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Inhalational mercury toxicity from artisanal gold extraction reported to the Oregon poison center, 2002-2015
Matthew J Noble1, Stewart L Decker2, B Z Horowitz1
1a Department of Emergency Medicine , Oregon-Alaska Poison Center, Oregon Health and Science University , Portland , OR , USA.
Context:
Mercury exposure has been described among small-scale gold mining communities in developing countries, but reports of inhalational mercury toxicity among home gold extractors in the US remain uncommon.
Objective:
We sought to identify inhalational mercury exposures and toxicity among artisanal gold extractors.
Methods:
This is an observational case series of a single Poison Center database from 2002-2015. We review all cases of "mercury" or "mercury inhalation" exposures, with detailed description of a recent representative case.
Results:
Nine cases were reported, with patients' ages ranging 32-81 years. Eight (89%) patients were male. Seven of eight (88%) patients with acute exposures reported pulmonary symptoms consistent with mercury vapor inhalation such as dyspnea and cough; two (29%) patients had severe toxicity requiring intubation. Four of six (67%) patients had markedly elevated whole blood mercury concentrations up to 346 mcg/L; each received a different chelation regimen. Four (44%) patients used methamphetamines at the time of their exposure. The case report describes a patient with elevated mercury concentrations who required intubation for hypoxic respiratory failure. He received chelation therapy based on chelator availability, with decreasing 24-hour urine mercury concentrations. The house where he was exposed remains uninhabitable from elevated ambient mercury vapor concentrations.
Conclusion:
Artisanal gold extraction may be associated with inhalational mercury toxicity, including elevated blood mercury concentrations and acute hypoxic lung injury requiring intubation.
