A 69-year-old white man was transferred to Harper Hospital following a 36-hour hospitalization for progressive respiratory insufficiency that necessitated endotracheal intubation and mechanical ventilatory support. The patient had complained of nausea, vomiting, and diarrhea for one day prior to his admission to a local hospital. Other than a temperature of 38.5°C, the patient’s vital signs were normal. Arterial blood gases on 90 percent oxygen and 14 cm H20 of positive end-expiratory pressure demonstrated a Po2 of 139 mm Hg, Pco2 of 36 mm Hg, and a pH of 7.38 on transfer to Harper Hospital. The chest roentgenogram on transfer revealed difluse bilateral pulmonary infiltrates. Results of screening laboratory studies were normal except for serum urea nitrogen of 47 mg/dl and a serum creatinine of 1.7 mg/dl. ampicillin antibiotic
Progressive deterioration in arterial oxygenation together with chest roentgenogram and pulmonary artery catheter data consistent with the adult respiratory distress syndrome were noted. With hemodynamic support, the serum urea nitrogen and serum creatinine values normalized. On obtaining the history of mercury vapor exposure, dimercaprol therapy was commenced. On the fifth hospital day, a tension pneumothorax and hypotension developed requiring the addition of significant vasopressor therapy and thoracostomy to maintain an adequate blood pressure. On the seventh hospital day, clinical deterioration with computed tomographic evidence of difluse cerebral edema and subfalcine herniation developed. Clinical protocols for cerebral silence were commenced and the patient was declared dead three days later. The postmortem serum mercury level was 36.8 p-g/dl.