(CR3) A Case Report of Elemental Mercury Ingestion in A Psychiatric Patient

Introduction:

Pica, an eating habit disorder which substances with no significant nutritional value is consumed and it is related to psychiatric illness. We describe a case of intentional lightbulb ingestion which contained elemental mercury.

Case Presentation :

46-year-old gentleman brought by police officers for attempted suicide, sustained soft tissue injury with a normal vitals, conscious level, and unremarkable findings of physical assessment. abdominal x-ray (AXR) showed multiple heterogenous opacities; ‘fireflies. Further history revealed that he has auditory and  visual hallucinations for the past 3 years and worsened. He admitted that he enjoyed ingesting fluorescent light bulbs, which contain elemental mercury. Blood and urine samples were sent to detect mercury level, however, due to unavoidable glitch, no results able to be traced. Serial AXR was performed to monitor the passage of the radio-opaque substance which cleared on the fifth day. The patient was then discharged but defaulted his follow-up appointment.

Conclusion :

History of eating disorder in neuropsychiatric patients often abandoned. Classic triad of chronic mercury toxicity (tremor, gingivitis and erethism) was observed in our patient. Whole-blood mercury level of >5 micrograms/L or 24-hour urine mercury level of >20 micrograms/L only confirms the exposure but not its toxicity. Mercury appeared like ‘fireflies’ and ‘Christmas tree’  on abdominal and chest x-ray respectively.  Chelating antidotes (dimercaprol and succimer) rarely required but prompt intervention needed in suspected perforation. For suspected mercury toxicity, thorough history; occupations, and dietary intake need to be explored. There is a role of observational medicine in alleged ingestion of mercury poisoning.