Acrodynia

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Acrodynia
Other namesBilderbeck's, Selter's, Swift's and Swift-Feer disease.
Specialty Emergency medicine   OOjs UI icon edit-ltr-progressive.svg

Acrodynia is a medical condition which occurs due to mercury poisoning. The condition of pain and dusky pink discoloration in the hands and feet is due to exposure or ingesting of mercury. It was known as pink disease (due to these symptoms) before it was accepted that it was just mercury poisoning. [1] The word acrodynia is derived from the Greek : ακρος, which means end or extremity, and Greek : οδυνη, which means pain. As such, it might be (erroneously) used to indicate that a patient has pain in the hands or feet. The condition is known by various other names including hydrargyria, mercurialism, erythredema, erythredema polyneuropathy, Bilderbeck's, Selter's, Swift's and Swift-Feer disease.

Contents

Symptoms and signs

Besides peripheral neuropathy (presenting as paresthesia or itching, burning or pain) and discoloration, swelling (edema) and desquamation may occur. Since mercury blocks the degradation pathway of catecholamines, epinephrine excess causes profuse sweating (diaphora), tachycardia, salivation and elevated blood pressure. Mercury is suggested to inactivate S-adenosyl-methionine, which is necessary for catecholamine catabolism by catechol-o-methyl transferase. Affected children may show red cheeks and nose, red (erythematous) lips, loss of hair, teeth, and nails, transient rashes, hypotonia and photophobia. Other symptoms may include kidney dysfunction (e.g. Fanconi syndrome) or neuropsychiatric symptoms (emotional lability, memory impairment, insomnia).[ citation needed ]

Thus, the clinical presentation may resemble pheochromocytoma or Kawasaki disease.[ citation needed ]

There is some evidence that the same mercury poisoning may predispose to Young's syndrome (men with bronchiectasis and low sperm count). [2]

Causes

Mercury compounds like calomel were historically used for various medical purposes: as laxatives, diuretics, antiseptics or antimicrobial drugs for syphilis, typhus and yellow fever. [3] Teething powders were a widespread source of mercury poisoning until the recognition of mercury toxicity in the 1940s. [4]

However, mercury poisoning and acrodynia still exist today. [5] Modern sources of mercury intoxication include broken thermometers. [6]

Diagnosis

Removal of the inciting agent is the goal of treatment. Correcting fluid and electrolyte losses and rectifying any nutritional imbalances (vitamin-rich diets, vitamin-B complex) are of utmost importance in the treatment of the disease.[ citation needed ]

The chelating agent meso 2,3-dimercaptosuccinic acid has been shown to be the preferred treatment modality. It can almost completely prevent methylmercury uptake by erythrocytes and hepatocytes. In the past, dimercaprol (British antilewisite; 2,3-dimer-capto-l-propanol) and D-penicillamine were the most popular treatment modalities. Disodium edetate (Versene) was also used. Neither disodium edetate nor British antilewisite has proven reliable. British antilewisite has now been shown to increase CNS levels and exacerbate toxicity. N -acetyl-penicillamine has been successfully given to patients with mercury-induced neuropathies and chronic toxicity, although it is not approved for such uses. It has a less favorable adverse effect profile than meso 2,3-dimercaptosuccinic acid. [ citation needed ]

Hemodialysis with and without the addition of L-cysteine as a chelating agent has been used in some patients experiencing acute kidney injury from mercury toxicity. Peritoneal dialysis and plasma exchange also may be of benefit.[ citation needed ]

Tolazoline (Priscoline) has been shown to offer symptomatic relief from sympathetic overactivity. Antibiotics are necessary when massive hyperhidrosis, which may rapidly lead to miliaria rubra, is present.[ citation needed ] This can easily progress to bacterial secondary infection with a tendency for ulcerating pyoderma.[ citation needed ]

Related Research Articles

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Wilson's disease is a genetic disorder characterized by the excess build-up of copper in the body. Symptoms are typically related to the brain and liver. Liver-related symptoms include vomiting, weakness, fluid build-up in the abdomen, swelling of the legs, yellowish skin, and itchiness. Brain-related symptoms include tremors, muscle stiffness, trouble in speaking, personality changes, anxiety, and psychosis.

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<span class="mw-page-title-main">Mercury poisoning</span> Poisoning caused by mercury chemicals

Mercury poisoning is a type of metal poisoning due to exposure to mercury. Symptoms depend upon the type, dose, method, and duration of exposure. They may include muscle weakness, poor coordination, numbness in the hands and feet, skin rashes, anxiety, memory problems, trouble speaking, trouble hearing, or trouble seeing. High-level exposure to methylmercury is known as Minamata disease. Methylmercury exposure in children may result in acrodynia in which the skin becomes pink and peels. Long-term complications may include kidney problems and decreased intelligence. The effects of long-term low-dose exposure to methylmercury are unclear.

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Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. Chelation therapy has a long history of use in clinical toxicology and remains in use for some very specific medical treatments, although it is administered under very careful medical supervision due to various inherent risks, including the mobilization of mercury and other metals through the brain and other parts of the body by the use of weak chelating agents that unbind with metals before elimination, exacerbating existing damage. To avoid mobilization, some practitioners of chelation use strong chelators, such as selenium, taken at low doses over a long period of time.

<span class="mw-page-title-main">Mercurial diuretic</span>

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<span class="mw-page-title-main">Polyneuropathy</span> Medical condition

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<span class="mw-page-title-main">1971 Iraq poison grain disaster</span> Incident of mass poisoning in Iraq in 1971

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References

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  2. Hendry WF, A'Hern FPA, Cole PJ (1993). "Was Young's syndrome caused by mercury exposure in childhood?". BMJ . 307 (6919): 1579–82. doi:10.1136/bmj.307.6919.1579. PMC   1697782 . PMID   8292944.
  3. Beck C, Krafchik B, Traubici J, Jacobson S (2004). "Mercury intoxication: it still exists". Pediatr Dermatol. 21 (3): 254–9. doi:10.1111/j.0736-8046.2004.21314.x. PMID   15165207. S2CID   7970810.
  4. Dally, Ann (1997). "The Rise and Fall of Pink Disease". Social History of Medicine. 10 (2): 291–304. doi:10.1093/shm/10.2.291. PMID   11619497.
  5. Weinstein M, Bernstein S (2003). "Pink ladies: mercury poisoning in twin girls". CMAJ. 168 (2): 201. PMC   140434 . PMID   12538551.
  6. Torres AD, Rai AN, Hardiek ML (2000). "Mercury intoxication and arterial hypertension: report of two patients and review of the literature". Pediatrics. 105 (3): E34. doi:10.1542/peds.105.3.e34. PMID   10699136.