Routine laboratory studies at the time of hospital admission revealed a white blood cell count of 36,500/cu mm, hemoglobin of 10.6 g/dl, a serum urea nitrogen of 39 mg/dl, and a creatinine of 1.7 mg/dl. Because of concerns of community-acquired pneumonia, intravenous erythromycin therapy was started at a dose of 1 g every 6 h. Decreasing urine output together with a low cardiac output believed to be secondary to ventilatory support was treated with dobutamine and dopamine, and normalization of urinary output, serum urea nitrogen, and serum creatinine was subsequently noted. On the fifth hospital day, the history of mercury exposure was obtained and chelation therapy with dimercaprol commenced. Serum levels of mercury were not obtained before her death, but urinary levels with chelation therapy rose from 94 to 220 (Jig/L.
Progressive respiratory insufficiency with roentgenographic features compatible with adult respiratory distress syndrome continued until the ninth hospital day when a right-sided tension pneumothorax and subsequent cardiac arrest developed. Despite successful resuscitation, postanoxic seizures developed two days later with EEG changes consistent with severe cerebral dysfunction. Her respiratory and hemodynamic condition continued to deteriorate and she died on the 14th hospital day. The postmortem serum mercury level was 21.2 jjug/dl.