A 28-year-old flight engineer from Singapore presented with nausea, lethargy, and tremor. He had been defecating an increasingly large quantity of silver droplets, which were identified on laboratory analysis as elemental mercury. An abdominal radiograph showed punctate opacities along the entire course of the colon. The urine mercury level was 26.1 µg per liter (130.1 nmol per liter). He required only antiemetic treatment in the hospital.
For 12 weeks, the patient's mother-in-law had provided him with a traditional Indian medicine containing elemental mercury and meals to which approximately 3 Tbs of elemental mercury had been added. The ingestion of elemental mercury is widely regarded as harmless because it is poorly absorbed. However, prolonged exposure caused by continuous oral intake of large quantities may result in systemic toxicity because the elemental mercury is volatized into a highly absorbable vapor or converted to a toxic divalent form. The patient's lethargy, nausea, and tremor resolved within 8 weeks after the cessation of mercury consumption, and his urine mercury level decreased to 20.5 µg per liter (102.2 nmol per liter) at 4 weeks, 13.8 µg per liter (68.8 nmol per liter) at 36 weeks, and 3.3 µg per liter (16.5 nmol per liter) at 2 years.