Mercuric Nitrate

CAS RN: 10045-94-0

Laboratory

A) Monitor serum electrolytes, CBC, renal function, and urine output.
B) Spot urine mercury is useful as an initial screening test. Urine should be collected in a trace heavy metal free container approved by the reference laboratory. Ideally, patients should not consume fish for 1 week prior to urine testing. If a spot urine mercury level greater than 20 mcg/L is obtained, a 24-hour urine collection should be obtained, again in a trace heavy metal free container. Urine mercury levels should be corrected for urine creatinine. Urine levels greater than 100 mcg/L are associated with overt neurologic symptoms.
C) Whole blood inorganic mercury levels may be obtained in large acute exposures, but whole blood levels become unreliable as inorganic mercury redistribute into the tissues. Whole blood mercury should be speciated to determine the percentage of inorganic and organic mercury present. Whole blood inorganic mercury levels over 500 mcg/L are associated with acute tubular necrosis and renal insufficiency.
D) There is no specific correlation between blood or urine mercury concentration and mercury toxicity.
A) Serum nitrite concentrations are not widely available or clinically useful.
B) Determine CBC and methemoglobin concentration in all cyanotic patients or patients with dyspnea or other signs of respiratory distress.
C) Arterial blood gases should be monitored in symptomatic or cyanotic patients. An arterial blood gas test will reveal a falsely normal calculated oxygen saturation despite low measured pulse oximetry. If oxygen saturation is measured, it will be low relative to the pO2. This saturation gap suggests methemoglobinemia.
D) Monitor vital signs.
E) Monitor renal function in symptomatic patients.
F) Monitor serum electrolyte status in patients with significant vomiting.
G) Monitor mental status and perform a neurologic exam in symptomatic patients.
H) Obtain an ECG and institute continuous cardiac monitoring in symptomatic patients.
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