From the Guidelines
The current management of mercury overload with levels of 42 nanomols per liter requires prompt chelation therapy, with the preferred treatment being oral dimercaptosuccinic acid (DMSA, also called succimer) at a dose of 10 mg/kg every 8 hours for 5 days, followed by 10 mg/kg every 12 hours for an additional 14 days, as supported by the most recent guidelines 1. The management of mercury overload involves removing the mercury from the body through chelation therapy.
- The first-line treatment is typically oral dimercaptosuccinic acid (DMSA, also called succimer) at a dose of 10 mg/kg every 8 hours for 5 days, followed by 10 mg/kg every 12 hours for an additional 14 days.
- For more severe cases or if oral administration isn't possible, dimercaptopropanol (BAL) may be used at 3-5 mg/kg intramuscularly every 4 hours for 2-10 days, with a recommended stocking of 800 mg for an 8-hour period and 2.4 g for a 24-hour period 1.
- Alternatively, other chelating agents like 2,3-dimercaptopropane-1-sulfonate (DMPS) can be considered, although the specific dosing may vary. During treatment,
- mercury levels should be monitored regularly,
- therapy may need to be extended if levels remain elevated,
- supportive care is also important, including
- maintaining proper hydration,
- managing neurological symptoms,
- removing the patient from the source of exposure. Chelation therapy works by binding to mercury in the bloodstream, forming water-soluble complexes that can be excreted through urine and feces. This treatment should be administered under close medical supervision due to potential side effects including
- allergic reactions,
- kidney damage,
- depletion of essential minerals. It's crucial to follow the most recent and highest quality guidelines for the management of mercury overload to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
INDICATIONS BAL in Oil (Dimercaprol Injection USP) is indicated in the treatment of arsenic, gold and mercury poisoning. For mercury poisoning, 5 mg/kg initially, followed by 2. 5 mg/kg one or two times daily for ten days.
The current management of mercury overload with levels of 42 nanomols per liter (nl) of blood includes the use of dimercaprol (IM). The recommended dosage for mercury poisoning is an initial dose of 5 mg/kg, followed by 2.5 mg/kg one or two times daily for ten days 2, 2.
- Key points:
- Dimercaprol Injection USP is effective for use in acute poisoning by mercury salts if therapy is begun within one or two hours following ingestion.
- It is not very effective for chronic mercury poisoning.
- Important consideration: Treatment is maintained for two to seven days depending on clinical response, and other supportive measures should always be used in conjunction with dimercaprol therapy.
From the Research
Current Management of Mercury Overload
The current management of mercury overload with levels of 42 nanomols per liter (nl) of blood, indicating mercury poisoning, involves various therapies.
- Diagnosis of mercury toxicity can be challenging but can be obtained with reasonable reliability, as stated in the study 3.
- Effective therapies for clinical toxicity have been described, including the use of chelating agents 3.
- The evaluation of mercury exposure level for diagnosis can be done using a provocation test with chelating agents, and appropriate therapy can be conducted according to the result 4.
- The therapy for symptomatic patients with mercury poisoning includes chelating agents, combination therapy with chelating agents, plasma exchange, hemodialysis, and plasmapheresis 4.
Chelation Therapy
Chelation therapy is a common approach for treating mercury poisoning.
- Dimercaptosuccinic acid (DMSA) is an oral, heavy-metal chelating agent used to treat lead and heavy-metal poisoning, and initial data has shown encouraging results for the treatment of mercury and arsenic poisoning as well 5.
- Meso-2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercapto-propanesulphonate (DMPS) can effectively mobilize deposits of mercury into the urine 6.
- N,N'bis-(2-mercaptoethyl) isophthalamide (NBMI) is a new compound that has shown promise in reducing plasma and urine mercury concentrations 7.
Treatment Options
Treatment options for mercury poisoning include:
- Chelating agents such as DMSA, DMPS, and NBMI
- Combination therapy with chelating agents
- Plasma exchange
- Hemodialysis
- Plasmapheresis As stated in the study 4, the therapy for symptomatic patients with mercury poisoning is not yet fully established, and further evaluations are necessary for the effects and side effects of each therapy.