Methylmercury poisoning

Answer 1

Definition

Methylmercury poisoning is brain and nervous system damage from the chemical methylmercury.

Alternative Names

Minamata Bay disease; Basra poison grain poisoning

Causes, incidence, and risk factors

Methylmercury is a type of mercury ("quicksilver"), a metal that is liquid at room temperature. Most compounds containing Mercury are poisonous. Methylmercury has been used to preserve seed grain, which is fed to animals. Methylmercury may also form in water when other forms of mercury in the water react with certain bacteria. Methylmercury poisoning has occurred after people have eaten meat from animals fed seed grain or fish from waters contaminated with methylmercury (such as Minamata Bay in Japan).

Unborn babies and young infants are very sensitive to methylmercury's effects. Methylmercury causes central nervous system(brain and spinal cord) damage. How bad the damage is depends on how much poison gets into the body. Many of the symptoms of mercury poisoning are similar to those seen in cerebral palsy. In fact, methylmercury is thought to cause a form of cerebral palsy.

The FDA recommends that women who are pregnant, or may become pregnant, and nursing mothers avoid fish that may contain unsafe levels of methylmercury. Such fish includes swordfish, king mackerel, shark, or tilefish. (Young infants should not be given these fish, either.) You should not eat any type of these fish caught by friends and family. Check with your local or state health departments for warnings against locally caught, noncommercial fish.

Some health care providers have raised concerns about ethyl mercury (thimerosal), a chemical used in some vaccines. However, research shows that childhood vaccines do not lead to dangerous mercury levels in the body. Vaccines used in children today only contain trace amounts of thimerosal. Thimerosal-free vaccines are available.

Symptoms

• Blindness
• Cerebral palsy
• Deafness
• Growth problems
• Mental retardation
• Microcephaly(small head)

Signs and tests

Tests will vary depending on the symptoms that occur.

Treatment

Methylmercury damage is irreversible. Treatment is determined by the severity of the condition and is similar to that given for cerebral palsy. The patient should be removed from the source of exposure. Treatment may involve:

• Activated charcoal (if mercury is swallowed)
• Fluids and electrolytes
• Dialysis (kidney machine)

Expectations (prognosis)

The symptoms are irreversible; however, they do not usually worsen unless there is a new exposure to methylmercury.

Complications

Complications depend on the severity of the condition, and the specific symptoms manifested (such as blindness or deafness).

Methylmercury poisoning has been linked to an increased heart attack rate.

Calling your health care provider

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

Prevention

Strict avoidance of any foods contaminated with methylmercury will prevent poisoning. Because of manufacturing, mercury has become so common in the environment that trace amounts of methylmercury are present in many foods derived from the ocean, including deep-sea tuna. Fortunately, the levels are low enough that most of these foods remain safe. Contact poison control if you believe you may have been exposed.

References

Long H, Nelson LS. Metals and metalloids. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 184.

Answer 2

Definition

Merthiolate is a mercury-containing substance that was once widely used as germ-killer and a preservative in many different products, including vaccines.

Merthiolate poisoning occurs when large amounts of the substance are swallowed or come in contact with your skin. Poisoning may also occur if you are exposed to small amounts of merthiolate constantly over a long period of time.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Poisonous Ingredient

Thimerosal

Where Found

• Merthiolate
• Some eye drops
• Some nasal drops

The FDA banned the use of merthiolate in over-the-counter products in the late 1990s.

Symptoms

• Abdominal pain
• Diarrhea
• Decreased urine output
• Drooling
• Extreme difficulty breathing
• Metallic taste
• Memory problems
• Mouth sores
• Seizures
• Shock
• Skin numbness
• Swelling within the throat, which may be severe
• Thirst
• Walking problems
• Vomiting

Home Treatment

If you are concerned about a possible overdose, contact your local poison control center for advice.

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

Poison Control, or a local emergency number

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to expect at the emergency room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

• Activated charcoal
• Cathartic (a medication used to empty the bowels)
• Medicine called a chelator that tries to remove merthiolate from the body over time

Expectations (prognosis)

Merthiolate poisoning is difficult to treat. In the case of a large exposure, recovery would be very slow and may never occur.

References

Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw Hill; 2006.

Answer 3

Definition

Methylmercury poisoning is brain and nervous system damage from the chemical methylmercury.

Alternative Names

Minamata Bay disease; Basra poison grain poisoning

Causes, incidence, and risk factors

Methylmercury is a type of mercury ("quicksilver"), a metal that is liquid at room temperature. Most compounds containing mercury are poisonous. Methylmercury has been used to preserve seed grain, which is fed to animals. Methylmercury may also form in water when other forms of mercury in the water react with certain bacteria. Methylmercury poisoning has occurred after people have eaten meat from animals fed seed grain or fish from waters contaminated with methylmercury (such as Minamata Bay in Japan).

Unborn babies and young infants are very sensitive to methylmercury's effects. Methylmercury causes central nervous system(brain and spinal cord) damage. How bad the damage is depends on how much poison gets into the body. Many of the symptoms of mercury poisoning are similar to those seen in cerebral palsy. In fact, methylmercury is thought to cause a form of cerebral palsy.

The FDA recommends that women who are pregnant, or may become pregnant, and nursing mothers avoid fish that may contain unsafe levels of methylmercury. Such fish includes swordfish, king mackerel, shark, or tilefish. (Young infants should not be given these fish, either.) You should not eat any type of these fish caught by friends and family. Check with your local or state health departments for warnings against locally caught, noncommercial fish.

Some health care providers have raised concerns about ethyl mercury (thimerosal), a chemical used in some vaccines. However, research shows that childhood vaccines do not lead to dangerous mercury levels in the body. Vaccines used in children today only contain trace amounts of thimerosal. Thimerosal-free vaccines are available.

Symptoms

• Blindness
• Cerebral palsy
• Deafness
• Growth problems
• Mental retardation
• Microcephaly(small head)

Signs and tests

Tests will vary depending on the symptoms that occur.

Treatment

Methylmercury damage is irreversible. Treatment is determined by the severity of the condition and is similar to that given for cerebral palsy. The patient should be removed from the source of exposure. Treatment may involve:

• Activated charcoal (if mercury is swallowed)
• Fluids and electrolytes
• Dialysis (kidney machine)

Expectations (prognosis)

The symptoms are irreversible; however, they do not usually worsen unless there is a new exposure to methylmercury.

Complications

Complications depend on the severity of the condition, and the specific symptoms manifested (such as blindness or deafness).

Methylmercury poisoning has been linked to an increased heart attack rate.

Calling your health care provider

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

Prevention

Strict avoidance of any foods contaminated with methylmercury will prevent poisoning. Because of manufacturing, mercury has become so common in the environment that trace amounts of methylmercury are present in many foods derived from the ocean, including deep-sea tuna. Fortunately, the levels are low enough that most of these foods remain safe. Contact poison control if you believe you may have been exposed.

References

Long H, Nelson LS. Metals and metalloids. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 184.

Reviewed By

Review Date: 01/14/2010

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

Definition

Merthiolate is a mercury-containing substance that was once widely used as germ-killer and a preservative in many different products, including vaccines.

Merthiolate poisoning occurs when large amounts of the substance are swallowed or come in contact with your skin. Poisoning may also occur if you are exposed to small amounts of merthiolate constantly over a long period of time.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Poisonous Ingredient

Thimerosal

Where Found

• Merthiolate
• Some eye drops
• Some nasal drops

The FDA banned the use of merthiolate in over-the-counter products in the late 1990s.

Symptoms

• Abdominal pain
• Diarrhea
• Decreased urine output
• Drooling
• Extreme difficulty breathing
• Metallic taste
• Memory problems
• Mouth sores
• Seizures
• Shock
• Skin numbness
• Swelling within the throat, which may be severe
• Thirst
• Walking problems
• Vomiting

Home Treatment

If you are concerned about a possible overdose, contact your local poison control center for advice.

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

Poison Control, or a local emergency number

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to expect at the emergency room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

• Activated charcoal
• Cathartic (a medication used to empty the bowels)
• Medicine called a chelator that tries to remove merthiolate from the body over time

Expectations (prognosis)

Merthiolate poisoning is difficult to treat. In the case of a large exposure, recovery would be very slow and may never occur.

References

Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw Hill; 2006.

Reviewed By

Review Date: 02/02/2011

Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.