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[Arterial hypertension due to mercury poisoning: diagnostic value of captopril]
S Cloarec1, G Deschênes, M Sagnier
1Service de pédiatrie R, hôpital Gatien-de-Clocheville, Tours, France.
Insights
Mercury poisoning in children can present with low urine mercury levels. Prompt chelation therapy with dimercaptosuccinic acid or BAL is crucial for recovery from acrodynia.
Area of Science:
- Pediatric Toxicology
- Environmental Health
Background:
- Mercury poisoning is a rare but serious condition in children, potentially causing hypertension.
- Urinary mercury levels may not accurately reflect intoxication severity initially.
Observation:
- A 32-month-old girl presented with hypertension, tachycardia, and neurological symptoms indicative of acrodynia.
- Initial urine mercury levels were normal, despite significant clinical intoxication from inhaled mercury vapor.
- Captopril increased urinary mercury but did not alleviate symptoms.
Findings:
- Low basal urinary mercury excretion can occur in cases of mercury poisoning.
- Exposure to mercury vapor from a broken thermometer led to severe intoxication in a young child.
- Chelation therapy with British Anti-Lewisite (BAL) and dimercaptosuccinic acid (DMSA) was required for clinical improvement.
Implications:
- Unexpected exposure routes and low initial urine mercury do not rule out mercury poisoning.
- Effective treatment for mercury-induced acrodynia requires long-term chelation therapy.
- Understanding mercury vapor toxicity is critical for pediatric environmental health.
Background:
Mercury poisoning is a rare cause of hypertension in children. Urinary excretion sometimes remains low despite severe clinical intoxication.
Case Report:
A 32 month-old girl was admitted with hypertension, tachycardia, apathy, irritability and excessive sweating. Erythromelalgia and neurologic symptoms permitted the diagnosis of acrodynia. Urine mercury remained normal until chelation. Captopril significantly increased urine mercury concentration but failed to improve clinical manifestations. Clinical improvement required infusions of BAL for 5 days then oral dimercaptosuccinic acid for 3 months. Metal vapors originated from the mercury which spilled from a broken thermometer onto the carpet.
Comments:
Low basal urine mercury could be associated with real mercury poisoning. Small amounts of metal mercury held in a thermometer could produce a high level of mercury vapor leading to intoxication in young children. The binding capacity of metal ions by captopril could be used to increase urine mercury output. Nevertheless, captopril therapy fails to improve acrodynia. Total elimination of mercury requires long-term therapy with BAL or dimercaptosuccinic acid.
Conclusions:
An unexpected mode of intoxication and low basal urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.