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Query Trace: Pandalai SL[original query] |
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Case files of the Emory University Medical Toxicology Fellowship: inhalational mercury toxicity from a traditional Vietnamese product
Pandalai SL , Morgan BW . J Med Toxicol 2011 7 (4) 295-305 A 41-year-old woman attempted to treat her sinus congestion with a complementary and alternative medicine (CAM) product consisting of dime-size white pellets originally purchased in Vietnam by a family member who brought it with her to the USA. The remedy was obtained from one of her relatives who stated that treatment with these pellets had alleviated similar symptoms of other persons from her hometown in Vietnam. The patient was advised to heat the pellets on an electric stove for 2–3 days at various times, and inhale the fumes that were produced. After using the product for 2 days, she developed generalized malaise, dry skin, and poor appetite. She was later informed by a family member in Vietnam that the remedy may contain mercury and lead. She presented to her primary care clinic for metal testing, where initial total blood mercury (organic plus inorganic) and total blood lead concentrations were found to be 409 μg/L (normal, ≤10 μg/L) and 1 μg/L (normal, <10 μg/L), respectively. Her physician advised her to discontinue this treatment and was subsequently referred to the authors’ toxicology clinic. | The patient’s initial evaluation in our toxicology clinic was approximately 4 weeks after her initial exposure to the CAM product, and she continued to describe overall malaise and dry skin. She also complained of depressed mood and poor appetite. On physical examination, the patient was in no distress and her vital signs included a temperature of 36.9°C, heart rate of 109 beats per minute, blood pressure of 125/81 mmHg, and respiratory rate of 18 breaths per minute. Her oral exam showed mild erythema of the tongue, but no evidence of gingivostomatitis (which may occur with mercury toxicity). Her mini-mental status examination including orientation to person, place, time, attention, immediate and delayed recall, naming, repetition, reading, writing and copying was normal. She was able to follow a three-stage command with no difficulty. No other abnormalities were noted on the remainder of her neurological examination, which included gross cranial nerve testing, deep tendon reflexes, muscle strength, gait, cerebellar function, and sensation to pin-prick testing. Her skin exam was notable for generalized dryness of the extremities. |
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