Quicksilver in the Gut: No Mad as a Hatter?

Abstract

Purpose: An 18-year-old healthy male presented with suicidal ingestion of approximately 3 ounces of elemental Mercury (Quicksilver) about 20 minutes after ingestion. Patient remained asymptomatic. Vital signs were normal and physical exam unremarkable. Complete blood count, basic metabolic panel, liver function tests, serum salicylate, acetaminophen, alcohol, creatine kinase and prothrombin time were within normal limits. Blood mercury level was 0.185 ug/L (normal blood mercury level less than 5ug/L). The patient was diagnosed with acute mercury ingestion without toxicity and admitted for observation. Mercury exists in three forms: elemental, organic and inorganic salts, each with differing toxicities based upon method of introduction to the body. Elemental mercury can be introduced to the body via intravenous (IV) injection, inhalation, cutaneous exposure or ingestion. Whereas cases of IV injection leading to pulmonary embolism have been reported, toxicity from elemental mercury is best known from inhalation of vapors, leading to widespread organ distribution, especially the nervous system, kidneys, lungs and Gastrointestinal tract (GIT). On the other hand, cutaneous exposure and oral ingestion rarely result in absorption of significance and the classic symptoms of tremor, salivation and changes in personality are generally absent. Because orally ingested quicksilver is poorly absorbed in the GIT and eliminated well in feces, in collaboration with poison control center, patient was observed and daily abdominal roentgenograms obtained. Although numerous chelating agents are available,treatment is generally reserved for patients exhibiting the symptoms described above. Abdominal films showed the majority of quicksilver had been excreted, patient was discharged to follow up with psychiatry clinic.Figure