HYPERTENSION DUE TO MERCURY-POISONING - D IAGNOSTIC-VALUE OF CAPTOPRIL

Background. - Mercury poisoning is a rare cause of hypertension in chi ldren. Urinary excretion sometimes remains low despite severe clinical intoxication. Case report. - A 32 month-old girl was admitted with hy pertension, tachycardia, apathy, irritability and excessive sweating. Erythromelalgia and neurologic symptoms permitted the diagnosis of acr odynia. Urine mercury remained normal until chelation. Captopril signi ficantly increased urine mercury concentration but failed to improve c linical manifestations. Clinical improvement required infusions of BAL (R) for 5 days then oral dimercaptosuccinic acid for 3 months. Metal v apors originated from the mercury which spilled from a broken thermome ter onto the carpet. Comments. - Low basal urine mercury could be asso ciated with real mercury poisoning. Small amounts of metal mercury hel d in a thermometer could produce a high level of mercury vapor leading to intoxication in young children. The binding capacity of metal ions by captopril could be used to increase urine mercury output. Neverthe less, captopril therapy fails to improve acrodynia. Total elimination of mercury requires long-term therapy with BAL(R) or dimercaptosuccini c acid. Conclusions. - An unexpected mode of intoxication and low basa l urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.