniak PJ , Clarkson TW & Al-Abbasi AH An extracorporeal complexing haemodialysis system for the treatment of methylmercury poisoning. II. In vivo applications in the dog. Journal of Pharmacology and Experimental Therapeutics 1977; 202; 253-63.

Al-Abbasi AH , Kostyniak PJ & Clarkson TW An extracorporeal complexing hemodialysis system for the treatment of methylmercury poisoning, III. Clinical applications. Journal of Pharmacology and Experimental Therapy 1979; 207: 249-54.

Magos L. & Clarkson TW Atomic absorption determination of total, inorganic, and organic mercury in blood. Journal of the Association of Official Analytical Chemists 1972; 55: 966-71.

Kostyniak PJ Mobilization and removal of methylmercury in the dog during extracorporeal complexing hemodialysis with 2,3-dimercaptosuccinic acid (DMSA). Journal of Pharmacology and Experimental Therapy 1982; 221: 63-8.

Kostyniak PJ Methylmercury removal in the dog during infusion of 2,3-dimercaptosucinic acid (DMSA). Journal of Toxicology and Environmental Health 1983; 11: 947-57.

10.

Sauder PH , Livardjani F. , Jaeger A. et al. Acute mercury chloride intoxication. Effects of haemodialysis and plasma exchange on mercury kinetic. Clinical Toxicology 1988; 26: 189-97.