Chemical pneumonitis following acute exposure to mercury vapor is well described in recent literature. Prior to our series, only four adult deaths have been reported. Pulmonary toxicity appears related to local irritant effects created by oxidized mercury ions. There may be direct damage to bronchial and parenchymal cells with resultant acute lung injury. Mercury ions are also known to bind sulfhydryl groups and thus may disrupt sulfhydryl containing enzyme systems contributing to the injury cascade. flovent inhaler
Respiratory absorption of mercury vapor is rapid and complete through the alveolar membrane. Studies by Berlin and Johannson reported that inhaled mercury ions were quickly transferred into the blood of guinea pigs. Jung and Aaronson concluded that inhalation of mercury vapor can expose a person to very high toxic serum concentrations. The serum concentration in our patients are shown in Table 1. Case 1 had a serum level of 16.1 p-g/dl and case 2 had a serum level of 12.7 (ig/dl prior to the start of chelation therapy. The toxic serum concentration is greater than 1 jJLg/dl. Serum concentrations of case 3 and case 4 were obtained postmortem after receiving chelation therapy and were 21.2 and 36.8 p-g/dl, respectively.
Table 1—Serum and Urine Mercury Concentrations
|Days after Exposure||Serum, jigMl||Urine, )jig/L|
|Case 4||11 (postmortem)||36.8|