Transcript Document 7927659

‫بسم هللا الرحمن الرحيم‬
‫بنام خداوند بخشنده مهربان‬
‫جيوه‬
MERCURY
‫بردگان و محكومين را در معادن جيوه به كار وادار مي كردند‬
‫اولين بار عالئم مسموميت با جيوه توسط‬
‫ژان فرنل (‪ )Jean Fernel‬توصيف شد‬
‫كوسمول مسموميت جيوه در آينه سازان را شرح داد و نشانه‬
‫كوسمول ( قرمزي ته حلق ) و مراحل بيماري را در آنها بيان كرد‬
‫خواص ‪ :‬فلزي است سنگين به رنگ سفيد مايل به نقره اي‬
‫تنها فلزي است كه در دماي معمولي بصورت مايع است‬
‫فشار بخار باالئي دارد ( خطر استنشاق )‬
‫عنصر ضروري بدن نمي باشد‬
‫مصارف‬
‫ساخت دماسنج ‪ ،‬فشار سنج ‪ ،‬باطري و وسايل الكتريكي‬
‫تهيه كلر و سود سوزآور‬
‫ضد قارچ ‪ ،‬ضد كپك ‪ ،‬فوميگانت‬
‫آبكاري ‪ ،‬تاكسيدرمي ‪ ،‬دباغي‬
‫ساخت كاله نمدي‬
‫لرزه كاله سازان ( )‪mad as a hatter‬‬
‫توليد فوم پلي اورتان بعنوان كاتاليزور‬
‫مواجهه‬
‫كارگران استخراج و بازيافت جيوه ( بخار جيوه )‬
‫كارگران كارخانجات توليد كلر‬
‫كارگران كارخانجات ساخت وسائل الكتريكي ‪ ،‬دندانپزشکان‪ ،‬دهان و دندان‬
‫بهداشتكاران‬
‫كشاورزان‬
‫آلودگي محيطي ناش ي از فاضالبها و ها گنداب‬
‫آمالگام جيوه در دندانپزشكي‬
•
A miner tries to
protect himself
from vapors as he
blowtorches a ball
of purloined gold
ore and mercury.
However, covering
his nose and mouth
with his shirt
provides no
effective protection
from the poisonous
fumes.
A miner (left)
displays a 'pot of
gold' that has
been separated
from rock and
sediment with
the help of
mercury.
Hg – Like Water
• Abraham Lincoln 'suffered mercury poisoning'
Abraham Lincoln took medication for depression
Case Studies
China's first emperor of unified China,
Qin Shi Huang Di
was driven insane and killed by
mercury pills intended to give him
eternal life.
“Great Shock”
In December 1997
a chemistry professor
death of
Karen Wetterhahn
at Dartmouth College
was contaminated with dimethylmercury
when she spilled a drop on her latex glove.
Mercury poisoning
There are 3 different forms of mercury •
- elemental
- inorganic
- organic
• Each has a different toxicological profile
Sources of mercury
• Elemental mercury:
– Sphygmomanometers, thermometers, barometers
– Liquid at room temp – volatilises easily
• Inorganic mercury:
– Traditional remedies (ayurvedic, chinese)
– Used in gold extraction, caustic soda
manufacturing
– Rodenticides
• Organic mercury:
– Fungicides, seed dressings
– Methylmercury in fish …
Mercury - Absorption
• Inhalation :
60-80%
• Dermal :
3-15%
• GI Tract :
Metallic <0.2%
Inorganic 15%
Organic 90+%
Organic mercury poisoning:
Rare … but severe
Exposure: ingestion, topical or inhalation
• CNS Toxicity:
• poor concentration, fatigue, ataxia, tremor,
constricted visual fields,
• coma & convulsions
• BM suppression
• Renal toxicity - dealkylation to inorganic form
• Poorer response to treatment
Inorganic mercury poisoning
• Gastrointestinal phase: Hg2+ is a potent GI irritant
– gingivitis, stomatitis
- oesophageal, gastric, small and large bowel erosions
- haematemesis, bloody diarrhoea, CVS collapse
• Systemic toxicity: ‫مهارآنزیم سولفیدریل توسط جیوه‬
– hypotension, lactic acidosis
• Nephrotoxicity: ‫ رسوب جیوه در توبول ها‬ ATN
– acute renal failure
- potentially leads to CRF in survivors
‫جذب ‪ ،‬متابوليسم و دفع‬
‫بخار جيوه جذب پوستي ندارد‬
‫جيوه معدني از طرق استنشاق و گوارش ي‬
‫جذب ميگردد‬
‫جيوه آلي ( تركيبات آلكيل )‬
‫از طريق تمام راهها‬
‫( استنشاق ‪ ،‬خوردن ‪ ،‬پوست ) جذب‬
‫ميشود‬
Pure elemental mercury
• is a cumulative heavy-metal poison
rather poorly absorbed through the gastrointestinal tract
moderately absorbed through the skin,
readily absorbed as vapor through the lungs.
‫عالئم باليني‬
‫التهاب حفره دهان ‪،‬متورم شدن غدد بزاقي ‪،‬التهاب لثه‬
‫(ژنژيويت ) ‪ ،‬ديده شدن يك خط تيره‬
‫(آبي رنگ ) ناش ي از سولفيد جيوه روي لثه هاي ملتهب ‪ ،‬لق‬
‫شدن دندانها‬
‫عالئم عصبي ‪ ،‬رواني‬
‫تغييرات شخصيتي ( تحريك پذيري ‪ ،‬تند مزاجي ‪،‬‬
‫بيقراري و‪، ) ...‬ترمور (لرزش )‬
Acrodynia : A disease of infants and
young children caused by chronic
mercury poisoning.
TREATMENT:
• removing the source of the mercury,
•administering dimercaprol (BAL) antidote,
• providing supportive therapy
Pink Disease (Acrodynia)
Mercury Poisoning in Children
from Teething Powders
Discharge in Minamata Bay
Polluting with HG
• Mercury damages the central nervous system, endocrine
system, kidneys, and other organs, mouth, gums, and
teeth.
• Exposure over long periods of time or heavy exposure to
mercury vapor can result in brain damage and death.
Mercury and its compounds are particularly toxic to
fetuses and infants.
Case Studies
• From 1932 to 1968 methyl mercury was released
into the sea around the city of Minamata, Japan.
• The toxin bioaccumulated in fish, which when
eaten by the local population caused the largest
case of mercury poisoning known
• Minamata disease caused the deaths of over 1000
people and permanently disabled a great many
more.
Life-Long Effects of MeHg
Planting Seed with Mercury
• Another case of widespread mercury
poisoning occurred in rural Iraq in 19711972, when grain treated with a
methylmercury-based fungicide was used
by the rural population to make bread.
Iraq Infant Effects of Mercury
‫عالئم آزمايشگاهي‬
‫افزايش دفع پروتئين در ادرار‪ ،‬اندازه گيري جيوه خون و ادرار‬
‫تشخيص‬
‫شرح حال شغلي‬
‫عالئم اصلي مسموميت با جيوه‬
‫تغييرات روحي و رواني ‪ ،‬تغييرات لثه ‪ ،‬ترمور‬
‫پايش بيولوژيك‪ :‬اندازه گيري جيوه ادرار‬
‫درمان‬
‫شستشوي معده با محلول سولفوكسيالت فورمالدئيد سديم ‪ ،‬درمان‬
‫فوري با ‪BAL‬‬
‫درمان سوختگي ناش ي از جيوه آلي ‪ :‬برداشتن سريع تاول ها و مايع درون آنها‬
‫ميباشد‬
‫افراد با مسموميت مزمن بايد از تماس بيشتر خودداري نمايند‬
• The epithelial lining of proximal tubules is necrotic and
appears as large, esosinophilic cells with no nuclei.
• Mercury poisoning can reslt from
vapor inhalation,
ingestion,
injection,
or absorption through skin.
• Elemental mercury in liquid form is lipid soluble
and converted into a divalent or mercuric form by
catalase in the erythrocytes.
• The resulting inorganic form (also found in
batteries) has poor lipid solubility and
accumulates mostly in the kidney, causeing
significant kidney damage.
the pictures below are
from a person who
stepped onto a broken
CFL bulb whose foot
was subsequently
infected with mercury
poisoning. This person
spent two weeks in the
ICU, and at one point it
was feared that his foot
would need to be
amputated. Note in one
photo the vacuum pump
which was needed to
continuously remove
dead tissue.
Diagnosis of Mercury poisoning
• Blood mercury:
– only really useful acutely
- normal <10µg/l
- symptoms with blood mercury >150-200µg/l
• Urine mercury:
– probably the most reliable indicator
- normal <10µg/l
- symptoms with urine mercury >100-150µg/l
• U&E
• Radiology: for elemental ingestion/aspiration/injection
Treatment of Mercury poisoning
• Remove from source
• Supportive care
– particularly important with inhalation
• DMPS Chelation (2,3-Dimercapto-1-propanesulphonate)
- Chelation therapy of choice for mercury
- For both acute and chronic mercury poisoning
- For all forms of Hg (inorganic > metallic >> organic)
- Indications:
- symptomatic patients
- blood/urine mercury persistently > 100 - 150mg/l
• "Bernardino Ramazzini (1633- 1714)
made an accurate recording of the signs
and symptoms of mercury poisoning
‫پيشگيري‬
‫اگاهي از خطرات بخار جيوه‬
‫بكار گيري مناسب مواد‬
‫رعايت دقيق بهداشت عمومي و فردي‬
‫جايگزيني جيوه با مواد ديگر (در صورت امكان )‬
‫استفاده از تهويه مناسب ( در صورتيكه در دماي معمولي از جيوه‬
‫استفاده شود )‬
‫استفاده از فيلترهاي مناسب در هواكش هاي محيط كار‬
‫كنترل پخش مواد صنعتي حاوي جيوه‬
‫محيط هاي كاري بايد براحتي قابل تميز كردن باشد‬
‫كف زمين و ميز كار نبايد داراي منفذ باشد‬
‫كف زمين بايد به سمت كف شور شيب داشته باشد‬
‫گارگر بايد دو رختكن داشته باشد‬
‫در بين رختكن ها دوش وجود داشته باشد‬
‫لباس هاي محيط كار بايد هر روز شسته شود‬
‫لباس حفاظتي كارگر نبايد جيب داشته باشد‬
‫از بردن لباس كار به منزل بايد جدا” خوداري گردد‬
‫كارگران بايد قبل از خوردن غذا ‪ ،‬سيگار كشيدن و‬
‫نوشيدن مايعات دست ها را بشويند و دهانشان را با آب‬
‫غرغره كنند‬
‫در صورت عدم تهويه مناسب بايد از‬
‫ماسك هاي فيلتر دار استفاده نمود و از آنها به مدت‬
‫كوتاهي استفاده نمايند‬
‫معاينات قبل ازاستخدام‬
‫توجه به موارد زير بسيار ضروري است‬
‫سابقه قبلي تماس با جيوه دارد يا خير‬
‫سابقه اختالالت عصبي‬
‫بيماري كليه‬
‫بيماري تنفس ي مزمن‬
‫درماتيت مزمن‬
‫مشكالت دهان ودندان‬