Administer supplemental oxygen by mask to patients who have respiratory complaints. Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Mercury poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents and sympathomimetic bronchodilators may reverse bronchospasm in patients exposed to mercury vapor.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Young children are particularly susceptible to the acute pulmonary effects of mercury vapor. Both adults and children are treated by respiratory support and in some cases, mechanical ventilation may be necessary.
Early dyspnea can indicate upper-airway obstruction from swelling, reflex bronchospasm, or direct pulmonary injury, which all require treatment. Patients require careful assessment for stridor, wheezing, and rales. Patients who have chemically induced adult respiratory distress syndrom (ARDS) do not usually benefit from digoxin, morphine, afterload reduction, or diuretics. Supplemental oxygen, delivered by mechanical ventilation and positive end-expiratory pressure, if needed, are standard treatments. Corticosteroids and antibiotics have been commonly recommended for treatment of chemical pneumonitis, but their effectiveness has not been substantiated.
Elemental mercury does not cause a chemical burn. Washing the exposed skin with soap and water should remove any residual liquid mercury.
Ensure that adequate eye irrigation has been completed. Test visual acuity. Examine the eyes for conjunctival or corneal damage and treat appropriately. Patients should be referred to an ophthalmologist when they have apparent or suspected corneal injury.
Alkalization of the urine stabilizes the dimercaprol-metal complex, and has been recommended to protect the kidneys during chelation therapy. There is no role for hemodialysis in removing mercury. However, hemodialysis might be required for supportive therapy in the treatment of renal failure and it might enhance the removal of the dimercaprol-mercury complexes.
Respiratory effects from high-dose exposures might resolve or gradually progress to ARDS, respiratory failure, and death. Infrequently, severe pulmonary effects can progress to interstitial fibrosis and residual restrictive pulmonary disease. Other potential sequelae of exposure to elemental mercury include effects on the kidneys and central nervous system. These effects can occur after high-dose acute exposure to mercury vapor, and are similar to the effects observed from chronic lower-dose exposures. Children under 30 months of age are at increased risk for pulmonary toxicity and are more susceptible to death from respiratory failure.