The urine concentration of excreted mercury had increased to 438 |ig/L in case 1, 167 jig/L in case 2, and 220 (Jig/L in case 3. This demonstrates that while chelation therapy was effective in decreasing serum mercury concentrations in our patients, the concentrations still remained in the toxic range. buy flovent inhaler
Although chelation therapy has been shown to decrease serum mercury concentrations, review of the literature shows that this has no effect on progression of acute lung injury. Jaeger et al postulated that lung tissue damage is complete and that the treatment of serum levels with chelating agents has no effect on the reversal of lung damage. Aguado et al, however, were able to effectively treat acute renal failure following inhalation of mercury vapor with chelation therapy. In our patients, despite reduction in serum mercury levels with dimercaprol, there was no reversal in the progression of lung injury and respiratory dysfunction.
Corticosteroids have been used sporadically, as reported in the literature. We saw no benefit in the two patients in our series started on corticosteroid therapy. It has been suggested that steroids may prevent progression to severe interstitial fibrosis if used in mildly affected patients. The acute lung injury in our patients may have been too severe for steroids to show any sparing effect. Alternatively, the response to corticosteroids described in other cases may have been coincidental given the absence of response now demonstrated in the adult respiratory distress syndrome.