Abstract
FAMILIAL OUTBREAK OF MERCURY POISONING

Lizbeth I. Díaz-Trejo, Martha Ramiro-Mendoza*, Diana Quiñones-Jurado, Epidemiology Team Sonora-Mexico City, Ricardo Pacheco-Elías and Fernando Meneses-González

ABSTRACT

Mercury poisoning is often misdiagnosed due to the rarity of this condition; sometimes initially mild clinical presentation can rapidly progress to respiratory failure leading to mechanical ventilation and death. There is no consensus about treatment of mercury vapor intoxication with chelating agents when the etiological role in the patient’s illness is in question or when the therapy is to be initiated late in the clinical course. Cases of possible mercury exposure with symptoms and signs of intoxication, even without laboratory result, must be indicated aggressive treatment. Alarm symptoms, such as respiratory distress, suggest the need for chelation. A family of four started with a nonspecific illness that rapidly progressed to an aggressive pneumonia and acute respiratory distress syndrome (ARDS) of initially presumed infectious origin with 50% lethality. Mercury levels were measured in all four cases, and in the two survivors, chelation therapy with dimercaptopropanol (also called British Anti-Lewisite, BAL) was administered approximately a month after the start of illness. This resulted in no residual pulmonary disease in either case or obvious developmental delay in the child. When investigating a family outbreak with no additional cases among close contacts in shared environments outside the home, poisoning should be suspected and assessed, and the appropriate antidote located and administered promptly.

Keywords: Dimercaptopropanol, pneumonia and ARDS.


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