The question of serum concentration and extrapul-monary toxicity has been addressed throughout the literature. Matthes et al reviewed the cases of four patients and noted the lack of correlation between pathologic findings and the concentration of mercury found in the tissues. Hallee reported no correlation between the concentration of mercury found in urine and the condition of the patients. However, there have been two recent reports of extrapulmonary toxicity associated with acute mercury inhalation. Aguado et alu described the onset of acute renal failure following mercury inhalation, and Jaffe et al reported renal, hepatic, and neurologic dysfunction in a child following inhalational exposure. buy cipro
In our series, despite histologic evidence of acute tubular necrosis at autopsy in all four cases, only case 3 and case 4 showed transient laboratory evidence of renal insufficiency early in their hospital course. This was believed to be secondary to hemodynamic changes induced by ventilatory support, and responded to inotropic agents with resolution of the abnormal laboratory values. Case 4, after sustaining the subfalcine herniation and persistent hypotension, however, was noted to have an elevation of serum urea nitrogen and creatinine levels. This persisted until his death and was believed to be related to low renal blood flow and the persistent hypotension. There were no consistent abnormalities seen in the urine. Case 4 was noted to have two granular casts observed on hospital day 4. This appeared as an isolated finding as no other casts were seen during the rest of his hospital course.