Potassium-wasting nephropathy in an outbreak of chronic organic mercurial intoxication

An outbreak of organic mercurial intoxication in a peasant family from the Jordan West Bank is reported. Extrapyramidal symptoms, muscular wasting, oral ulcerations, and renal tubular dysfunction were the main manifestations. Hpyokalemia (1.9-2.7 mEq/l) due to urinary potassium wasting was present in all 4 patients. Type II RTA was observed in 2 cases. Urinary ammonium excretion was increased over the range predicted by the given urinary pH in all the patients. Intrinsic tubular damage, nonreabsorbable anions of catabolic origin, increased prostaglandin synthesis inducing renin-angiotensin axis activation, and, consequently, inappropriate relatively high levels of aldosterone, are advanced as an explanation for potassium wasting.