Chronic Effects of Mercury on Organisms: Excretion of mercury from the body.

Chronic Effects of Mercury on Organisms:

Excretion of mercury from the body

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Excretion of Mercury from the Body.

Mercury is excreted from the body by glands of the digestive and intestinal tract, the salivary glands, kidneys, mammary and sweat glands. Excretion beings within several hours after poisoning, and even after a single dose of mercury, often continues for several weeks. After repeated doses, the elimination of mercury often takes even longer. N. P. Kravkov (1933) stressed that excretion of mercury is accomplished extremely slowly, sometimes requiring several months.

R. N. Vol'fovskaya (1928), A. M. Gel'fand (1928), I. G. Gel'man (1935) observed prolonged excretion of mercury from workers who had frequent contact with mercury and its compounds. Z. I. Kheyfets (1941) reported that, in cases of poisoning by high concentrations of mercury it appeared in the urine the first day of poisoning, while two patients, after thirty-five days excreted even more mercury compounds.

E. D. Storlazzi and H. B. Elkins (1941) after studying persons who used preparations containing mercury, noted that it was observed in the urine of some patients several months after the use of mercury was stopped.

What is the basic route of excretion of mercury from the body?

N. P. Kravkov (1933) states that the largest quantity of mercury leaves the body via the feces; it is excreted in lesser quantities with urine; with sweat and the only trace amounts of mercury are left. Of the excretion of mercury by the sweat glands, this fact is established: in persons undergoing mercury therapy, gold objects (particularly rings) darken, covered with an amalgam of mercury. N. V. Lazarev (1938) stated that mercury, as with lead, manganese, nickel and certain other metals, are eliminated through the intestines in larger quantities than by the kidneys. He noted that mercury is excreted first by the digestive tract, which then ceases to have great significance in freeing the body from poisons. This knowledge is important in explaining certain symptoms of poisoning.

According to I. G. Gela'nan (1929), the elimination of mercury through the oral cavity causes the development of a specific stomatitis. He considers that mercury exits from the body primarily through the intestine, in a lesser degree through the kidneys. N. D. Rosenbaum (1934) proposed that most mercury exits from the body primarily through the intestine, in a lesser degree through the kidneys. N. D. Rosenbaum (1934) proposed that most mercury is excreted via the kidneys. This view is also held by A. M. Gel'fand (1928). He stresses that mercury is eliminated by all organs but "the primary excretory route for mercury is the urine."

P. Ye. Syrkina (1930) in studying workers at a mercury plant established that, in the urine, mercury is observed in larger quantities than in the feces. According to the author, this indicates that mercury enters the workers' bodies primarily through the respiratory tract.

M. F. Mirochnik (1934) stated that up to 40% of all mercury eliminated from the body was excreted by the kidneys; in second place were the glands of the large intestine, in the third, the salivary glands.

M. I. Livshits (1955) in studying the excretion of mercury via urine and feces in persons with chronic mercury poisoning, cam to the conclusion that significantly less mercury is excreted in the feces than in urine.

F. Koelsch (1959) considers that mercury is excreted from the body primarily by the kidneys.

F. Flyuri and F. Chernik (1938) suggested that mercury absorbed upon inhalation is excreted with the urine and feces almost as a unit quantity.

It is not hard to note that, in speaking of mercury's routes of entry, most researchers, as a rule, have not resolved the problem of the form in which mercury, in each specific case, interacts with the body. One can postulate that, depending on this, mercury can react as inorganic salts, organic compounds or as metallic mercury vapor, that it is eliminated from the body primarily through the intestines or the kidneys.

A. I. Cherkes (1943) considers that greater or lesser participation of one or another organ in the elimination of the poison depends primarily on the physical and chemical properties of the poison.

A. Kuznetsov (1934) stressed that the state in which mercury enters the body and its method of administration are decisive in determining its route of excretion. The author noted that, upon penetration of the skin by mercury, (primarily through the rubbing in of ointments containing mercury) most mercury is eliminated with the feces, the remaining solution, the bulk of the mercury is excreted via the kidneys; upon intravenous introduction of mercury, the metal is eliminated in both the urine and feces as a unit quantity.

Mercury is excreted by the liver to a greater or lesser degree. In the opinion of B. Ya. Agronovich (1948), this explains one of the phenomena of its hepato-toxic effect.

In analyzing for the presence of mercury in the duodenal contents in chronic poisoning cases, ). Ya. Mogilevskaya (1947) concluded that excretion of mercury from liver with the bile had definite practical significance. Nevertheless the author believes that the significance of the bile in mercury excretion is limited by the fact that mercury evidently reprecipates in the intestinal wall, in the blood stream and reenters the liver by the hepatic portal vein. The data of O. Ya. Mogilevskaya indicates that, in chronic mercury vapor poisoning, mercury is excreted from the liver with the bile in quantities approaching those excreted in the urine.

There is special interest in the problem of mercury excretion via the mammary glands. M. F. Mirochnik (1934), in surveying literature data,says some authors reject the possibility of the elimination of mercury by the mammaries. At the same time others noted definite and continuous excretion. N. V. Lazarev (1938) noted that mercury, like lead, can be excreted in t he milk and stressed that: "We don't know on what scale these poisons are eliminated in the milk of nursing women."

Cases of mercury poisoning in the newborn are known if the nurselings ingest mercury compounds. The literature described such a case in which completely healthy persons drank milk from cows which had been rubbed with a mercury ointment. The people showed signs of intoxication (stomatis, stomach pains, diarrhea).

Some investigators detected traces of mercury in the milk of mothers receiving a course of treatments with mercury preparations and also in women with mercury poisoning symptoms. E. I. Kheyfets (1941) described a case of mercury vapor poisoning in a family of four. Mercury was found in the milk of a nursing mother (0.004 mg/100 ml milk). Significantly, she continued to excrete mercury with the milk for quite a long time after poisoning.

There is also literature data referring to experiments in which, upon the inhalation of mercury vapor, mercury is excreted not only by the kidneys and intestines, but also through the lungs (G. L. Sklyanskaya-Vasilevskaya, 1938; A. Stock and W. Zimmerman, 1929).

In explaining a contrasting point of view excluding the possibility of mercury excretion from the body with exhaled air, Gerstner reported on his experiment in which he did not find mercury in air exhaled by persons who earlier had inhaled mercury vapor and then had spent time at sites with pure air.

There is still the question of establishing the practical value of mercury findings in experiments for the diagnosis of mercury poisoning. M. A. Frantsuzova (1940) believes that basic analyses for mercury must consider urinalysis results. I. G. Fridlyand (1963) also noted that practically the best data on urinary mercury content stressed the significance only of the comparatively large quantities of mercury observed.

A. M. Gel'fand (1928) considered urinalysis for mercury as an early method for diagnosing mercurialism, and that mercury excretion proceeded intermittently, first being absent and then present.

It is necessary to be reminded again that insignificant quantities of mercury can be detected in urine of persons who have never encountered mercury. Relatively high concentrations of mercury, as a rule, occur in persons who have had contact with mercury but all cases of these do of display symptoms of intoxication. A. Stock believes that mercury content in the daily urine of more than 0.01 mg indicates the possibility of poisoning and a content of over 0.05 mg usually leads to a confirmed diagnosis of mercurialism.

In agreement with the data of Totusek (Cited in J. Teisinger, S. Scramovski, I. Srobova, 1959.), the maximum safe limit of urinary mercury concentration is 0.2 mg/1 Especially high and little justified quantities (0.25 - 0.3 mg) of mercury were recommended as permissible urinary concentrations by the American investigator (L. Fairhall, 1949). This author cites the fact that this quantity of mercury in the urine corresponds with a permissible (by American standards) air concentration of (0.1 mg/m3).

It should be considered unfounded that such a direct quantification between urinary and air concentrations of mercury exists.

According to I. G. Fridlyand (1963) the occurrence of high concentration of mercury in excreta in the absence of some symptoms of intoxication does not truly diagnose poisoning; on the other hand the author admits the possibility of mercury poisoning in the absence of high urinary mercury concentration. Ye. Ye. Syroyechkoviskiy (1933) stated that in cases where mercury appears in excreta, but clinical symptoms of intoxication re not evident, one can speak not of poisoning but of "carriership" of mercury. Based on data from the investigation of 233 mercury production workers, I. G. Fridlyand concluded that even the presence of (0.1 - 0.4 mg/¹) mercury in the urine does not always indicate poisoning. P. Ye Syrkina studied urine of animals poisoned by mercury vapor and came to an analogous conclusion that mercury in the urine corresponds to the mercury uptake phase which later can lead to clinical symptoms of poisoning.

I. D. Gadaskina (1939), in discussing the diagnosis of mercury poisoning, stated that in case mercury occurs in the excreta in the absence of some sign of poisoning "it is possible to think not only of having taken in poison but of poisoning such that the yet healthy man can still excrete mercury from his depots for a long time." The author stresses that, on the other hand, the absence of mercury in the urine still does not indicate that there is no poisoning, rather that the body is excreting no mercury at that time. This is confirmed by materials obtained by S. S. Shalyt (1940) in the process of periodic surveys of workers in the mercury industry. I. D. Gadaskina believes that the state of the organism cannot be judged by the presence of more or less mercury found in the excreta, because following a period of intoxication, it is not excreted continuously and therefore is no parallel to the development of intoxication. An analogous point of view is that of L. M. Frumin (1936) that "the presence of mercury in the urine does not move parallel to the gravity of poisoning." The results of the experiments of P. Ye. Syrikina (1934) and G. L. Sklyanskaya-Vasilyevskaya (1938) indicate that upon the inhalation of mercury vapor by animals at the beginning of poisoning, where symptoms of intoxication have not yet occurred, much more mercury is excreted than later. A. M. Gel'fand's data (1928) indicates that mercury first appears in the urine, then all the symptoms of mercury poisoning are developed in slight degree.

In evaluating several methods of treating mercury poisoning, E. I. Kheyfets (1940) stated that a complete parallelism between improvement in the condition of the patients and urinary mercury excretion did not occur, but in a majority of cases, at the end of therapy urinary mercury excretion had diminished.

According to data of A. Ye. Kul'kova (1931), in patients with mercurical encephalopathy, the urinary excretion of mercury occurred inversely to the severity of the illness. Other data published by I. M. Livshin (1939) noted the presence of a definite relationship between mercury excretion and the degree of intoxication.

M. A. Frantsuzova (1940) also stated that there exists a dependence between the quantity of mercury excreted in the urine and the appearance of clinical symptoms of intoxication. Along with a majority of other investigations, the other stresses that "there is no complete parallelism in this respect."