Acute mercury poisoning among children in two provinces of Turkey
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ORIGINAL ARTICLE
Acute mercury poisoning among children in two provinces of Turkey Kursat Bora Carman & Engin Tutkun & Hinc Yilmaz & Cengiz Dilber & Tahir Dalkiran & Baris Cakir & Didem Arslantas & Yildirim Cesaretli & Selin Aktaş Aykanat Received: 29 December 2012 / Accepted: 4 February 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Elemental mercury exposure occurs frequently and is potentially a toxic, particularly in children. Children are often attracted to elemental mercury because of its color, density, and tendency to form beads. Clinical manifestations of elemental mercury intoxication vary depending on its form, concentration, route of ingestion, and the duration of exposure. We present data on 179 pediatric cases of elemental mercury poisoning from exposure to mercury in schools in two different provinces of Turkey. Of all patients, 160 children had both touched/played with the mercury and inhaled its vapors, while 26 children had only inhaled the mercury vapor, two children reported having tasted the mercury. The median duration of exposure was 5 min (min 1–max 100), and 11 (6 %) children were exposed to the K. B. Carman (*) Department of Pediatric Neurology, Gaziantep Children’s Hospital, Vehbi Dincerler Cad., Sena Apt B Blok No 26/9, İbrahimli-Sehitkamil, Gaziantep, Turkey e-mail: [email protected] E. Tutkun : H. Yilmaz Ankara Occupational Diseases Hospital, Ankara, Turkey C. Dilber : T. Dalkiran Department of Pediatric Neurology, Kahramanmaras Sutcu Imam University Hospital, Kahramanmaras, Turkey B. Cakir Department of Pediatrics, Kilis State Hospital, Kilis, Turkey D. Arslantas Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey Y. Cesaretli The Refik Saydam Hygiene Institute, Ankara, Turkey S. A. Aykanat Department of Dermatology Gaziantep, 25 Aralık State Hospital, Istanbul, Turkey
mercury for more than 24 h at home. More than half of the children (51.9 %) were asymptomatic at admission. Headache was the most common presenting complaint. The results of physical and neurological examinations were normal in 80 (44.6 %) children. Mid-dilated/dilated pupils were the most common neurological abnormality, and this sign was present in 90 (50.2 %) children. Mercury levels were measured in 24-h urine samples daily, and it was shown that the median urinary level of mercury was 29.80 μg/L (min, 2.40 μg/L; max, 4,687 μg/L). A positive correlation was also found between the duration of exposure and urinary mercury levels (r=0.23, p=0.001). All patients were followed up for 6 months. On the first follow-up visit performed 1 month after discharge, the neurological examinations of all patients were normal except for those patients with peripheral neuropathy and visual field defects. On the last follow-up visit at the sixth month, only two children still experienced visual field defects. In conclusion, this study is one of the largest case series of mercury intoxication of students in schools. Elemental mercury exposure can be potentially toxic, and its symptomatology is vari
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