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Erukkambattu J, Sharma T, Atlani M, Kapoor N. Unusual Manifestation of Mercuric Chloride Poisoning as Intratubular Nephrocalcinosis - A Rare Case Report. Indian J Nephrol 2023; 33:307-309. [PMID: 37781549 PMCID: PMC10503587 DOI: 10.4103/ijn.ijn_177_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 08/07/2022] [Indexed: 10/03/2023] Open
Abstract
Mercuric chloride salts are highly toxic compounds that have been linked to suicidal or accidental poisoning. Because of their high solubility, mercuric chloride salts can cause acute tubular injury, corrosive effects in the gastrointestinal system, hematemesis and hematochezia, circulatory collapse, and death. Here, we report an unusual case of mercuric chloride poisoning in a 17-year-old girl who manifested with acute tubular necrosis in association with intratubular nephrocalcinosis and emphasize the role of hemodialysis in the patient's successful recovery.
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Affiliation(s)
- Jayashankar Erukkambattu
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Tanya Sharma
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mahendra Atlani
- Department of Nephrology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Neelkamal Kapoor
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Magdalan J, Sozański T, Nowak K, Zawadzki M. Acute intranasal intoxication with mercuric chloride taken accidently instead of cocaine - A case report. J Forensic Leg Med 2021; 78:102129. [PMID: 33581407 DOI: 10.1016/j.jflm.2021.102129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male. CASE REPORT Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 μg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition. DISCUSSION Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism.
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Affiliation(s)
- Jan Magdalan
- Department of Toxicology and Internal Medicine, Lower Silesia Specialist Hospital T. Marciniak in Wrocław, Fieldorfa 2, Wrocław, PL 54-049, Poland; Department of Pharmacology, Wroclaw Medical University, Jana Mikulicza-Radeckiego 2, Wrocław, PL 50-345, Poland
| | - Tomasz Sozański
- Department of Pharmacology, Wroclaw Medical University, Jana Mikulicza-Radeckiego 2, Wrocław, PL 50-345, Poland
| | - Karolina Nowak
- Institute of Toxicology Research, Kasztanowa 45, Borowa, PL 55-093, Poland
| | - Marcin Zawadzki
- Department of Forensic Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 4, Wroclaw, PL 50-345, Poland.
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The Role of Therapeutic Plasma Exchange in the Treatment of Childhood Intoxication: A Single-Center Experience. Pediatr Crit Care Med 2020; 21:e988-e995. [PMID: 32701752 DOI: 10.1097/pcc.0000000000002462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Therapeutic plasma exchange is used to treat neurologic, hematological, renal, and autoimmune diseases with a known or suspected etiopathogenesis. However, there is incomplete understanding of the use of therapeutic plasma exchange in pediatric cases of intoxication. This study investigated 5 years of experience with therapeutic plasma exchange to treat intoxication cases. DESIGN A retrospective, case series, single-center study. SETTING PICU of Baskent University, Dr. Turgut Noyan Teaching, and Medical Research Center Hospital in Adana, Turkey. PATIENTS Fourteen patients diagnosed with intoxication who underwent therapeutic plasma exchange between January 2013 and January 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data pertaining to 14 patients, including their medical history (exposure to drugs/toxicants), demographics, initial presentation, and severity of clinical symptoms (requirement of mechanical ventilation, Glasgow Coma Scale score, and the pediatric severity of illness score [Pediatric Logistic Organ Dysfunction] were retrospectively reviewed. The most common indication for therapeutic plasma exchange was multiple drug intoxication, followed by amitriptyline, Amanita phalloides mushroom, carbamazepine, mercury, verapamil, and botulism. All patients underwent therapeutic plasma exchange and two patients underwent hemodialysis before therapeutic plasma exchange. There was no mortality or complications related to the therapeutic plasma exchange procedure. Clinical improvement was observed after therapeutic plasma exchange in 13 of the 14 patients; one patient with verapamil intoxication died. CONCLUSIONS Therapeutic plasma exchange appears to be safe and effective for treating pediatric cases of intoxication, including multidrug and amitriptyline intoxication, and is associated with significant recovery in the majority of severely affected patients. Treatment of intoxication with therapeutic plasma exchange should be guided primarily by the properties of the causative toxic substances/drugs, and consideration of patient age, the severity of clinical symptoms, Pediatric Logistic Organ Dysfunction score and response to initial supportive and antidotal treatment.
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Cappelletti S, Piacentino D, Fineschi V, Frati P, D'Errico S, Aromatario M. Mercuric chloride poisoning: symptoms, analysis, therapies, and autoptic findings. A review of the literature. Crit Rev Toxicol 2019; 49:329-341. [PMID: 31433682 DOI: 10.1080/10408444.2019.1621262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Among mercury-related intoxications, the re-emerging of mercuric chloride poisoning has been recently described in literature. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the analytical procedures or the treatment have been published and no exhaustive analysis of all these factors exists in literature. The classic symptoms associated with toxicity of mercuric chloride is a combination of renal, gastrointestinal (GI) and central nervous system (CNS) damages, eventually leading to death. Fatalities related to exposure to mercuric chloride have been reported since the nineteenth century. To date, there have been 45 published cases in the medical literature in which the intoxication or the death is attributed to mercuric chloride. In this review, we will describe the modern medical treatments, with particular attenztion to the developments of the lasts two decades, in order to provide an exhaustive description of the clinical symptoms, the post-mortem findings, and the analytical procedures to act out when mercuric chloride intoxication occurs. The analysis of the data obtained permitted us to accurately describe all the organs and apparatus involved in mercuric chloride intoxication. The target organs were the kidneys, the GI tract and the CNS. A description of the analytical procedures for the determination of mercuric chloride in biological materials, to carry out in vivo and in post-mortem samples has also been described.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,State Police Health Service Department, Ministry of Interior , Rome , Italy
| | - Daria Piacentino
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse (NIDA) Intramural Research Program, National Institutes of Health , Bethesda , MD , USA
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy
| | - Stefano D'Errico
- Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome , Rome , Italy.,Legal Medicine Unit, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
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Dhanapriya J, Gopalakrishnan N, Arun V, Dineshkumar T, Sakthirajan R, Balasubramaniyan T, Haris M. Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning. Indian J Nephrol 2016; 26:206-8. [PMID: 27194836 PMCID: PMC4862267 DOI: 10.4103/0971-4065.164230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mercury is a toxic heavy metal and occurs in organic and inorganic forms. Inorganic mercury includes elemental mercury and mercury salts. Mercury salts are usually white powder or crystals, and widely used in indigenous medicines and folk remedies in Asia. Inorganic mercury poisoning causes acute kidney injury (AKI) and gastrointestinal manifestations and can be life-threatening. We describe a case with unknown substance poisoning who developed AKI and disseminated intravascular coagulation (DIC). Renal biopsy showed acute tubular necrosis. Later, the consumed substance was proven to be mercuric chloride. His renal failure improved over time, and his creatinine normalized after 2 months.
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Affiliation(s)
- J Dhanapriya
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - N Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - V Arun
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Dineshkumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - R Sakthirajan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - T Balasubramaniyan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - M Haris
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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Bottino C, Vázquez M, Devesa V, Laforenza U. Impaired aquaporins expression in the gastrointestinal tract of rat after mercury exposure. J Appl Toxicol 2015; 36:113-20. [DOI: 10.1002/jat.3151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Cinzia Bottino
- Department of Molecular Medicine, Human Physiology Unit; University of Pavia; Pavia Italy
| | - Marta Vázquez
- Institute of Agrochemistry and Food Technology (IATA-CSIC); Paterna Valencia Spain
| | - Vicenta Devesa
- Institute of Agrochemistry and Food Technology (IATA-CSIC); Paterna Valencia Spain
| | - Umberto Laforenza
- Department of Molecular Medicine, Human Physiology Unit; University of Pavia; Pavia Italy
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Friesenbichler J, Maurer-Ertl W, Sadoghi P, Wolf E, Leithner A. Auto-aggressive metallic mercury injection around the knee joint: a case report. BMC Surg 2011; 11:31. [PMID: 22093686 PMCID: PMC3226429 DOI: 10.1186/1471-2482-11-31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 11/17/2011] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Accidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions. CASE PRESENTATION Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally. CONCLUSION Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.
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Affiliation(s)
- Joerg Friesenbichler
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Elisabeth Wolf
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Alhamad T, Rooney J, Nwosu A, MacCombs J, Kim YS, Shukla V. Lessons learned from a fatal case of mercury intoxication. Int Urol Nephrol 2011; 44:647-51. [DOI: 10.1007/s11255-010-9896-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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Accidental inorganic mercury chloride poisoning in a 2-year old child. Indian J Pediatr 2010; 77:1153-5. [PMID: 20721700 DOI: 10.1007/s12098-010-0143-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
Inorganic mercury poisoning is uncommon, but when it occurs it can result in severe, life threatening features and acute renal failure. A 2-year old well thriving child presented with alleged history of accidental ingestion of inorganic mercury chloride. He presented with evidence of corrosive trauma to the gastrointestinal tract mucosa, but with normal renal function at admission, which was managed with BAL and other supportive treatment. But he developed non-oliguric renal failure after admission, which also improved gradually. On follow-up, two months later, the patient's renal function was normal; indicating that renal failure caused by acute inorganic mercury poisoning produced no permanent renal damage. We have hereby presented a case of mercury intoxication in a 2-year old child, with an excellent clinical improvement and normalization of laboratory results.
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Abstract
There is compelling evidence that various chemical agents are important determinants of myriad health afflictions--several xenobiotics have the potential to disrupt reproductive, developmental, and neurological processes and some agents in common use have carcinogenic, epigenetic, endocrine-disrupting, and immune-altering action. Some toxicants appear to have biological effect at miniscule levels and certain chemical compounds are persistent and bioaccumulative within the human body. Despite escalating public health measures to preclude further exposures, many people throughout the world have already accrued a significant body burden of toxicants, placing them at potential health risk. As a result, increasing discussion is underway about possible interventions to facilitate elimination of persistent toxicants from the human organism in order to obviate health affliction and to potentially ameliorate chronic degenerative illness. An overview of the clinical aspects of detoxification is presented with discussion of established and emerging interventions for the elimination of persistent xenobiotics. Potential therapies to circumvent enterohepatic recirculation and a case report highlighting a clinical outcome associated with detoxification are also presented for consideration.
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Affiliation(s)
- Stephen J Genuis
- University of Alberta, 2935-66 Street, Edmonton, Alberta, Canada.
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11
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Post-mortem CT findings following intentional ingestion of mercuric chloride. Leg Med (Tokyo) 2009; 11:136-8. [DOI: 10.1016/j.legalmed.2008.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 12/04/2008] [Accepted: 12/07/2008] [Indexed: 11/22/2022]
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Affiliation(s)
- John W Osborne
- University of Colorado, Health Sciences Center, Denver, CO, USA
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Bhan A, Sarkar NN. Mercury in the environment: effect on health and reproduction. REVIEWS ON ENVIRONMENTAL HEALTH 2005; 20:39-56. [PMID: 15835497 DOI: 10.1515/reveh.2005.20.1.39] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Mercury is a heavy metal that is found naturally in the environment in various forms. Human activity can release mercury into the air, water, and soil. Mercury is also released into the environment after its conversion to methylmercury by bacteria. Mercury was once used in medicine, but the medicinal aspect changed because of its devastating poisoning effect on humans and animals. Today, mercury is one of the most potent neurotoxins known, having a number of adverse health effects in animals and humans. As the sources of mercury are many, the general population is exposed to mercury in day-to-day life, in occupational settings, and in cases of accidental exposure. In addition, ignorance about the use of mercury in cosmetics and religious materials has opened an additional source of exposure. Therefore, making people aware of mercury's effects on health, its sources of entry into the environment, and its chelating remedies becomes a necessity so that strategies can be adopted to minimize use and exposure.
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Affiliation(s)
- Ashima Bhan
- Department of Reproductive Biology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
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Pai P, Thomas S, Hoenich N, Roberts R, House I, Brown A. Treatment of a case of severe mercuric salt overdose with DMPS (dimercapo-1-propane sulphonate) and continuous haemofiltration. Nephrol Dial Transplant 2000; 15:1889-90. [PMID: 11071989 DOI: 10.1093/ndt/15.11.1889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yoshida M, Satoh M, Yasutake A, Shimada A, Sumi Y, Tohyama C. Distribution and retention of mercury in metallothionen-null mice after exposure to mercury vapor. Toxicology 1999; 139:129-36. [PMID: 10614694 DOI: 10.1016/s0300-483x(99)00117-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We studied the role of metallothionein (MT) in the distribution and retention of mercury in the brain, lung, liver and kidney of MT-null and wild-type mice after exposure to mercury (Hg0) vapor. Mice were exposed to Hg0 vapor at 5.5-6.7 mg/m3 for 3 h and killed at 1, 24, 72 or 168 h after exposure. One hour after exposure to Hg0 vapor, there were no differences in mercury concentrations in these organs from MT-null and wild-type mice. However, the elimination rate of mercury from the organs, except the brain, were remarkably faster in MT-null mice than in wild-type mice. MT-I and -II levels in the lung and kidney were increased significantly in wild-type mice but not in MT-null mice at 24 h after exposure to Hg0 vapor. At this time point, over 65% of the mercury was retained in the MT fraction of the cytosol of organs from wild-type mice. In contrast, mercury appeared mainly in the high-molecular-weight protein fractions in the cytosol of organs from MT-null mice. In the brain, a large amount of mercury was bound to MT in both strains of mice immediately after exposure. No difference was observed in the elimination rate of mercury from the brain between both strains of mice. Brain MT levels were elevated slightly in wild-type mice at 168 h after exposure but could not be detected in MT-null mice. These data suggest that no detectable MT-I and -II levels were found in the brain of MT-null mice and that mercury was apparently bound to MT-III. Using MT-null mice, we showed also that MT-III may play an important role in the retention of mercury in the brain.
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Affiliation(s)
- M Yoshida
- Department of Chemistry, St. Marianna University School of Medicine, Kawasaki, Japan.
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Andersen O. Principles and recent developments in chelation treatment of metal intoxication. Chem Rev 1999; 99:2683-710. [PMID: 11749497 DOI: 10.1021/cr980453a] [Citation(s) in RCA: 283] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- O Andersen
- Department of Life Sciences and Chemistry, Roskilde University, Postbox 260 4000, Roskilde, Denmark
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