NEUROTOXICOSISNEUROTOXICOSIS

Bodnar Bodnar R.Ya.R.Ya.

PLANPLANNEUROTOXICOSISNEUROTOXICOSIS

MercuryMercury poisoning poisoning Industrial uses.Industrial uses. Pathogenesis ofPathogenesis of

MercuryMercury poisoning. poisoning. Clinical picture. Clinical picture.

Diagnosis.Diagnosis. Treatment.Treatment.

Tetraethyllead poisoningTetraethyllead poisoning Industrial uses.Industrial uses. Pathogenesis Pathogenesis

of of TetraethylleadTetraethyllead poisoning.poisoning.

Clinical picture. Clinical picture. Diagnosis.Diagnosis.

Treatment.Treatment.

ManganeseManganese poisoningpoisoning Industrial uses.Industrial uses. Pathogenesis ofPathogenesis of

ManganeseManganese poisoning.poisoning.

Clinical picture. Clinical picture. Diagnosis.Diagnosis.

Treatment.Treatment.

MERCURYMERCURY POISONINGPOISONING

MERCURYMERCURY POISONING POISONING MMercury has been used commercially and ercury has been used commercially and

medically for centuries.medically for centuries. In the past it was a common constituent of In the past it was a common constituent of

many medications. It ismany medications. It is still used in still used in hospitals in thermometers and blood-hospitals in thermometers and blood-pressure cuffs and commerciallypressure cuffs and commercially in in batteries, switches, and fluorescent light batteries, switches, and fluorescent light bulbs. bulbs.

Large quantities of metallicLarge quantities of metallic mercury are mercury are employed as electrodes in the electrolytic employed as electrodes in the electrolytic production of chlorine andproduction of chlorine and sodium sodium hydroxide from saline. hydroxide from saline.

These uses still give rise to accidental and These uses still give rise to accidental and occupationaloccupational exposures.exposures.

MERCURYMERCURY POISONING POISONING Today, however, exposure of the general Today, however, exposure of the general

population comes from three major sources:population comes from three major sources: fish fish consumption, dental amalgams, and vaccines.consumption, dental amalgams, and vaccines.

Each has its own characteristicEach has its own characteristic form of mercury form of mercury and distinctive toxicologic profile and clinical and distinctive toxicologic profile and clinical symptoms.symptoms.

Dental amalgamsDental amalgams emit mercury vapor that is emit mercury vapor that is inhaled and absorbed into the bloodstream. inhaled and absorbed into the bloodstream.

DentistsDentists and anyone with an amalgam filling are and anyone with an amalgam filling are exposed to this form of mercury. exposed to this form of mercury.

Liquid metallicLiquid metallic mercury (quicksilver) still finds its mercury (quicksilver) still finds its way into homes, causing a risk of poisoning fromway into homes, causing a risk of poisoning from the vapor and creating major cleanup costs. the vapor and creating major cleanup costs.

Humans are also exposed to two distinct butHumans are also exposed to two distinct but related organic forms, methyl mercury (CH3Hg+) related organic forms, methyl mercury (CH3Hg+) and ethyl mercury (CH3CH2Hg+).and ethyl mercury (CH3CH2Hg+).

MERCURYMERCURY POISONING POISONING Fish are the main if not the only source of Fish are the main if not the only source of

methyl mercury, since it is no longer used asmethyl mercury, since it is no longer used as a a fungicide. fungicide.

In many countries, babies are exposed to ethyl In many countries, babies are exposed to ethyl mercury through vaccination,mercury through vaccination, since this form is since this form is the active ingredient of the preservative the active ingredient of the preservative thimerosal used in vaccines.thimerosal used in vaccines.

Whereas removal of certain forms of mercury, Whereas removal of certain forms of mercury, such as that in blood-pressuresuch as that in blood-pressure cuffs, will not cuffs, will not cause increased health risks, removal of each of cause increased health risks, removal of each of the three major sourcesthe three major sources described in this article described in this article entails health risks and thus poses a dilemma entails health risks and thus poses a dilemma to the health professional.to the health professional.

MERCURYMERCURY POISONING POISONINGExposure to mercury from dental amalgams Exposure to mercury from dental amalgams

and fish consumption has been a concernand fish consumption has been a concern for for decades, but the possible risk associated decades, but the possible risk associated with thimerosal is a much newer concern.with thimerosal is a much newer concern.

These fears have been heightened by a These fears have been heightened by a recent recommendation by the recent recommendation by the EnvironmentalEnvironmental Protection Agency (EPA) that Protection Agency (EPA) that the allowable or safe daily intake of methyl the allowable or safe daily intake of methyl mercury bemercury be reduced from 0.5 μg of mercury reduced from 0.5 μg of mercury per kilogram of body weight per day, the per kilogram of body weight per day, the threshold establishedthreshold established by the World Health by the World Health Organization in 1978,Organization in 1978, to 0.1 μg of mercury to 0.1 μg of mercury per kilogramper kilogram per day.per day.

The Global Cycle of MercuryThe Global Cycle of Mercury In nature, mercury vapor In nature, mercury vapor

(Hg0), a stable monatomic gas,(Hg0), a stable monatomic gas, evaporates from the earth’s surface evaporates from the earth’s surface (both soil and water)(both soil and water) and is emitted and is emitted by volcanoes Anthropogenicby volcanoes Anthropogenic sources sources include emissions from coal-burning include emissions from coal-burning power stationspower stations and municipal and municipal incinerators. After approximatelyincinerators. After approximately one one year, mercury vapor is converted to year, mercury vapor is converted to a soluble forma soluble form (Hg2+) and returned (Hg2+) and returned to the earth in rainwater. It may beto the earth in rainwater. It may be converted back to the vapor form converted back to the vapor form both in soil and in waterboth in soil and in water by by microorganisms and reemitted into microorganisms and reemitted into the atmosphere.the atmosphere. Thus, mercury may Thus, mercury may recirculate for long periods.recirculate for long periods. Mercury Mercury attached to aquatic sediments is attached to aquatic sediments is subject to microbialsubject to microbial conversion to conversion to methyl mercury (MeHg), whereuponmethyl mercury (MeHg), whereupon it enters the aquatic food chain. It it enters the aquatic food chain. It reaches its highestreaches its highest concentrations in concentrations in long-lived predatory fish, such aslong-lived predatory fish, such as sharks. sharks.

The Global Cycle of The Global Cycle of MercuryMercury

Panel Panel indicates indicates the the routes of routes of transfortransfor--mation mation toto methyl methyl mercury mercury as as originally originally

The Global Cycle of MercuryThe Global Cycle of Mercury

Panel depicts the Panel depicts the increase in mercury increase in mercury concentrationsconcentrations in in feathers of fish-feathers of fish-eating birds in eating birds in Sweden.Sweden.

The periodThe period covered covered by these data by these data corresponds corresponds approximately to approximately to thethe growth of growth of industrialization in industrialization in Sweden. Sweden.

Acute Acute MERCURY MERCURY poisoningpoisoning

Acute mercury poisoning occurs Acute mercury poisoning occurs rarely. rarely.

It arises up after contact with lIt arises up after contact with large arge quantitiesquantities of mercury.of mercury.

Acute Acute MERCURY MERCURY poisoningpoisoningThe main symptoms of the acute poisoning The main symptoms of the acute poisoning are are

hypersalivation, hypersalivation, inflammation and formation of ulcers of inflammation and formation of ulcers of

mucous of the mouth,mucous of the mouth, swelling of salivary glands, swelling of salivary glands, increase of submandibular lymph nodes, increase of submandibular lymph nodes, inflammation of gums,inflammation of gums, nausea,nausea, vomiting,vomiting, diarrhea,diarrhea, tenesmus, tenesmus, intestinal colic. intestinal colic.

Acute Acute MERCURY MERCURY poisoningpoisoning

Necrotizing nephrosis with acute renal Necrotizing nephrosis with acute renal failure often develops. failure often develops.

acute bronchitis,acute bronchitis, pneumonia.pneumonia. Very often liver, nervous system are Very often liver, nervous system are

affected.affected. In bloodIn blood: : hemolysis, leukocytosis, increase hemolysis, leukocytosis, increase

of ESR (to 30-50 mm/h), increase of blood of ESR (to 30-50 mm/h), increase of blood protein, nitrogen. protein, nitrogen.

MercuryMercury poisoning poisoningNecrotizing nephrosisNecrotizing nephrosis

Acute Acute MERCURY MERCURY poisoningpoisoning

After the acute poisoningAfter the acute poisoning::a chronic diseases of kidneys, a chronic diseases of kidneys, chronic colitis, chronic colitis, hepatitishepatitisastheniastheniс с syndrome. syndrome. After the treatment may be complete After the treatment may be complete

recovery.recovery.

Chronis Chronis MERCURY MERCURY poisoningpoisoning

Occurs after contact with mercury Occurs after contact with mercury during 8-10 years.during 8-10 years.

Clinical symptoms develop gradually Clinical symptoms develop gradually and are characterized by affection of and are characterized by affection of the NERVOUS SYSTEM.the NERVOUS SYSTEM.

According to the degree of According to the degree of expressiveness of pathological expressiveness of pathological process chronic poisoning is divided process chronic poisoning is divided into 3 stages: INITIAL (FUNCTIONAL), into 3 stages: INITIAL (FUNCTIONAL), MODERATE AND SEVERE.MODERATE AND SEVERE.

MERCURY MERCURY POISONINGPOISONING DIAGNOSDIAGNOSISIS

Early typical symptomsEarly typical symptoms:: irritability, irritability, weakness, weakness, GingivitisGingivitisstomatitis.stomatitis.

Confirmation of diagnosis is Confirmation of diagnosis is mercury determination in urine and mercury determination in urine and feces.feces.

Presence of mercury in urine Presence of mercury in urine without proper clinical symptoms without proper clinical symptoms indicates a “mercury carriage”.indicates a “mercury carriage”.

MERCURY MERCURY POISONINGPOISONING TreatmentTreatment

-To-To destroydestroy mercury and mercury and excrete it excrete it from from organism antidoteorganism antidotes are s are recommend: recommend: Unitiol, Sucsimer, sodium thiosulphate.Unitiol, Sucsimer, sodium thiosulphate.

- - Most effective is Unitiol (sodium 2,3-Most effective is Unitiol (sodium 2,3-dymercaptopropansulfonat)dymercaptopropansulfonat) - - 5%5% 5-10 ml5-10 ml ((0,05 g or 5% 1 ml 0,05 g or 5% 1 ml per 10 kgper 10 kg of of patient’s patient’s weight)weight). 1 . 1 dayday - - 2-4 injections, next 6-7 2-4 injections, next 6-7 days –1 injectiondays –1 injection/ day/ day..

- Its- Its sulfhydryl groups form sulfhydryl groups form untoxic untoxic complexes complexes with poison with poison and and are excretedare excreted with urine. with urine.

MERCURY MERCURY POISONINGPOISONING TreatmentTreatment

Sodium thiosulphate 30% 5-10 ml Sodium thiosulphate 30% 5-10 ml i/v i/v slowlyslowly..

Drugs whichDrugs which improve metabolism improve metabolism and blood supply of brainand blood supply of brain ((Pyracetam, StugeronPyracetam, Stugeron).).

GGlucose lucose 40% 40% 20 ml20 ml + + Vit. CVit. C,,VVitit..B 1, B 12, B 6.B 1, B 12, B 6.TTranquilizers. ranquilizers. Symptomatic therapy.Symptomatic therapy.

TETRAETHYLLEADTETRAETHYLLEAD

POISONINGPOISONING

TETRAETHYLLEADTETRAETHYLLEAD POISONINGPOISONING

TEL is an oily transparent liquid TEL is an oily transparent liquid which contains a 64,07 % of lead, which contains a 64,07 % of lead,

well dissolves in organic solvents well dissolves in organic solvents (ether, alcohol, benzol, petrol and (ether, alcohol, benzol, petrol and other) and in fats.other) and in fats.

TETRAETHYLLEADTETRAETHYLLEAD POISONINGPOISONING

ТЕТЕL is applied as antidetonate. L is applied as antidetonate. A dangerous contact with TEL may A dangerous contact with TEL may

occuroccur

--at its producing, at its producing,

- - mixing with a fuel, mixing with a fuel,

- - at cleaning of petrol cisterns.at cleaning of petrol cisterns.Tetraethyllead is a strong neurotrop Tetraethyllead is a strong neurotrop

poison. poison.

TETRAETHYLLEADTETRAETHYLLEAD POISONINGPOISONING

MODE OF ABSORPTION

INHALATION SKIN INGESTION

TETRAETHYLLEADTETRAETHYLLEAD POISONINGPOISONING

TYPE of POISONINGPOISONING

ACUTE SUBACUTE CHRONIC

TETRAETHYLLEADTETRAETHYLLEAD POISONINGPOISONING

Tetraethyllead PoisoningTetraethyllead Poisoningis is characterized by neurological characterized by neurological symptoms.symptoms.

Toxic affection of cerebral Toxic affection of cerebral neurocytesneurocytes

ACUTEACUTE TETRAETHYLLEAD TETRAETHYLLEAD POISONINGPOISONING

in 1-3 hours after a contact with in 1-3 hours after a contact with ТЕТЕL the L the first symptoms of the acute poisoning first symptoms of the acute poisoning appear. appear.

According to the degree of According to the degree of expressiveness of clinical manifestations expressiveness of clinical manifestations there are three there are three STAGESSTAGES of the acute of the acute poisoning by poisoning by ТЕТЕL: L: - - INITIAL, INITIAL, - - PRECULMINATION,PRECULMINATION,-- CULMINATION. CULMINATION.

CHRONICCHRONIC TETRAETHYLLEADTETRAETHYLLEAD

POISONINGPOISONING is observed in workers who worked in is observed in workers who worked in

contact with contact with ТЕТЕLL during long period. during long period. A clinic develops gradually and can be A clinic develops gradually and can be

poorly expressed.poorly expressed. According to theAccording to the

degree of expressiveness of clinical degree of expressiveness of clinical manifestations there are three manifestations there are three STAGESSTAGES of of the chronic poisoning: the chronic poisoning:

I-st (initial), I-st (initial), II-nd II-nd III-rd.III-rd.

ACUTEACUTE TELTEL POISONINGPOISONING TreatmentTreatment

To wash up skin (with warm water and soap), To wash up skin (with warm water and soap), to make gastric washing,to make gastric washing, to use absorbentsto use absorbents..

PaPatients with acute tients with acute TEL TEL poisoning need poisoning need complete rest, hypnotic medicines from the complete rest, hypnotic medicines from the group of barbituratus (phenobarbital, group of barbituratus (phenobarbital, barbital sodium or etaminal sodium).barbital sodium or etaminal sodium).

At At hyperexcitabilityhyperexcitability barbamil (i barbamil (i/m/m or i or i/v/v) or ) or hexenalhexenal are are prescribed. prescribed.

hypertensive solution of glucosehypertensive solution of glucose i/v, i/v, Vitamine therapyVitamine therapy..

Warm baths are recommended before sleep.Warm baths are recommended before sleep.

CHRONIC TELCHRONIC TEL POISONINGPOISONING TreatmentTreatment

Treatment of patients with the chronic Treatment of patients with the chronic form of TEL poisoning is appointed taking form of TEL poisoning is appointed taking into account expressiveness of clinical into account expressiveness of clinical manifestations. manifestations.

For such patients For such patients

- - drugs which influence on a tissue drugs which influence on a tissue metabolismmetabolism (glutamine acid, glucose, (glutamine acid, glucose, vitamins C, B1, B2, ATF, riboxin), vitamins C, B1, B2, ATF, riboxin),

- - tranquilizerstranquilizers (Diasepam, Tazepam) are (Diasepam, Tazepam) are recommended.recommended.

MANGANESEMANGANESE POISONINGPOISONING

ManganeseManganese poisoningpoisoningThe occupational manganese poisoning occurs among The occupational manganese poisoning occurs among workers who workworkers who work

- on the manganese mines, - on the manganese mines, - in metallurgical industry at steel making ,- in metallurgical industry at steel making ,-special alloys producing (ferromanganese – to -special alloys producing (ferromanganese – to

80 % of manganese, mirror cast-iron – to 15 % of 80 % of manganese, mirror cast-iron – to 15 % of manganese),manganese),

- at making of electrodes and gumboils which are - at making of electrodes and gumboils which are used for the electric welding,used for the electric welding,

- in chemical and lacquer-paint industry, - in chemical and lacquer-paint industry, - in agriculture (stain of seed for stimulation of - in agriculture (stain of seed for stimulation of

plant growth),plant growth), - in rubber industry. - in rubber industry.

- - Most dangerous is ground and sifting of pound ore, Most dangerous is ground and sifting of pound ore, because a lot of small disperse dust of manganese because a lot of small disperse dust of manganese appear. appear.

VARIANTS OF CLINICAL VARIANTS OF CLINICAL COURSECOURSE

Ways of Ways of ManganeseManganese poisoningpoisoning

RespiratoryRespiratory systemsystem GastrointestinalGastrointestinal

tracttract SkinSkin

ManganeseManganese poisoningpoisoning- The oxides of manganese are - The oxides of manganese are

quickly absorbed. quickly absorbed. - In blood manganese circulates - In blood manganese circulates

as an unsteady complex with plasma as an unsteady complex with plasma proteins.proteins. - Manganese is - Manganese is deposited in bones, cerebrum, deposited in bones, cerebrum, parenchyma organs. parenchyma organs.

- It is excreted from the - It is excreted from the organism with feces and urine.organism with feces and urine.

- Manganese may cause - Manganese may cause bronchial asthma and eczema bronchial asthma and eczema because of its allergic influence.because of its allergic influence.

ManganeseManganese poisoningpoisoning PathogenesisPathogenesis

Manganese, as a microelement, takes part Manganese, as a microelement, takes part in biological processes of organism. in biological processes of organism.

It influences on metabolic processes, It influences on metabolic processes, depresses cholinesterase activity, affects depresses cholinesterase activity, affects metabolism of serotonin.metabolism of serotonin.

At the protracted and systematic getting At the protracted and systematic getting into the organism it has a direct influence into the organism it has a direct influence on nervous tissue, and causes vascular on nervous tissue, and causes vascular violations, increase capillary permeability. violations, increase capillary permeability.

It changes activity of enzymes of nervous It changes activity of enzymes of nervous cells, depresses the biosynthesis of cells, depresses the biosynthesis of catecholamines, intensifies protein catecholamines, intensifies protein metabolism. metabolism.

ManganeseManganese poisoningpoisoning PathogenesisPathogenesis

The action of manganese is divided The action of manganese is divided into two phases. into two phases.

I phase – cholinergic – is characterized I phase – cholinergic – is characterized by predominance of cholinergic by predominance of cholinergic influence.influence.

II phase – phase of areactivity – injury of II phase – phase of areactivity – injury of acetylcholinoreactive structures. acetylcholinoreactive structures.

A manganese influences on the function A manganese influences on the function of thyroid, cardiovascular system, of thyroid, cardiovascular system, gastrointestinal tract, liver and other.gastrointestinal tract, liver and other.

Acute ManganeseAcute Manganese poisoningpoisoning

In industry acute manganese poisoning In industry acute manganese poisoning occurs rarely. occurs rarely.

It arises up at breathing in lIt arises up at breathing in large quantitiesarge quantities of dust which contains manganese. of dust which contains manganese.

Manganese poisoning causes severe Manganese poisoning causes severe disorders of disorders of blood circulation, dyspnea, blood circulation, dyspnea, frequent syncopesfrequent syncopes. .

In easy cases of poisoning In easy cases of poisoning irritation of the irritation of the mucous of respiratory tracts, cough, and mucous of respiratory tracts, cough, and headacheheadache are observed. are observed.

CHRONIC MANGANESE CHRONIC MANGANESE POISONINGPOISONING

Clinical picture of the chronic Clinical picture of the chronic manganese poisoning is manganese poisoning is characterized by three stages.characterized by three stages.

!!! The special feature of clinical !!! The special feature of clinical course of chronic manganese course of chronic manganese poisoning is inclination to its poisoning is inclination to its progress after stopping contact with progress after stopping contact with a metal.a metal.

MANGANESE POISONINGMANGANESE POISONINGDIAGNOSISDIAGNOSIS

Special attention is paid to early diagnosis of Special attention is paid to early diagnosis of chronic manganese poisoning. chronic manganese poisoning.

It’s necessary to find out a professional It’s necessary to find out a professional route, route,

sanitary description of labor conditions sanitary description of labor conditions (manganese concentration in the workplace,(manganese concentration in the workplace,

duration of contact during work day, duration of contact during work day, experience of work, influence of other experience of work, influence of other harmful professional factors),harmful professional factors),

to analyse results of biochemical to analyse results of biochemical investigations (level of manganese in blood, investigations (level of manganese in blood, urine, saliva, milk).urine, saliva, milk).

MANGANESE POISONINGMANGANESE POISONING

A decline of patient activity, A decline of patient activity, dormancy of psychical processes, dormancy of psychical processes, insufficient critical relation to the insufficient critical relation to the state of organism predetermine the state of organism predetermine the late appeal of patients for medical late appeal of patients for medical help. help.

Handwriting in different stages Handwriting in different stages of manganese poisoningof manganese poisoning

MANGANESE POISONINGMANGANESE POISONING TreatmentTreatment

GlucoseGlucose 40 % 40 % + Vit.C+ Vit.C (300-500 mg) (300-500 mg) i/v i/v,, vitamin B1 (40-50 mg), vitamin B1 (40-50 mg), 0,25 % novocaine 10-15 ml (15-20 0,25 % novocaine 10-15 ml (15-20

injections). injections). At appearance of Parkinsonism signs it is At appearance of Parkinsonism signs it is

necessary to necessary to prescribe prescribe antiparkinsonism antiparkinsonism ccholinolholinolyytics (Ctics (Cyyklodol, Norakin, Amedin, klodol, Norakin, Amedin, Tropacin, Tropacin, tab.tab. “Korbella”). “Korbella”).

Tropacinum – is effective antiparkinsonism Tropacinum – is effective antiparkinsonism ccholinolholinolyytictical drugal drug ( (10-20 mg 1-2 times 10-20 mg 1-2 times per a day after mealper a day after meal)). “Karbella” decrease . “Karbella” decrease tremor and diminish tonus of muscles (1 tremor and diminish tonus of muscles (1 tablet before sleep).tablet before sleep).

MANGANESE POISONINGMANGANESE POISONING TreatmentTreatment

medical gymnastics medical gymnastics bath (36-37Cbath (36-37C, duration - 20 minutes, , duration - 20 minutes,

course of treatment - 10 baths)course of treatment - 10 baths) Application of ozocerite on spine (20-Application of ozocerite on spine (20-

25 minutes 7-10 days)).25 minutes 7-10 days)).