Full Recovery from a Potentially Lethal Dose of Mercuric Chloride

• Published in: Journal of medical toxicology 2014-03, Vol.10 (1), p.40-44
• Main Authors: Beasley, D. Michael G., Schep, Leo J., Slaughter, Robin J., Temple, Wayne A., Michel, Jonathan M.
• Format: Article
• Language: English
• Subjects: Acidosis; Adult; Biomedical and Life Sciences; Biomedicine; Blood; Blood levels; Case reports; Chelating Agents - administration & dosage; Chelating Agents - therapeutic use; Chelation; Chelation Therapy; Chlorides; Diarrhea; Dimercaprol; Dimercaprol - administration & dosage; Dimercaprol - therapeutic use; Emergency management; Emergency medical services; Emergency response; Female; Fever; Hemodynamics; Humans; Hypokalemia; Indicators and Reagents - chemistry; Indicators and Reagents - pharmacokinetics; Indicators and Reagents - toxicity; Ingestion; Injections, Intramuscular; Lethal dose; Leukocytosis; Mercuric chloride; Mercuric Chloride - antagonists & inhibitors; Mercuric Chloride - pharmacokinetics; Mercuric Chloride - toxicity; Mercury; Mercury (metal); Mercury - blood; Mercury - chemistry; Mercury compounds; Mercury Poisoning - blood; Mercury Poisoning - drug therapy; Mercury Poisoning - therapy; Nausea; Patients; Pharmacology/Toxicology; Poisoning; Radiographs; Renal failure; Suicide, Attempted; Suicides & suicide attempts; Toxicity; Toxicology Observation; Treatment Outcome; Vomiting; Young Adult
• ISSN: 1556-9039; 1937-6995
• DOI: 10.1007/s13181-013-0311-1

Introduction Mercuric chloride poisoning is rare yet potentially life-threatening. We report a case of poisoning with a potentially significant amount of mercuric chloride which responded to aggressive management. Case Report A 19-year-old female presented to the Emergency Department with nausea, abdominal discomfort, vomiting of blood-stained fluid, and diarrhea following suicidal ingestion of 2–4 g of mercuric chloride powder. An abdominal radiograph showed radio-opaque material within the gastric antrum and the patient’s initial blood mercury concentration was 17.9 μmol/L (or 3.58 mg/L) at 3 h post-ingestion. Given the potential toxicity of inorganic mercury, the patient was admitted to the intensive care unit and chelation with dimercaprol was undertaken. Further clinical effects included mild hemodynamic instability, acidosis, hypokalemia, leukocytosis, and fever. The patient’s symptoms began to improve 48 h after admission and resolved fully within a week. Discussion Mercuric chloride has an estimated human fatal dose of between 1 and 4 g. Despite a reported ingestion of a potentially lethal dose and a high blood concentration, this patient experienced mild to moderate poisoning only and she responded to early and appropriate intervention. Mercuric chloride can produce a range of toxic effects including corrosive injury, severe gastrointestinal disturbances, acute renal failure, circulatory collapse, and eventual death. Treatment includes close observation and aggressive supportive care along with chelation, preferably with 2,3-dimercapto-1-propane sulfonate or 2,3-meso-dimercaptosuccinic acid.