A factory worker has come to the OPD complaining of excessive salivation, blue lines on gums, tremors, disturbed personality, insomnia and loss of appetite. The physician is suspecting it to be a case of metallic poisoning. Which of the following metals the physician has in his mind?
The patient with a positive history of working in a factory and now having presented with the classical symptoms (excessive salivation, tremors, disturbed personality and blue lines on gums) points towards the diagnosis of chronic mercury poisoning. The mercury poisoning can occur from various mercuric compounds. They are Mercuric chloride, Mercuric oxide, Mercuric oxide, Mercuric cyanide, Mercuric sulphide, Mercuric nitrite, Mercuric sulphate, Mercurous chloride, Sulphate of mercury, Ammoniomercuric chloride and organic compunds of mercury. Elemental mercury is found in glass thermometers, electrical switches, fluorescent light bulbs, older dental fillings and few medical equipments. Inorganic mercury is found in batteries, chemistry labs, disinfectants, folk culture medicines and red cinnabar mineral. Organic mercury is found in older germ-killers (antiseptics), thimerosal, fumes from burning coal and in a few fishes that have consumed organic mercury. Mercury poisoning can occur as acute poisoning or chronic poisoning. The mercuric ion tends to bind with the sulphydryl groups of cellular proteins, enzymes, nucleic acids and mitotic apparatus thus interferes with the cellular and enzymatic functions. Renal tubular function get affected and in the pas of the central nervous system that are mainly targeted are cerebellum, basal ganglia, temporal lobe and corpus callosum. In acute poisoning the symptoms are bronchitis, constriction in throat, hoarse voice, dyspnea, pulmonary edema, fibrosis, abdominal pain associated with nausea, vomiting, blood stained diarrhea, glossitis, ulcerative gingivitis, renal tubular necrosis, cylinduria, uraemia and acidosis. Chronic mercury poisoning is also known as hydrargyrism. The common symptoms are sore mouth, gingivitis, salivation, formation of blue lines at the junction with teeth (Buonian line), Danbury tremors, Glass blower's shakes (hatter's shakes), Concussio mercurialis, Mercurial erethism, Mercuria lentis (brownish deposition of mercury on anterior lens capsule) and Acrodynia or pink disease. Ref: The Essentials of Forensic Medicine and Toxicology By Dr. K. S. Narayan Reddy, 27th Edition, Pages 473-483.
Iron
Barium
Mercury
Thallium