SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

C19
A CASE OF SURREPTITIOUS NON-FATAL MERCURY POISONING
Alphonse Poklis*. Department of Pathology, Medical College ofVirginia Campus at Virginia
Commonwealth University, Richmond, VA 23298-0165
A case of non-fatal mercury poisoning disclosed suspicion of criminal poisoning and resultant toxicology
testing is presented. A 46 yr-old, white male Fire Chief with episodes of chest pain and diaphoresis,
presented in the emergency department with a one month history of fatigue, generalized weakness,
headaches, "inability to focus at work" and "hardly able to walk up stairs", but denies shortness of breath.
He had a prior history of episodes of chest pain and diaphoresis. Physical examination and chest X-rays
were unremarkable, serum chemistries and enzymes including CPK and LDH, and thyroid were normal. He
displayed an EKG on normal rhythm. His hospital course was uneventful and he was discharged after four
days. Five weeks later, the chief once again presented in the emergency department with a four day history
of: "chills and shakes", a fever of 102 0 F, back pain, headaches, increasing fatigue and muscular weakness,
tingling in his fingers and toes and a palpable tender left axilla lymph node. Once again the physical
examination was unremarkable and laboratory test normal with the exception of a serum creatinine of 1.5
mg/dL and a urine protein of 60 mg. His hospital course was uneventful and he was discharged after three
days. Three weeks after discharge while eating at work a lunch provided by his assistant-chief, the chief
began vomiting violently. Suspicion of poisoning was raised by the comments of co-workers. Therefore,
coffee prepared the next morning for the chief by his assistant was saved and given to the police. Initial
screening of the coffee for toxic metals by the Reinsch Test resulted in a classic "silver mirror" indicating
the presence of mercury. The coffee and a 24 hour urine specimen obtained from the chief were then
analyzed in a "cold vapor" Mercury Analyzer System (Perkin Elmer Corp.). The urine contained 20ug of
mercury/gm of creatinine. While executing a search warrant at the assistant-chiefs home, the police found
over 128 reagent chemicals and explosives, including several mercury compounds. The assistant admitted
adding mercurous nitrate periodically to the chiefs coffee, to sandwiches the day the chief was violently
vomiting, and to doughnuts the day of the chiefs first emergency room admission. The motive for the
poisoning was that the assistant had been passed over for promotion. Three years prior to the presented
case, a former chief working with the assistant, was retired with "complete disability" due to a
neuromuscular disease of unknown etiology characterized by slow mental functioning, peripheral
neuropathy and chronic nephritis! This case exemplifies the difficultly of diagnosing the rather diffuse and
non-specific signs and symptoms of surreptitious chronic mercury poisoning.
Keywords: Mercury poisoning, criminal poisoning, mercury analysis
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