Disclosures: Evan R. Zeldin, MD: No financial relationships or conflicts of interest

Case Description: The patient initially presented to the emergency department with acute onset of abdominal pain, respiratory distress, and hypoxia. She was found to have pneumonitis, pneumomediastinum, and metabolic acidosis. She was intubated and placed on extracorporeal membrane oxygenation (ECMO). Social services found high levels of mercury in her home, which was confirmed on blood testing.

Setting: Academic Acute Pediatric Inpatient Rehabilitation Hospital

Patient: 21-month-old female Assessment/

Results: She was started on dimercaptosuccinic acid (DMSA) for chelation which resulted in profound cardiorespiratory improvement. She was weaned off ECMO and eventually admitted to the pediatric inpatient rehabilitation hospital. She was non-verbal, had significant developmental delay, exhibited frank aspiration on videofluoroscopic swallow study, required total assistance with age-appropriate ADLs, and needed maximal assistance with transfers. At discharge, she has progressed to being more interactive, was able to tolerate an age appropriate diet with nectar thick liquids, and walk 200 feet with supervision.

Discussion: Elemental mercury is a rare toxin that can cause pulmonary, neurologic, and renal toxicity. Efforts to eliminate mercury from household products, such as older thermometers and compact fluorescent light bulbs, have led to a decline in exposure. Absorption occurs most commonly through the lungs as a vapor but it can also be absorbed through the gastrointestinal tract or skin. Chronic exposure results in tremor or insomnia, with severe cases resulting in permanent central nervous system damage. The diagnosis is made by measuring blood levels; treatment is supportive or with chelation. Because of the pulmonary and neurologic damage from mercury toxicity, patients often present with severe functional deficits which can benefit from intensive interdisciplinary therapies.

Conclusion: Elemental mercury poisoning is a rare cause of interstitial pneumonitis and neurologic problems. While rare, it should be considered in patients with a constellation of neurologic, pulmonary, and renal manifestations. These patients can benefit from an intensive inpatient rehabilitation program.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/inpatient-rehabilitation-of-a-21-month-old-female-with-acute-mercury-poisoning-a-case-report/