A 70-year-old white female presented approximately 24 h after ingesting three 475 mg
tablets (1.425 g) of
mercuric chloride in a suicide attempt.
Acute renal failure necessitated the initiation of haemodialysis approximately 4 d after the ingestion. Treatment with BAL (2,3-dimercaptopropanol) resulted in only small increases in
mercury output into
dialysate. A new procedure involving the extracorporeal infusion of the
chelating agent dimercaptosuccinic acid (
DMSA) into the arterial blood line during haemodialysis was initiated. This procedure of Extracorporeal Regional Complexing Haemodialysis (ERCH) had been effective in increasing methylmercury removal in patients poisoned by contaminated grain. The first
DMSA-ERCH procedure was performed 6 d after
poisoning. There was a dramatic increase in
mercury output into the
dialysate. During three treatment sessions of 80 min each, 1189 micrograms of
mercury were removed from the patient. The dialysed
mercury represented the only
mercury output since the patient was anuric and not producing faeces.
DMSA-ERCH appears to be much more effective than BAL and haemodialysis in the treatment of acute
inorganic mercury poisoning. The long interval between
poisoning and initiation of treatment probably contributed to the patients ultimate demise, 28 d after
poisoning. Efficacy of the
DMSA-ERCH procedure for
inorganic mercury poisoning is likely to be improved as the interval between exposure and treatment is reduced.