Public Health Department Response to Mercury Poisoning: The Importance of Biomarkers and Risks and Benefits Analysis for
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Public Health Department Response to Mercury Poisoning: The Importance of Biomarkers and Risks and Benefits Analysis for Chelation Therapy Charles A. McKay, Jr.
Published online: 6 November 2013 # American College of Medical Toxicology 2013
Abstract Chelation therapy is often used to treat mercury poisoning. Public health personnel are often asked about mercury toxicity and its treatment. This paper provides a public health department response to use of a mercurycontaining cosmetic in Minnesota, a perspective on two unpublished cases of chelation treatment for postulated mercury toxicity, and comments on the use of a nonsystemic treatment for removal of mercury following the Iraqi seed coat poisoning incident. Physicians should evaluate sources of exposure, biomarkers, and risks and benefits before recommending chelation therapy for their patients. Potential risks to chelation therapy and its little understood subtle or latent effects are areas of public health concern.
Keywords Chelation therapy . Mercury poisoning . Sources of exposure . Biomarkers . Risks and benefits
This paper is largely taken from a presentation by Carl Herbrandson, PhD, toxicologist for the Minnesota Department of Health (MDH) at the ACMT “Use and Misuse of Metal Chelation Therapy” held in Atlanta GA on February 29, 2012. This conference was jointly sponsored by the American College of Medical Toxicology and the Medical Toxicology Foundation with support from the Agency for Toxic Substances and Disease Registry. That transcript has been edited and additional material provided by Charles McKay, MD C. A. McKay Jr. (*) Division of Medical Toxicology, Department of Emergency Medicine, Hartford Hospital/University of Connecticut School of Medicine, American College of Medical Toxicology, 10645 N. Tatum Blvd. Suite 200-111, Phoenix, AZ 85028, USA e-mail: [email protected]
Background Public health department professionals frequently receive inquiries about heavy metal exposure and chelation treatment. A very common call relates to mercury, particularly as most health departments have provided health advisories regarding organic mercury and fish consumption by at risk populations, namely pregnant women [1]. As with any metal, it is critical to understand the sources of exposure for mercury poisoning, as well as the risks and benefits of treatment before considering chelation therapy to treat toxicity. An important first step is to confirm that there has, in fact, been an exposure, and that the exposure is a likely cause of disease or toxicity. Toxicity is caused by extraordinary exposure. This can occur from an atypical environmental exposure to a substance or an occupational exposure. Limited and trivial exposures, such as inhalation exposures to a broken fluorescent light bulb or from living downwind of a coal-fired power plant, will not result in toxicity. However, individuals with repeated exposure in the workplace, for example in a fluorescent light bulb recycling plant, could have exposurerelated symptoms. It is impor
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