Acute Mercurial Intoxication Treated by Hemodialysis

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Abstract
Ten patients were treated between 1953 and 1962. Seven recovered. One patient took 2g of Hg(CN)2 7 took HgCl2. The type of Hg compound was not known in 2 patients. Six patients admitted, and 2 were suspected of, suicide attempts. There was no history of poison in 2 patients. However the diagnosis was suggested in 1 case by a renal biopsy and confirmed in the other autopsy. In 1 case the HgCl2 may have been administered by a friend. All patients had oliguria and uremia except for 1 patient who remained fairly asymptomatic in spite of 3 days of severe oliguria. Hematemesis and gastrointestinal bleeding occurred in 4 patients. A colectomy was done because of persistant bleeding in 1 patient. However, the bleeding continued from the rectum which had to be removed also. Pathologically this was the most severely involved portion of the colon in this patient. Abdominal pain, nausea and vomiting were common symptoms. Pulmonary infections, ileus and peritonitis complicated the course of the 3 patients who died. Therapy consisted of hemodialysis with the Kolff Twin Coil and rotating drum artificial kidneys and the usual management of renal failure. BAL (dimercaprol) was used in 6 patients. Early and frequent hemodialysis should be used to alleviate the uremia until tubular regeneration can occur especially in those who receive BAL late or do not respond to early administration of it. If colectomy is necessary because of uncontrollable hemorrhage, the rectum should be removed also. The common cause of death which used to be uremia can be eliminated, and the prognosis of acute Hg intoxication would depend on the toxic effects of the Hg in other locations than the kidney, e.g., the gastrointestinal tract and its subsequent complications.