Inorganic mercury intoxication: A case report

Toxic nephropathy secondary to chronic mercury poisoning: clinical characteristics and outcomes

Introduction

Kidney disease secondary to mercury poisoning has not been well documented and is often misdiagnosed and mistreated.

Methods

We performed a retrospective analysis of patients diagnosed with having mercury poisoning over a 6-year period between July 2013 and June 2019. Demographics, clinical measures, renal pathologic examinations, treatments, and outcomes were compared between patients with kidney disease and those without kidney disease.

Results

Of the 172 patients with mercury poisoning, 46 (26.74%) had renal damage. Among the 46 patients, 41 (89.13%) presented nephrotic syndrome, and 5 (10.87%) showed proteinuria alone. The pathologic abnormality associated with kidney disease caused by mercury poisoning was mainly membranous nephropathy (18 of 35 patients, 51.43%). Among 41 patients with nephrotic syndrome, 25 were treated with chelation therapy alone and 12 with mercury chelation therapy and glucocorticoids. The remaining 4 patients were treated with chelation therapy, glucocorticoids, and immunosuppressive therapies. The overall effective rate was 97.5% (40 patients). There was no significant difference in complete remission rate among the 3 treatment methods (P < 0.05).

Conclusion

The main clinical manifestation of kidney disease secondary to chronic mercury poisoning was nephrotic syndrome, which was reflected in pathologic examinations as membranous nephropathy. Kidney disease to chronic mercury poisoning is prone to misdiagnosis and missed diagnosis. Chelation therapy is the main treatment, and the prognosis is good. Patients with severe condition can be supplemented with glucocorticoid.

Changes in mercury distribution and its body burden in delphinids affected by a morbillivirus infection: Evidences of methylmercury intoxication in Guiana dolphin

An unusual mortality event (UME) attributed to morbillivirus infection was identified in two Guiana dolphin populations from the Southeastern Brazilian coast. The aim of this study was to characterize total mercury (THg), methylmercury (MeHg) and selenium (Se) bioaccumulation and body burden in Guiana dolphins from Sepetiba Bay (RJ) collected before (n = 61) and during the UME (n = 20). Significantly lower Se concentrations were found in the livers of individuals collected during the UME (Mann-Whitney test; p = 0.03), probably due to impairment of the detoxification process in the liver. There were differences in THg and Se concentrations in the organs and tissues of individuals (Kruskal-Wallis test, p < 0.05), but not MeHg (Kruskal-Wallis test, p = 0.07). For THg, the liver showed the higher concentrations and differed among organs and tissues analyzed such as blubber (Tukey's test for unequal N; p = 0.003). For Se concentrations, the skin and kidney presented the higher concentrations and varied among other tissues/organs, like muscle (Tukey's test for unequal N; p = 0.02). Differences in body burdens were observed among specimens collected previously and during the UME probably due to the remobilization and transport of the muscle-stored MeHg to other tissues/organs. This abrupt input of MeHg into the bloodstream may cause serious health damage. Indeed, evidences of methylmercury intoxication was observed in Guiana dolphins in Sepetiba Bay. In conclusion, bioaccumulation patterns, the detoxification process and body burden were affected by morbillivirus.

Comparison and Risk Assessment for Trace Heavy Metals in Raw Pu-erh Tea with Different Storage Years

This research conducted an exploration of the content of microelements (As, Cr, Cd, Pb, Cu, Zn, Mn, and Hg) in raw Pu-erh tea with different storage years. The contents of As, Cr, Cd, Pb, Cu, Zn, Mn, and Hg were 0.14, 0.82, 0.02, 0.52, 14.59, 33.51, 564.02, and 0.01 μg/g, respectively, and were all less than the national standard limit values in China. The target hazard quotients (THQs) of each heavy metal were all lower than 1, and the value of combined risk hazard index (HI) of all to adults was 0.221, which presents no health risk when consumed properly by adults of the raw Pu-erh tea infusions. Interestingly, there was no significant correlation between the heavy metal element (As, Cr, Cd, Pb, Cu, Zn, Mn, and Hg) contents and the THQ values of raw Pu-erh tea samples and storage years; the correlation coefficients (R²) range from 0.01 to 0.33 and from 0.01 to 0.57, respectively. The result showed that the storage years showed no effect on the exposure risk of heavy metals; the heavy metal elements in tea samples come from the atmosphere and soil.

Carbon monoxide: An emerging therapy for acute kidney injury

Treating acute kidney injury (AKI) represents an important unmet medical need both in terms of the seriousness of this medical problem and the number of patients. There is also a large untapped market opportunity in treating AKI. Over the years, there has been much effort in search of therapeutics with minimal success. However, over the same time period, new understanding of the underlying pathobiology and molecular mechanisms of kidney injury have undoubtedly helped the search for new therapeutics. Along this line, carbon monoxide (CO) has emerged as a promising therapeutic agent because of its demonstrated cytoprotective, and immunomodulatory effects. CO has also been shown to sensitize cancer, but not normal cells, to chemotherapy. This is particularly important in treating cisplatin-induced AKI, a common clinical problem that develops in patients receiving cisplatin therapies for a number of different solid organ malignancies. This review will examine and make the case that CO be developed into a therapeutic agent against AKI.

Mercury in aquatic fauna contamination: A systematic review on its dynamics and potential health risks

Mercury is an important pollutant, released into aquatic ecosystems both naturally and by anthropogenic action. This element is transferred to aquatic organisms in different ways, causing potential health risks. In addition, mercury can be accumulated by humans, especially through the consumption of contaminated food. This systematic review aims to present mercury pathways, the major routes through which this element reaches the aquatic environment and its transformations until becoming available to living animals, leading to bioaccumulation and biomagnification phenomena. The key biotic and abiotic factors affecting such processes, the impact of mercury on animal and human health and the issue of seafood consumption as a source of chronic mercury contamination are also addressed. A total of 101 articles were retrieved from a standardized search on three databases (PubMed, Emabse, and Web of Science), in addition to 28 other studies not found on these databases but considered fundamental to this review (totaling 129 articles). Both biotic and abiotic factors display fundamental importance in mediating mercurial dynamics, i.e., muscle tropism, and salinity, respectively. Consequently, mercurial contamination in aquatic environments affects animal health, especially the risk of extinction species and also on human health, with methylmercury the main mercury species responsible for acute and chronic symptomatology.

Mercury exposure and its effects on fertility and pregnancy outcome

Mercury (Hg), a highly toxic environmental pollutant, shows harmfulness which still represents a big concern for human health, including hazards to fertility and pregnancy outcome. Research has shown that Hg could induce impairments in the reproductive function, cellular deformation of the Leydig cells and the seminiferous tubules, and testicular degeneration as well as abnormal menstrual cycles. Some studies investigated spontaneous abortion and complicated fertility outcome due to occupational Hg exposure. Moreover, there is a relation between inhaled Hg vapour and reproductive outcome. This MiniReview evaluates the hypothesis that exposure to Hg may increase the risk of reduced fertility, spontaneous abortion and congenital deficits or abnormalities.

Full Atrioventricular Block Secondary to Acute Poisoning Mercury: A Case Report

Background: The biological behaviour and clinical significance of mercury toxicity vary according to its chemical structure. Mercury differs in its degree of toxicity and in its effects on the nervous, digestive and immune systems as well as on organs such as the lungs, kidneys, skin, eyes and heart. Human exposure occurs mainly through inhalation of elemental mercury vapours during industrial and artisanal processes such as artisanal and small-scale gold mining. Case presentation: A 52-years-old female, housewife, with a body mass index of 25.3 kg/cm², without smoking or alcohol habits or any important clinical or chronic cardiovascular history, was admitted to the emergency room due to probable accidental poisoning by butane gas. Clinical manifestations with a headache, dizziness, cough, and dyspnoea of medium to small efforts. An initial physical exploration with Glasgow scored at 15, with arrhythmic heart sounds, pulmonary fields with bilateral subcrepitant rales and right basal predominance. Electrocardiographic findings were as follows: a cardiac frequency of 50 beats per minute and atrioventricular dissociation. Laboratory parameters were: white blood cells at 15.8 × 10⁸/L; aspartate aminotransferase at 38 U/L; lactate dehydrogenase at 1288 U/L; creatine-kinase at 115 U/L; CK-MB fraction at 28 U/L; and other biochemical parameters were within the reference values. A radiographic evaluation showed flow cephalization, diffuse bilateral infiltrates with right basal predominance. In addition, the patient presented data of low secondary expenditure to third-degree atrioventricular (AV) block for which the placement of a transvenous pacemaker was decided, substantially improving the haemodynamic parameters. Subsequently, after a family interrogation, the diagnosis of mercury inhalation poisoning was established. An initial detection of mercury concentration (Hg(0)) was carried out, reporting 243.5 µg/L. In view of this new evidence, mercury chelation therapy with intravenous calcium disodium ethylenediamine tetraacetic acid (CaNa₂·EDTA) was initiated. After 8-days of hospital stay, she presented a favourable evolution with both clinical and radiological improvements, so that the mechanical ventilation progressed to extubating. Subsequently, she was referred for cardiology because of her persistent 3rd-degree atrioventricular block, deciding to place a definitive bicameral pacemaker. The patient was discharged from the hospital 14 days after admission due to clinical improvements with mercury plasma levels at 5 µmol/L and a heart rhythm from the pacemaker. Conclusions: We show evidence that acute exposure to elemental mercury can affect the heart rhythm, including a complete atrioventricular blockage.

Regulation of Sirt1/Nrf2/TNF-α signaling pathway by luteolin is critical to attenuate acute mercuric chloride exposure induced hepatotoxicity

Inorganic mercury, though a key component of pediatric vaccines, is an environmental toxicant threatening human health via accumulating oxidative stress in part. Luteolin has been of great interest because of its antiinflammatory, anticarcinogenic and antioxidative effects. Here we hypothesized that luteolin would attenuate hepatotoxicity induced by acute inorganic mercury exposure. Kunming mice were treated with luteolin (100 mg/kg) 24 h after administration of 4 mg/kg mercuric chloride (HgCl₂). The results showed that luteolin ameliorated HgCl₂ induced anemia and hepatotoxicity, regulating radical oxygen species (ROS) production and hepatocyte viability in vitro and oxidative stress and apoptosis in vivo. Furthermore, luteolin reversed the changes in levels of inflammation- and apoptosis-related proteins involving NF-κB, TNF-α, Sirt1, mTOR, Bax, p53, and Bcl-2, and inhibited p38 MAPK activation. Luteolin enhanced antioxidant defense system based on Keap1, Nrf2, HO-1, NQO1, and KLF9. Moreover, luteolin did not affect miRNA-146a expression. Collectively, our findings, for the first time, elucidate a precise mechanism for attenuation of HgCl₂-induced liver dysfunction by dietary luteolin via regulating Sirt1/Nrf2/TNF-α signaling pathway, and provide a foundation for further study of luteolin as a novel therapeutic agent against inorganic mercury poisoning.