Inhalational mercury toxicity from artisanal gold extraction reported to the Oregon poison center, 2002-2015.

CONTEXT Mercury exposure has been described among small-scale gold mining communities in developing countries, but reports of inhalational mercury toxicity among home gold extractors in the US remain uncommon. OBJECTIVE We sought to identify inhalational mercury exposures and toxicity among artisanal gold extractors. METHODS This is an observational case series of a single Poison Center database from 2002-2015. We review all cases of "mercury" or "mercury inhalation" exposures, with detailed description of a recent representative case. RESULTS Nine cases were reported, with patients' ages ranging 32-81 years. Eight (89%) patients were male. Seven of eight (88%) patients with acute exposures reported pulmonary symptoms consistent with mercury vapor inhalation such as dyspnea and cough; two (29%) patients had severe toxicity requiring intubation. Four of six (67%) patients had markedly elevated whole blood mercury concentrations up to 346 mcg/L; each received a different chelation regimen. Four (44%) patients used methamphetamines at the time of their exposure. The case report describes a patient with elevated mercury concentrations who required intubation for hypoxic respiratory failure. He received chelation therapy based on chelator availability, with decreasing 24-hour urine mercury concentrations. The house where he was exposed remains uninhabitable from elevated ambient mercury vapor concentrations. CONCLUSION Artisanal gold extraction may be associated with inhalational mercury toxicity, including elevated blood mercury concentrations and acute hypoxic lung injury requiring intubation.