Epidemiology and toxicity of mercury
- Carl-Gustaf Elinder, MD, PhD
Carl-Gustaf Elinder, MD, PhD
- Professor of Renal Medicine
- Karolinska Institute, Sweden
Mercury exists in metallic, inorganic, and organic forms, which are characterized by different toxic properties. Metallic and organic forms, the latter found as methylated mercury in contaminated fish, are toxic to the central nervous system and the fetus, whereas inorganic forms of mercury may affect the kidneys. Although mercury is a silvery white liquid, the metal is volatile at room temperature because of its high vapor pressure. Mercury also exists in different oxidation states and can form a number of organomercuric compounds. These physical properties contribute to the considerable toxicity observed with mercury. In order of importance, the principal organ systems affected by mercury poisoning are the central nervous system and the kidneys [1-3].
USES OF MERCURY
The unique physical properties of mercury have led to its use from prehistoric times to the present day.
●Colored cave drawings from more than 10,000 years ago have been found to contain the red stone of mercury ore (cinnabar, mercury sulfide, HgS).
●In the 19th century, epidemics of occupational mercury poisoning resulted from heavy exposure to mercury in the mirror and felt hat industries.
●Mercury is still used in the manufacture of many technical and medical instruments, including sphygmomanometers, manometers, thermometers, and barometers.
- WHO. Inorganic mercury. Environmental Health Criteria 118. World Health Organization, Geneva, 1991.
- Clarkson TW, Magos L, Myers GJ. The toxicology of mercury--current exposures and clinical manifestations. N Engl J Med 2003; 349:1731.
- Fowler BA, Whittaker MH, Elinder CG. Mercury-induced renal effects. In: Clinical Nephrotoxins. Renal Injury from Drugs and Chemicals, 3rd ed, De Broe M, Porter GA (Eds), Springer, New York 2008. p.811.
- Schutte NP, Knight AL, Jahn O. Mercury and its compounds. In: Occupational Medicine, 3rd ed, Zenz C, Dickerson OB, Horovath EP (Eds), Mosby-Year Book, St. Louis 1994. p.549.
- Byrne L. Brazil's mercury poisoning disaster. BMJ 1992; 304:1397.
- Malm O. Gold mining as a source of mercury exposure in the Brazilian Amazon. Environ Res 1998; 77:73.
- WHO. Methylmercury. Environmental Health Criteria 101. World Health Organization, Geneva 1990.
- Sällsten G, Barregård L, Osterberg T. [Tooth grinding among wearers of amalgam fillings--a cause of high mercury release?]. Lakartidningen 1991; 88:232.
- Bates MN. Mercury amalgam dental fillings: an epidemiologic assessment. Int J Hyg Environ Health 2006; 209:309.
- Elinder CG, Friberg L, Nordberg GF, et al. Biological monitoring of metals. Chemical Safety Monographs. International Program on Chemical Safety. WHO/EHG/94.2 1994; 1.
- Ronchetti R, Zuurbier M, Jesenak M, et al. Children's health and mercury exposure. Acta Paediatr Suppl 2006; 95:36.
- Sällsten G, Barregård L, Järvholm B. Mercury in the Swedish chloralkali industry--an evaluation of the exposure and preventive measures over 40 years. Ann Occup Hyg 1990; 34:205.
- Bridges CC, Zalups RK. Transport of inorganic mercury and methylmercury in target tissues and organs. J Toxicol Environ Health B Crit Rev 2010; 13:385.
- Berlin M. Mercury. In: Handbook on the Toxicology of Metals, Friberg L, Nordberg GF, Vouk VB (Eds), Elsevier, Amsterdam 1986. Vol 2, p.387.
- Clarkson TW. Mercury--an element of mystery. N Engl J Med 1990; 323:1137.
- Grandjean P, Weihe P, White RF, Debes F. Cognitive performance of children prenatally exposed to "safe" levels of methylmercury. Environ Res 1998; 77:165.
- Nierenberg DW, Nordgren RE, Chang MB, et al. Delayed cerebellar disease and death after accidental exposure to dimethylmercury. N Engl J Med 1998; 338:1672.
- Kulig K. A tragic reminder about organic mercury. N Engl J Med 1998; 338:1692.
- CAMERON JS, TROUNCE JR. MEMBRANOUS GLOMERULONEPHRITIS AND THE NEPHROTIC SYNDROME APPEARING DURING MERSALYL THERAPY. Guys Hosp Rep 1965; 114:101.
- BECKER CG, BECKER EL, MAHER JF, SCHREINER GE. Nephrotic syndrome after contact with mercury. A report of five cases, three after the use of ammoniated mercury ointment. Arch Intern Med 1962; 110:178.
- MUNCK O, NISSEN NI. Development of nephrotic syndrome during treatment with mercurial diuretics. Acta Med Scand 1956; 153:307.
- BURSTON J, DARMADY EM, STRANACK F. Nephrosis dur to mercurial diuretics. Br Med J 1958; 1:1277.
- RIDDLE M, GARDNER F, BESWICK I, FILSHIE I. The nephrotic syndrome complicating mercurial diuretic therapy. Br Med J 1958; 1:1274.
- PREEDY JR, RUSSELL DS. Acute salt depletion associated with the nephrotic syndrome developing during treatment with a mercurial diuretic. Lancet 1953; 265:1181.
- WILLIAMS NE, BRIDGE HG. Nephrotic syndrome after the application of mercury ointment. Lancet 1958; 2:602.
- WILSON VK, THOMSON ML, HOLZEL A. Mercury nephrosis in young children, with special reference to teething powders containing mercury. Br Med J 1952; 1:358.
- Barr RD, Rees PH, Cordy PE, et al. Nephrotic syndrome in adult Africans in Nairobi. Br Med J 1972; 2:131.
- Oliveira DB, Foster G, Savill J, et al. Membranous nephropathy caused by mercury-containing skin lightening cream. Postgrad Med J 1987; 63:303.
- Agner E, Jans H. Mercury poisoning and nephrotic syndrome in two young siblings. Lancet 1978; 2:951.
- FRIBERG L, HAMMARSTROM S, NYSTROM A. Kidney injury after exposure to inorganic mercury. AMA Arch Ind Hyg Occup Med 1953; 8:149.
- KAZANTZIS G, SCHILLER KF, ASSCHER AW, DREW RG. Albuminuria and the nephrotic syndrome following exposure to mercury and its compounds. Q J Med 1962; 31:403.
- Li SJ, Zhang SH, Chen HP, et al. Mercury-induced membranous nephropathy: clinical and pathological features. Clin J Am Soc Nephrol 2010; 5:439.
- Tang HL, Chu KH, Mak YF, et al. Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J 2006; 12:316.
- Aymaz S, Gross O, Krakamp B, et al. Membranous nephropathy from exposure to mercury in the fluorescent-tube-recycling industry. Nephrol Dial Transplant 2001; 16:2253.
- Roels H, Gennart JP, Lauwerys R, et al. Surveillance of workers exposed to mercury vapour:validation of a previously proposed biological threshold limit value for mercury concentration in urine. Am J Ind Med 1985; 7:45.
- Zalups RK, Aslamkhan AG, Ahmad S. Human organic anion transporter 1 mediates cellular uptake of cysteine-S conjugates of inorganic mercury. Kidney Int 2004; 66:251.
- Zalups RK, Ahmad S. Homocysteine and the renal epithelial transport and toxicity of inorganic mercury: role of basolateral transporter organic anion transporter 1. J Am Soc Nephrol 2004; 15:2023.
- Stonard MD, Chater BV, Duffield DP, et al. An evaluation of renal function in workers occupationally exposed to mercury vapour. Int Arch Occup Environ Health 1983; 52:177.
- Barregård L, Hultberg B, Schütz A, Sällsten G. Enzymuria in workers exposed to inorganic mercury. Int Arch Occup Environ Health 1988; 61:65.
- Langworth S, Elinder CG, Sundquist KG, Vesterberg O. Renal and immunological effects of occupational exposure to inorganic mercury. Br J Ind Med 1992; 49:394.
- Van Vleet TR, Schnellmann RG. Toxic nephropathy: environmental chemicals. Semin Nephrol 2003; 23:500.
- Cárdenas A, Roels H, Bernard AM, et al. Markers of early renal changes induced by industrial pollutants. I. Application to workers exposed to mercury vapour. Br J Ind Med 1993; 50:17.
- Frumkin H, Letz R, Williams PL, et al. Health effects of long-term mercury exposure among chloralkali plant workers. Am J Ind Med 2001; 39:1.
- Brownawell AM, Berent S, Brent RL, et al. The potential adverse health effects of dental amalgam. Toxicol Rev 2005; 24:1.
- Sandborgh-Englund G, Nygren AT, Ekstrand J, Elinder CG. No evidence of renal toxicity from amalgam fillings. Am J Physiol 1996; 271:R941.
- Bellinger DC, Trachtenberg F, Barregard L, et al. Neuropsychological and renal effects of dental amalgam in children: a randomized clinical trial. JAMA 2006; 295:1775.
- Barregard L, Trachtenberg F, McKinlay S. Renal effects of dental amalgam in children: the New England children's amalgam trial. Environ Health Perspect 2008; 116:394.
- Sällsten G, Barregård L, Schütz A. Clearance half life of mercury in urine after the cessation of long term occupational exposure: influence of a chelating agent (DMPS) on excretion of mercury in urine. Occup Environ Med 1994; 51:337.
- Bluhm RE, Bobbitt RG, Welch LW, et al. Elemental mercury vapour toxicity, treatment, and prognosis after acute, intensive exposure in chloralkali plant workers. Part I: History, neuropsychological findings and chelator effects. Hum Exp Toxicol 1992; 11:201.