Mercury poisoning 344287 225054308 2008-07-11T17:44:24Z 159.178.231.146 {{Infobox_Disease | Name = Mercury poisoning | Image = Hg_Mercury.jpg | Caption = [[Chemical element|Elemental]] [[Mercury (element)|mercury]] | DiseasesDB = 8057 | ICD10 = {{ICD10|T|56|1|t|51}} | ICD9 = {{ICD9|985.0}} | ICDO = | OMIM = | MedlinePlus = 002476 | eMedicineSubj = emerg | eMedicineTopic = 813 | MeshID = | }} {{toxicology}} '''Mercury poisoning''' (also known as '''mercurialism''', '''hydrargyria''', '''Hunter-Russell syndrome''', or '''acrodynia''' when affecting children) is a [[disease]] caused by exposure to [[mercury (element)|mercury]] or its [[toxic]] compounds. Mercury is a [[bioaccumulate|cumulative]] [[heavy metals|heavy metal]] [[poison]] which occurs in its elemental form, [[inorganic]]ally as [[salt (chemistry)|salt]]s, or [[organic compound|organic]]ally as [[organomercury]] compounds; the three groups vary in effects due to differences in their [[absorption (pharmacokinetics)|absorption]] and [[metabolism]], among other factors.<ref>{{cite journal |journal= J Toxicol Environ Health B Crit Rev |date=2001 |volume=4 |issue=2 |pages=161–205 |title= Toxicology and immunotoxicology of mercury: a comparative review in fish and humans |author= Sweet LI, Zelikoff JT |doi=10.1080/10937400117236 |pmid=11341073}}</ref> However, with sufficient exposure all mercury-based toxic compounds damage the [[central nervous system]] and other [[organs]] or [[organ systems]] such as the [[liver]] or [[gastrointestinal tract]]. Symptoms typically include sensory impairment (vision, hearing, speech), disturbed sensation and a lack of coordination. The type and degree of symptoms exhibited depend upon the individual toxin, the dose, and the method and duration of exposure. Due to its [[toxicity]], there have been campaigns in many countries to ban mercury altogether. ==Signs and symptoms== Common symptoms include [[peripheral neuropathy]] (presenting as [[paresthesia]] or [[itching]], burning or [[pain]]), skin discoloration (pink cheeks, fingertips and toes), [[edema]] (swelling), and [[desquamation]] (dead skin peels off in layers). Because mercury blocks the degradation pathway of [[catecholamines]], [[epinephrine]] excess causes [[hyperhidrosis]] (profuse sweating), [[tachycardia]] (persistently faster-than-normal heart beat), [[mercury (element)|mercurial]] [[ptyalism]] ([[salivation|hypersalivation]]) and [[hypertension]] (high blood pressure). Mercury is thought to inactivate [[S-adenosyl-methionine]], which is necessary for catecholamine [[catabolism]] by [[catechol-o-methyl transferase]]. Affected children may show red [[cheeks]] and [[nose]], [[erythema]]tous [[lips]] (red lips), loss of [[hair]], [[teeth]], and [[nail (anatomy)|nails]], transient rashes, [[hypotonia]] (muscle weakness), and [[photophobia]]. Other symptoms may include [[kidney]] disfunction (e.g. [[Fanconi syndrome]]) or neuropsychiatric symptoms (emotional lability, [[memory]] impairment, [[insomnia]]). Thus, the clinical presentation may resemble [[pheochromocytoma]] or [[Kawasaki disease]]. An example of desquamation of the hand of a child with severe mercury poisoning acquired by handling elemental mercury is [http://adc.bmj.com/content/vol86/issue6/images/large/90015199.f1.jpeg this photograph] in Horowitz, ''et al'' (2002).<ref name=siblings>Horowitz Y, Greenberg D, Ling G, Lifshitz M. Acrodynia: a case report of two siblings. ''Arch Dis Child'' 2002; '''86''': 453. PMID 12023189</ref><!-- do not delete this reference; it is cited again in the "Acrodynia epidemic" section --> ==Causes== Mercury poisoning is caused by sufficient exposure to elemental mercury or mercury compounds. The consumption of fish is by far the most significant source of ingestion-related mercury exposure in humans, although plants and livestock also contain mercury due to [[bioaccumulation]] of mercury from soil, water and atmosphere, and due to [[biomagnification]] by ingesting other mercury-containing organisms.<ref name=EPAMercuryStudyIII>{{Citation| author = [[United States Environmental Protection Agency]]| title =Mercury Study Report to Congress| publisher =United States Environmental Protection Agency| date =December 1997| location =[[Washington, D.C.]]| volume =3| url =http://www.epa.gov/ttn/oarpg/t3/reports/volume3.pdf| format=PDF}}</ref> Exposure to mercury can occur from breathing contaminated air,<ref>{{cite web|name=ATSDR Mercury ToxFAQ | title =ToxFAQs: Mercury | publisher =[[Agency for Toxic Substances and Disease Registry]] | date =1999-04 | url =http://www.atsdr.cdc.gov/tfacts46.html#bookmark04 | accessdate =2007-07-25 }}</ref> or from improper use or disposal of mercury and mercury-containing objects, for example, after spills of elemental mercury or improper disposal of [[fluorescent light bulb]]s.<ref name=Pediatrics>{{cite journal| last =Goldman| first =Lynn R.| coauthors =Michael W. Shannon and the Committee on Environmental Health| title =Mercury in the Environment: Implications for Pediatricians | journal =Pediatrics| volume =108| issue =1| pages =197–205| date =2001-07| url =http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/1/197| accessdate =2007-07-25| doi =10.1542/peds.108.1.197| pmid =11433078 }}</ref> Human-generated sources such as coal plants emit approximately half of atmospheric mercury, with natural sources such as [[volcano]]es responsible for the remainder. An estimated two-thirds of human-generated mercury comes from stationary combustion, mostly of [[coal]]. Other important human-generated sources include [[Gold mining|gold production]], [[non-ferrous metal]] production, [[cement]] production, [[waste disposal]], [[crematoria]], [[caustic soda]] production, [[pig iron]] and [[steel]] production, mercury production (mostly for batteries), and biomass burning.<ref name=Pacyna>{{cite journal |journal= Atmos Environ |date=2006 |volume=40 |issue=22 |pages=4048–63 |title= Global anthropogenic mercury emission inventory for 2000 |author= Pacyna EG, Pacyna JM, Steenhuisen F, Wilson S |doi=10.1016/j.atmosenv.2006.03.041}}</ref> Mercury and many of its chemical compounds, especially [[organomercury]] compounds, can also be readily absorbed through direct contact with bare, or in some cases (such as dimethyl mercury) insufficiently protected, skin. Mercury and its compounds are commonly used in chemical laboratories, hospitals, dental clinics, and facilities involved in the production of items such as fluorescent light bulbs, batteries, and explosives.<ref name=EPAMercuryStudyIV>{{Citation | author = [[United States Environmental Protection Agency]] | title =Mercury Study Report to Congress | publisher =United States Environmental Protection Agency | date =December 1997 | location =[[Washington, D.C.]] | volume =4 | url =http://www.epa.gov/ttn/oarpg/t3/reports/volume4.pdf | format=PDF}}</ref> ==Toxic effects== Mercury damages the [[central nervous system]], [[endocrine system]], [[kidney]]s, and other organs, and adversely affects the mouth, gums, and teeth. Exposure over long periods of time or heavy exposure to mercury vapor can result in brain damage and ultimately death. Mercury and its compounds are particularly toxic to [[fetus]]es and infants. Women who have been exposed to mercury in pregnancy have sometimes given birth to children with serious birth defects (see [[Minamata disease]]). Mercury exposure in young children can have severe neurological consequences, preventing nerve sheaths from forming properly. Mercury inhibits the formation of [[myelin]], the building block protein that forms these sheaths.<ref>[http://movies.commons.ucalgary.ca/showcasetv/mercury How Mercury Causes Brain Neuron Degeneration<!-- Bot generated title -->]</ref> There is some evidence that mercury poisoning may predispose to [[Young's syndrome]] (men with [[bronchiectasis]] and [[low sperm count]]).<ref name=hendry>Hendry WF, A'Hern FPA, Cole PJ. Was Young's syndrome caused by mercury exposure in childhood? ''[[BMJ]]'' 1993;'''307''':1579-82. PMID 8292944</ref> Mercury poisoning's effects partially depend on whether it has been caused by exposure to elemental mercury, inorganic mercury compounds (as salts), or organomercury compounds. ===Elemental mercury=== [[Quicksilver]] (liquid metallic mercury) is poorly absorbed by ingestion and skin contact. It is hazardous due to its potential to release mercury vapour. Animal data indicate that less than 0.01% of ingested mercury is absorbed through the intact [[gastrointestinal tract]]; though it may not be true for individuals suffering from [[ileus]]. Cases of systemic toxicity from accidental swallowing are rare, and attempted suicide via intravenous injection does not appear to result in systemic toxicity.<ref name=Clarkson-Magos/> Though not studied quantitatively, the physical properties of liquid elemental mercury limit its absorption through intact skin and in light of its very low absorption rate from the gastrointestinal tract, skin absorption would not be high.<ref>ATSDR. 1999. Toxicological Profile for Mercury. Atlanta, GA:Agency for Toxic Substances and Disease Registry.</ref> Some mercury vapour is absorbed dermally but uptake by this route is only approximately 1% of that by inhalation.<ref name="hursh1989">{{cite journal|author=Hursh JB, Clarkson TW, Miles E, Goldsmith LA | title=Percutaneous absorption of mercury vapour by man | journal=Arch. environ. Health | volume=44 | issue=2 | pages=120–127 | year=1989 | pmid=2494955}}</ref> In humans, approximately 80% of inhaled mercury vapour is absorbed via the [[respiratory tract]] where it enters the [[circulatory system]] and is distributed throughout the body.<ref>Cherian M.G., Hursh J.G., Clarkson T.W. 1978. Radioactive mercury distribution in biological fluids and excretion in human subjects after inhalation of mercury vapor. Archives of Environmental Health 33: 190-214.</ref> Chronic exposure by inhalation, even at low concentrations in the range 0.7–42 μg/m<sup>3</sup>, has been shown in [[case control studies]] to cause effects such as tremors, impaired cognitive skills, and sleep disturbance in workers.<ref name="ngim">{{cite journal|author=Ngim CH, Foo SC, Boey KW, and Keyaratnam J | title=Chronic neurobehavioral effects of elemental mercury in dentists | journal=British Journal of Industrial Medicine | volume=49 | pages=782–790 | year=1992}}</ref><ref name="liang">{{cite journal|author=Liang YX, Sun RK, Chen ZQ, and Li LH | title=Psychological effects of low exposure to mercury vapor: Application of computer-administered neurobehavioral evaluation system | journal=Environmental Research | volume=60 | pages=320–327 | doi=10.1006/enrs.1993.1040 | year=1993}}</ref> ===Inorganic mercury compounds=== Mercury occurs inorganically as salts such as [[mercury(II) chloride]]. Mercury salts primarily affect the gastro-intestinal tract and the [[kidney]]s, and can cause severe kidney damage; however, as they can not cross the [[blood-brain barrier]] easily, mercury salts inflict little neurological damage without continuous or heavy exposure.<ref name=Hypertension>{{cite journal | last =Langford | first =N.J. | coauthors =R.E. Ferner | title =Toxicity of mercury | journal =Journal of Human Hypertension | volume =13 | issue =10 | pages =651–656 | date =October 1999 | url =http://www.nature.com/jhh/journal/v13/n10/pdf/1000896a.pdf | accessdate =2007-07-31 | doi =10.1038/sj.jhh.1000896}}</ref> As two [[oxidation state]]s of mercury form salts (Hg<sup>+</sup> and Hg<sup>2+</sup>), mercury salts occur in both mercury(I) (or mercurous) and mercury(II) (mercuric) forms. Mercury(II) salts are usually more toxic than their mercury(I) counterparts because their [[solubility]] in water is greater; thus, they are more readily absorbed from the gastrointestinal tract.<ref name=Hypertension/> ===Organic mercury compounds=== Compounds of mercury tend to be much more toxic than the element itself, and organic compounds of mercury are often extremely toxic and have been implicated in causing [[brain damage|brain]] and [[hepatitis|liver damage]]. The most dangerous mercury compound, [[dimethyl mercury]], is so toxic that even a few [[micro]][[liter]]s spilled on the skin, or even a latex glove, can cause death.<ref name=bris/><ref name=osha/> [[Methyl mercury]] is the major source of organic mercury for all individuals.<ref name=Clifton/> It works its way up the [[food chain]] through [[bioaccumulation]] in the environment, reaching high concentrations among populations of some species. Larger species of fish, such as [[tuna]] or [[swordfish]], are usually of greater concern than smaller species. The U.S. [[Food and Drug Administration]] (FDA) and the U.S. [[United States Environmental Protection Agency|Environmental Protection Agency]] (EPA) advise women of child-bearing age, nursing mothers, and young children to completely avoid [[swordfish]], [[shark]], [[king mackerel]] and [[tilefish]] (golden bass), to limit consumption of [[albacore|albacore ("white") tuna]] to no more than {{convert|6|oz|g|lk=on|abbr=on}} per week, and of all other fish and shellfish to no more than {{convert|12|oz|g|abbr=on}} per week.<ref name="fda2004">[http://www.cfsan.fda.gov/~dms/admehg3b.html What you need to know about mercury in fish and shellfish - Advice for women who might become pregnant women who are pregnant nursing mothers young children.] U.S. [[Food and Drug Administration|FDA]] and U.S. [[United States Environmental Protection Agency|EPA]] Advisory EPA-823-F-04-009, March 2004.</ref> However, there is no evidence that moderate consumption of fish in the U.S. poses a significant health hazard.{{Fact|date=April 2008}} A 2006 review of the risks and benefits of fish consumption found that for adults the benefits of one to two servings of fish per week outweigh the risks, even (except for a few fish species) for women of childbearing age, and that avoidance of fish consumption could result in significant excess [[coronary heart disease]] deaths and suboptimal [[neural development]] in children.<ref>{{cite journal |journal=JAMA |date=2006 |volume=296 |issue=15 |pages=1885–99 |title= Fish intake, contaminants, and human health: evaluating the risks and the benefits |author= Mozaffarian D, Rimm EB |url=http://jama.ama-assn.org/cgi/content/full/296/15/1885 |pmid=17047219 |doi=10.1001/jama.296.15.1885}}</ref> [[Ethylmercury]] is a breakdown product of the antibacteriological agent ethylmercurithiosalicylate, which has been used as a topical antiseptic and a vaccine preservative (further discussed under [[#Thiomersal|Thiomersal]] below). Its characteristics have not been studied as extensively as methyl mercury. It is cleared from the blood much more rapidly, with a half-life of 7 to 10 days, and it is metabolized much more quickly than methyl mercury. It probably does not have methyl mercury's ability to cross the [[blood-brain barrier]] via a transporter, but instead relies on simple diffusion to enter the brain.<ref name=Clifton/> Other exposure sources of organic mercury include phenylmercuric acetate and phenylmercuric nitrate. These were used in indoor latex paints for their anti-mildew properties, but were removed in 1990 because of cases of toxicity.<ref name=Clifton/> ==Treatment== Identifying and removing the source of the mercury is crucial. Decontamination requires removal of clothes, washing skin with soap and water, and flushing the eyes with saline solution as needed. Inorganic ingestion such as mercuric chloride should be approached as the ingestion of any other serious [[caustic]]. Immediate [[chelation therapy]] is the [[standard of care]] for a patient showing symptoms of severe mercury poisoning or the laboratory evidence of a large total mercury load.<ref name=Clifton/> Even if the patient has no symptoms or documented history of mercury exposure, a growing number of physicians, particularly those in [[alternative medicine]], use chelation to "rid" the body of mercury, which they believe to cause [[neurological]] and other disorders. A common practice is to challenge the patient's body with a chelation agent, collect urine samples, and then use laboratory reports to diagnose the patient with toxic levels of mercury; often no pre-chelation urine sample is collected for comparison. The patient is then advised to undergo further chelation. No controlled studies show that this procedure actually improves outcome. Inappropriate use of chelators may present untoward danger to the patient, or (in the case of pregnant patients) to a developing fetus.<ref name=Risher/> Chelation for acute inorganic mercury poisoning can be done with [[2,3-Dimercaptosuccinic acid|DMSA]], [[2,3-dimercapto-1-propanesulfonic acid]] (DMPS), [[D-penicillamine]] (DPCN), or [[dimercaprol]] (BAL).<ref name=Clifton/> Only DMSA is FDA-approved for use in children for treating mercury poisoning. However, several studies found no clear clinical benefit from DMSA treatment for poisoning due to mercury vapor.<ref name=Risher>{{cite journal |journal= Neurotoxicology |date=2005 |volume=26 |issue=4 |pages=691–9 |title= Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning |author= Risher JF, Amler SN |doi=10.1016/j.neuro.2005.05.004 |pmid=16009427}}</ref> No chelator for methylmercury or ethylmercury is approved by the FDA; DMSA is the most frequently used for severe methylmercury poisoning, as it is given orally, has fewer side effects, and has been found to be superior to BAL, DPCN, and DMPS.<ref name=Clifton/> [[Alpha-lipoic acid]] (ALA) has been shown to be protective against acute mercury poisoning in several mammalian species when it is given soon after exposure; correct dosage is required, as inappropriate dosages increase toxicity. Although it has been hypothesized that frequent low dosages of ALA may have potential as a mercury chelator, studies in rats have been contradictory.<ref name=Rooney/> [[Glutathione]] and [[N-acetylcysteine]] (NAC) are recommended by some physicians, but have been shown to increase mercury concentrations in the kidneys and the brain.<ref name=Rooney>{{cite journal |journal= Toxicology |date=2007 |volume=234 |issue=3 |pages=145–56 |title= The role of thiols, dithiols, nutritional factors and interacting ligands in the toxicology of mercury |author= Rooney JP |doi=10.1016/j.tox.2007.02.016 |pmid=17408840}}</ref> Experimental findings have demonstrated an interaction between [[selenium]] and methylmercury, but epidemiological studies have found little evidence that selenium helps to protect against the adverse effects of methylmercury.<ref>{{cite journal |journal= Tohoku J Exp Med |date=2002 |volume=196 |issue=2 |pages=71–7 |title= Modification of mercury toxicity by selenium: practical importance? |author= Watanabe C |doi=10.1620/tjem.196.71 |pmid=12498318 |url=http://www.jstage.jst.go.jp/article/tjem/196/2/71/_pdf |format=PDF}}</ref> Some of the toxic effects of mercury are in some cases partially or wholly reversible, either through specific therapy or through natural elimination of the metal after exposure has been discontinued. However, heavy or prolonged exposure can do irreversible damage, particularly in fetuses, infants, and young children. ==Prevention and regulation== Mercury poisoning can be prevented (or minimized) by eliminating or reducing exposure to mercury and mercury compounds. To that end, many governments and private groups have made efforts to avoid common hazards or to ban mercury altogether. For example, the export from the [[European Union]] of mercury and some mercury compounds will be prohibited from [[2011-03-15]].<ref>{{cite press release |url=http://www.europarl.europa.eu/news/expert/infopress_page/064-29478-140-05-21-911-20080520IPR29477-19-05-2008-2008-false/default_en.htm |title= Export-ban of mercury and mercury compounds from the EU by 2011 |publisher= European Parliament |date=2008-05-21 |accessdate=2008-06-10}}</ref> The variability among regulations and advisories is at times confusing for the lay person as well as scientists. {| class="wikitable sortable" !Country !Regulating agency !Regulated activity !Medium !Type of mercury compound !Type of limit !Limit |- |US |[[OSHA]] |occupational exposure |air |elemental mercury |Ceiling (not to exceed) |0.1 mg/m³ |- |US |OSHA |occupational exposure |air |organic mercury |Ceiling (not to exceed) |0.05 mg/m³ |- |US |[[FDA]] |drinking |water |inorganic mercury |Maximum allowable concentration |2 [[Parts-per notation|ppb]] (0.002 mg/L) |- |US |FDA |eating |sea food |methyl mercury |Maximum allowable concentration |1 [[Parts-per notation|ppm]] |- |US |[[EPA]] |drinking |water |inorganic mercury |Maximum contaminant level |2 ppb (0.002 mg/L) |} <ref> [http://www.atsdr.cdc.gov/toxprofiles/tp46-c7.pdf ATSDR - Mercury - Regulations and Advisories]</ref> ==Occurrences of mercury poisoning== *The first emperor of unified China, [[Qin Shi Huang Di]], was driven insane and killed by mercury pills intended to give him eternal life. * The phrase ''mad as a hatter'' is likely a reference to mercury poisoning, as mercury-based compounds were once used in the manufacture of [[Felt|felt hats]] in the 18th and 19th century. (The [[Mad Hatter]] character of ''[[Alice in Wonderland]]'' was almost certainly inspired by an eccentric furniture dealer, not by a victim of mercury poisoning.)<ref>{{cite journal |journal= Br Med J (Clin Res Ed) |date=1983 |volume=287 |issue=6409 |pages=1961 |title= Did the Mad Hatter have mercury poisoning? |author= Waldron HA |pmid=6418283 |url=http://pubmedcentral.nih.gov/pagerender.fcgi?artid=1550196&pageindex=1}}</ref> * An early scientific study of mercury poisoning was in 1923-6 by the German inorganic chemist, [[Alfred Stock]], who himself became poisoned, together with his colleagues, by breathing mercury vapour that was being released by his laboratory equipment — [[diffusion pump]]s, [[float valve]]s, and [[manometer]]s — all of which contained mercury, and also from mercury that had been accidentally spilt and remained in cracks in the [[linoleum]] floor covering. He published a number of papers on mercury poisoning, founded a committee in Berlin to study cases of possible mercury poisoning, and introduced the term ''micromercurialism''.<ref>{{cite journal |last=Stock |first=Alfred |title=Die Gefaehrlichkeit des Quecksilberdampfes |journal=Zeitschrift für angewandte Chemie |pages=461–466 |volume=39 |year=1926 |doi=10.1002/ange.19260391502}}</ref> * The term ''Hunter-Russell syndrome'' derives from a study of mercury poisoning among workers in a seed packing factory in [[Norwich]], England in the late 1930s who breathed [[methylmercury]] that was being used as a seed disinfectant and preservative.<ref name="hunterwalker">{{cite journal | title=Poisoning by methylmercury compounds | author=Hunter, D, Bomford, R R, and Russell, D S | journal=Quart. J. Med. | volume=9 | pages=193–213 | year=1940}}</ref> * From 1932 to 1968 [[methyl mercury]] was released into the sea around the city of [[Minamata]] in [[Kumamoto prefecture]], [[Japan]]. The toxin bioaccumulated in fish, which when eaten by the local population caused the largest case of mercury poisoning known. [[Minamata disease]] and a second outbreak [[Niigata Minamata disease]] caused the deaths of over 1000 people and permanently disabled a great many more. * Widespread mercury poisoning occurred in rural [[Iraq]] in 1971-1972, when grain treated with a [[methyl mercury]]-based [[fungicide]] that was intended for planting only was used by the rural population to make bread, causing at least 6530 cases of mercury poisoning and at least 459 deaths (see [[Basra poison grain disaster]]).<ref name="basraincident">{{cite journal| url=http://www.questia.com/PM.qst?a=o&d=5002117801| title=Technology out of Control| first=Robert| last=Engler| journal=The Nation| volume=240| month=April 27| year=1985}}</ref> * On [[August 14]], [[1996]], [[Karen Wetterhahn]], a chemistry professor working at [[Dartmouth College]], spilled a small amount of [[dimethylmercury]] on her latex glove. She began experiencing the symptoms of mercury poisoning five months later and, despite aggressive [[chelation therapy]], died a few months later from [[Encephalopathy|brain malfunction]] due to mercury intoxication.<ref name=bris>[http://www.chm.bris.ac.uk/motm/dimethylmercury/dmmh.htm The Karen Wetterhahn story] - University of Bristol web page documenting her death, retrieved December 9th 2006</ref><ref name=osha>[http://www.osha.gov/dts/hib/hib_data/hib19980309.html OSHA update following Karen Wetterhahn's death]</ref> * In April of 2000, Alan Chmurny attempted to kill a former employee, Marta Bradley, by pouring mercury into the [[ventilation]] system of her car.<ref>{{cite news|title='Mad Scientist': On Court TV, Fatal Chemistry|url=http://www.washingtonpost.com/wp-dyn/content/article/2007/01/25/AR2007012502091.html|publisher=[[The Washington Post]]|author=Jose Antonio Vargas|date=[[2007-01-26]]|accessdate=2007-01-28}}</ref> *On [[March 19]], [[2008]], [[Tony Winnett]], 55, inhaled mercury vapors while trying to extract gold from computer parts, and died ten days later. His Oklahoma residence became so contaminated that it would have to be gutted.<ref>{{cite news |author= Swearengin M |title= Man dies from mercury poisoning after trying to extract gold |work= Durant Daily Democrat |<!-- after 14 days, convenience link goes to registration page: url=http://www.durantdemocrat.com/articles/2008/04/01/news/doc47f14876d8777987127925.txt summary still available: url=http://www.durantdemocrat.com/shared-content/search/index.php?search=go&o=0&q=mercury&d1=3-31-2008&d2=5-4-2008&section%5B%5D=news+or+breaking_news&s=relevance&r=Subject%2CAuthor%2CContent&l=20 --> | date=2008-04-01 }}</ref><ref>{{cite news | author=(Associated Press) | title=Colbert man dies from mercury poisoning | publisher=''Tulsa World'' | date=2008-04-01 | url=http://www.tulsaworld.com/news/article.aspx?articleID=20080401_12_80377 | accessdate=2008-04-20}}</ref> ===Acrodynia epidemic=== Acrodynia is a type of mercury poisoning in children characterized by pain and pink discoloration of the hands and feet. The word is derived from the [[Greek language|Greek]], where ακρος means high (as in:in an [[Limb (anatomy)|extremity]]) and οδυνη means pain. As such, it might be (erroneously) used to indicate that a patient has pain in the hands or feet. However, acrodynia is a disease rather than a symptom.<ref name=siblings/> Also known as pink disease, erythredema, Selter's disease, or Swift-Feer disease, acrodynia was relatively commonplace amongst children in the first half of the 20th century.<ref name="pink"/> Initially, the cause of the acrodynia [[epidemic]] among infants and young children was unknown; however, mercury poisoning, primarily from [[calomel]] in teething powders, began to be widely accepted as its cause in the 1950s and 60s.<ref name="pink"/> The prevalence of acrodynia decreased greatly after calomel was excluded from most teething powders in 1954.<ref name="pink">{{cite journal | title = The Rise and Fall of Pink Disease | author = Ann Dally | journal = Social History of Medicine | year = 1997 | volume = 10| issue = 2 | pages = 291–304 | doi = 10.1093/shm/10.2.291 | url = http://shm.oxfordjournals.org/cgi/content/abstract/10/2/291 | accessdate = 2007-08-01}}</ref> ===Medical procedures=== Because elemental mercury often passes through the GI tract without being absorbed, it was used medically for various purposes until the dangers of mercury poisoning became known. For example, elemental mercury was used to mechanically clear intestinal obstructions (due to its great weight and fluidity), and it was a key ingredient in various medicines throughout history, such as [[blue mass]]. The toxic effects often were either not noticed at all, or so subtle or generic that they were attributed to other causes and were not recognized as poisoning caused by mercury. While the usage of mercury in medicine has declined, mercury-containing compounds are still used medically in vaccines and dental [[amalgam]], both of which have been the subject of controversy regarding their potential for mercury poisoning. ====Thiomersal==== {{Details|Thiomersal controversy}} [[Thiomersal]], a preservative that contains mercury, has been added to vaccines to prevent their deterioration since the 1930s.<ref name=Clarkson-Magos/> No adverse effects of thiomersal have ever been proven, although some allergic reactions have been noted.{{Fact|date=August 2007}} Its use in vaccines has been hypothesized as a cause of [[autism|autistic]] behaviors.<ref>{{cite journal |journal= Med Hypotheses |date=2001 |volume=56 |issue=4 |pages=462–71 |title= Autism: a novel form of mercury poisoning |author= Bernard S, Enayati A, Redwood L, Roger H, Binstock T |doi=10.1054/mehy.2000.1281 |pmid=11339848 |url=http://safeminds.org/research/library/Bernard-et-al-2001.pdf |format=PDF |accessdate=2008-06-14}}</ref><ref>{{cite journal |author= Mutter J, Naumann J, Schneider R, Walach H, [[Boyd Haley|Haley B]] |title= Mercury and autism: accelerating evidence? |journal= Neuro Endocrinol Lett |volume=26 |issue=5 |pages=439–46 |date=2005 |pmid=16264412 |url=http://www.uniklinik-freiburg.de/iuk/live/forschung/publikationen/Mutter_Autism_NEL.pdf |format=PDF |accessdate=2007-08-15}}</ref> This hypothesis is controversial, as much evidence suggests that about 90% of autism is explained by genetics.<ref name=Freitag>{{cite journal |author= Freitag CM |title= The genetics of autistic disorders and its clinical relevance: a review of the literature |journal=Mol Psychiatry |volume=12 |issue=1 |pages=2–22 |year=2007 |doi=10.1038/sj.mp.4001896|pmid=17033636 |url=http://www.nature.com/mp/journal/v12/n1/full/4001896a.html}}</ref> The hypothesis has not been confirmed by reliable studies.<ref>{{cite journal |author= [[Michael Rutter|Rutter M]] |title= Incidence of autism spectrum disorders: changes over time and their meaning |journal= Acta Paediatr |volume=94 |issue=1 |date=2005 |pages=2–15 |pmid=15858952 |doi= 10.1080/08035250410023124}}</ref> However, organizations such as the [[American Academy of Pediatrics]] have recommended that the use of thiomersal be reduced as a precautionary measure. With the exception of some flu vaccines, it is no longer used as a preservative in routinely recommended childhood vaccines in the [[United States]]; it is still in limited use as a preservative in multi-dose flu and tetanus vaccines and a few other non-childhood vaccines.<ref>{{cite web |url=http://www.cdc.gov/od/science/iso/concerns/thimerosal.htm |title= Mercury and vaccines (thimerosal) |accessdate=2007-12-25 |publisher= Centers for Disease Control and Prevention}}</ref> ====Dental amalgam==== {{Details|Dental amalgam controversy}} [[Dental amalgam]], an alloy of about 50% elemental mercury, has been used to fill decayed teeth since 1830 in the U.S. Although this amalgam is a source of low-level exposure to mercury, no scientific evidence links it as a cause of clinically significant toxic effects, except for the rare local hypersensitivity reaction. The National Institutes of Health has stated that amalgam fillings pose no personal health risk, and that replacement by non-amalgam fillings is not indicated.<ref name=Clifton>{{cite journal |journal= Pediatr Clin North Am |year=2007 |volume=54 |issue=2 |pages=237–69, viii |title= Mercury exposure and public health |author= Clifton JC 2nd |doi=10.1016/j.pcl.2007.02.005 |pmid=17448359}}</ref> ===Cosmetics=== Some [[skin whitening]] products contain the toxic chemical mercury(II) chloride as the active ingredient. When applied, the chemical readily absorbs through the skin into bloodstream.<ref name="Whitening skin can be deadly">{{Citation|title=Whitening skin can be deadly|last=Counter|first=S. Allen|publisher=The Boston Globe|url=http://www.boston.com/news/globe/health_science/articles/2003/12/16/whitening_skin_can_be_deadly/|date=Dec 16, 2003}}</ref> The use of [[mercury (element)|mercury]] in cosmetics is illegal in the United States. However, cosmetics containing mercury are often illegally imported. Following a certified case of mercury poisoning resulting from the use of an imported skin whitening product, the [[FDA]] warned against the use of such products.<ref name="FDA Proposes Hydroquinone Ban">{{Citation|title=FDA Proposes Hydroquinone Ban|url=http://www.medicinenet.com/script/main/art.asp?articlekey=64167}}FDA bans hydroquinone in skin whitening products</ref><ref name="NYC HEALTH DEPT">{{Citation |title=NYC Health Dept. Warns Against Use of "Skin-lightening" Creams Containing Mercury or Similar Products Which Do Not List Ingredients|date=January 27, 2005|url=http://www.nyc.gov/html/doh/html/pr/pr008-05.shtml}}</ref> Symptoms of mercury poisoning have resulted from the use of various mercury-containing cosmetic products.<ref name="Mercury exposure in children: a review">{{cite journal|title=Mercury exposure in children: a review|last=Countera|first=S. Allen |coauthors=Leo H. Buchanan|url=http://www.state.nj.us/health/eoh/cehsweb/kiddiekollege/documents/counter04_mercuryexpochildren.pdf}}</ref><ref name=Clarkson-Magos>{{cite journal |title=The toxicology of mercury and its chemical compounds |author= Clarkson TW, Magos L |journal= Crit Rev Toxicol |year=2006 |volume=36 |issue=8 |pages=609–62 |doi=10.1080/10408440600845619 |pmid=16973445}}</ref><ref>{{Citation |title=Dynamics of Mercury Pollution on Regional and Global Scales |last=Mahaffey |first=Kathryn R. |url=http://www.springerlink.com/content/w245027uu23r4381/}}</ref> The use of skin whitening products is especially popular amongst Asian women.<ref name="synovate">In a survey, 28% of Koreans and 50% of Philippians say that they use skin whitening products.{{Citation |title=Skin lightening in Asia? A bright future? |url=http://www.synovate.com/knowledge/infact/issues/200406/}}</ref> In Hong Kong in 2002, two products were discovered to contain between 9,000 to 60,000 times the recommended dose.<ref name="SKIN DEEP: Dying to be white">{{Citation |title=SKIN DEEP: Dying to be white |last=Bray |first=Marianne |publisher=CNN |url=http://edition.cnn.com/2002/WORLD/asiapcf/east/05/13/asia.whitening/ }}</ref> ===Fluorescent lamps=== [[Fluorescent lamp]]s contain mercury which is released when bulbs are broken. Mercury in bulbs is typically present as either elemental mercury liquid, vapor or both since the liquid evaporates at ambient temperature.<ref>Aucott M, McLinden M, Winka M, 2003, Release of Mercury from Broken Fluorescent Bulbs, J Air Waste Manag Assoc 53:143-151.</ref> When broken indoors, bulbs may emit sufficient mercury vapor to present health concerns. Breakage of multiple bulbs presents a more significant concern. A 1987 report described a 23-month-old toddler who suffered [[anorexia]], weight loss, irritability, profuse sweating, and peeling and redness of fingers and toes. This case of acrodynia was traced to exposure of mercury from a carton of 8-foot fluorescent light bulbs that had broken in a potting shed adjacent to the main nursery. The glass was cleaned up and discarded, but the child often used the area for play.<ref>{{cite journal |journal=Pediatrics |date=1987 |volume=79 |issue=5 |pages=786–9 |title= Acrodynia: exposure to mercury from fluorescent light bulbs |author= Tunnessen WW Jr, McMahon KJ, Baser M |pmid=3575038}}</ref> ==See also== * [[Got Mercury?]] * [[Lead poisoning]] * [[Mercury Policy Project]] * [[Mercury vacuum]] * [[Mercury-containing and Rechargeable Battery Management Act]] * [[Erethism]] ==References== {{Reflist|2}} ==External links== * [http://www.atsdr.cdc.gov/toxprofiles/tp46.html ATSDR - Toxicological Profile: Mercury] at [[Centers for Disease Control and Prevention|CDC]] * [http://www.npi.gov.au/database/substance-info/profiles/53.html National Pollutant Inventory - Mercury and compounds Fact Sheet] at [[Department of the Environment and Water Resources]] * [http://www.nlm.nih.gov/medlineplus/mercury.html Overview] at [[National Institutes of Health|NIH]] * [http://wiki.stat.ucla.edu/niser/index.php/NISER_GeneralActivities_081107_ID Mercury activity] at [[National Internet Science Educational Resource]] {{Poisoning and toxicity}} [[Category:Toxicology]] [[Category:Mercury (element)]] [[Category:Element toxicology]] [[de:Quecksilbervergiftung]] [[fr:Aspects toxicologiques du mercure]] [[nl:Acrodynie]] [[ja:水銀中毒]] [[pl:Rtęcica]] [[ru:Отравления ртутью]] [[fi:Elohopeamyrkytys]] [[zh:汞中毒]]