revised final - Agency for Toxic Substances and Disease Registry ...

MERCURY 330
2. HEALTH EFFECTS
particularly difficult to treat, sometimes requiring exchange transfusion or other more elaborate measures.
Reducing the body burden or toxic effects of mercury in pregnant women presents an even greater
challenge (i.e., treatment must be effective for both the mother and the developing child), and specific
treatment protocols are needed.
2.10.1 Reducing Peak Absorption Following Exposure
Strategies used to reduce absorption of mercury may differ depending on the route of exposure and the
specific chemical to which one is exposed. Elemental mercury and certain organic forms of mercury have
high vapor pressures and are readily absorbed by the lungs; inhalation of these chemicals may be the
major exposure of concern. Because ingestion of most chemical forms of mercury is possible, strategies
for limiting absorption from the gastrointestinal tract would be of utmost concern in such situations. The
organic mercury compounds have greater absorption from the gut than elemental and inorganic mercury;
thus, strategies differ depending on the form of mercury ingested. Dermal absorption of the various forms
of mercury is also possible, so strategies should also consider limiting dermal absorption.
The first step in mitigating the toxic effects of inhalation and dermal exposures to mercury or its
compounds is removal from the contaminated area or source (Bronstein and Currance 1988; Gossel and
Bricker 1984; Haddad and Winchester 1990; Stutz and Janusz 1988). Since continued exposure may
occur when clothing is contaminated, clothing may be removed as well (Bronstein and Currance 1988;
Stutz and Janusz 1988). If dermal or ocular exposure has occurred, thoroughly washing the exposed areas
with water has been suggested; treatment protocols recommend the use of Tincture of Green® soap a
disinfectant) for the skin and normal saline for the eyes (Bronstein and Currance 1988; Stutz and Janusz
1988).
Several treatments have been suggested to reduce absorption of mercury from the gastrointestinal tract;
however, most refer to the inorganic forms of mercury. It is likely that strategies that are effective in
reducing the absorption of inorganic forms may also have some efficacy for organic forms. Several
procedures that have been recommended for trapping mercury in the gastrointestinal tract are based on the
mercury's affinity for binding to sulfhydryl groups. For example, oral administration of a protein solution
(e.g., milk or egg whites) has been suggested to reduce absorption (Gossel and Bricker 1984; Haddad and
Winchester 1990; Stutz and Janusz 1988). Salt-poor albumin administration has also been suggested
(Haddad and Winchester 1990). Nonabsorbable agents (e.g., polystyrene resins containing sulfhydryl