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Letters |
Unit of Industrial Toxicol., Catholic Univ. of Louvain, Clos Chapelle-aux-Champs, 30.54 1200 Bruxelles, Belgium
a Author for correspondence.
To the Editor:
The sources of exposure to mercury and its compounds are numerous, polymorphic, and often insidious. The fortuitous observation of an increased urinary mercury excretion of 19 µmol/mol creatinine (34 µg/g creatinine) in a gendarme lead us to search for the source of exposure, there being no indication of an occupational exposure to mercury.
Increased excretion of mercury was confirmed in a second sample taken by his general practitioner. A measurement of urinary Hg was then suggested to all the members of the family.
His two sons had values [0.73 and 1.13 µmol/mol creatinine (1.3 and 2 µg/g)] within the expected range for a nonoccupationally exposed population [<2.8 µmol/mol creatinine (<5 µg/g)]. Surprisingly, however, their mother showed a urinary mercury of 46 µmol/mol creatinine (82 µg/g). In early December 1995 the gendarme and his wife were referred to the clinic of industrial toxicology to elucidate the source of exposure. The urinary mercury of the wife, who was not occupationally exposed to mercury, was still high, 52 µmol/mol creatinine (93 µg/g) but her blood mercury was not (5.5 µg/L). Neither subject had complaints or signs of mercury intoxication. A detailed investigation was then carried out.
Their diet was unremarkable. According to their statement, they did not consume any classical or homeopathic drugs or herbal teas, nor had they undergone dental treatment—although even if they had, this hardly could have explained such a high urinary excretion in the mother. No object containing mercury (e.g., thermometer, precision instrument) had been broken in the home, either recently or earlier (such breakage would have been expected also to contaminate the sons, unless the object had been broken in a room not frequented by them). There was no indication of the use of lightening cream or soap or exposure to painting or pesticides containing mercury. They did not practice spiritism.
After almost 1 h of interview, we finally found the clue. "Are you sure you don't take any drug? The spray you may use when you have throat pain or the drops you put into your eyes or your nose are also drugs." Finally, the woman took out of her handbag a small bottle containing drops prepared by a local pharmacist that she used daily for a few years. She smoked and the smoke irritated her nasal mucosa. Every day she used a few drops of this "mixture." The husband used the same drops but less frequently. We contacted the pharmacist, who delivered the preparation without any medical prescription, and learned that it contained 300 mg/L of borate phenyl mercury.
We prescribed 2 g of dimercaptosuccinic acid (1) to be taken orally by the woman, whose subsequent Hg excretion in 24-h urines was 83.4 µmol/mol creatinine (148 µg/g). By 2.5 months later, her urinary excretion of Hg had decreased to 24.9 µmol/mol creatinine (44 µg/g); by 8 months after the withdrawal of the nose drops, the urinary concentration of mercury was 2 µmol/mol creatinine (3.8 µg/g).
References
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