Extracorporeal Membrane Oxygenation in the Treatment of Acute Elemental Mercury Inhalation Toxicity

Abstract

Inhalation of elemental mercury is a rare cause of ARDS, with limited published case reports to provide guidance regarding disease progression and management. Although extracorporeal membrane oxygenation (ECMO) has been used to treat toxin-induced lung injury, its application to initial treatment and long-term recovery for inhalation of mercury remains undescribed. We present a case of a 56-year-old man who works at a thermometer factory presenting with severe ARDS secondary to inhaled elemental mercury with confirmatory blood and urine mercury levels. Respiratory recovery and avoidance of neurologic and renal sequelae from elemental mercury was successfully accomplished with venovenous ECMO, steroids, and simultaneous dual-chelation therapy. This case demonstrates the efficacy of venovenous ECMO for severe inhalation of elemental mercury pulmonary injury and the utility of dual-chelation therapy for avoiding late development of neural and renal pathologic conditions and provides novel insight into the impact of ECMO circuits on blood mercury levels.

Keywords: acute respiratory distress syndrome; chelation; elemental mercury; extracorporeal membrane oxygenation; inhalational lung injury; mercury toxicity; occupational medicine.