Case Study 4
Microbiology
A 32-year-old woman enters a clinic complaining of vision impairment, itchy skin, a
redness on the cheeks and toes, loss of coordination, and skin peeling off her hands. She
reported that she was on a new diet and had been eating only fish for the past several
months. She was diagnosed with mercury poisoning.
Discussion
1. On the basis of the diagnosis, discuss the avenue of treatment for this type of
poisoning as well as the factors that should be considered in every case of poisoning.
(See the section Toxicity in Chapter 10.)
The treatment avenue is to stop the consumption of fish immediately and
identify/eliminate any other possible sources. In addition, chelation therapy using an
agent that binds mercury and increases excretion, give the patient IV fluids to make sure
they’re hydrated (help in renal clearance), regularly monitor blood and urine mercury
levels, and coordinate a neurological and dermatological follow-up appointment. Factors
that should be considered in every case of poisoning are what organ systems are involved,
the time since exposure, availability of antidotes, whether exposure was chronic or acute,
the patients’ weight, conditions, or possible pregnancy, type of poison (organic, inorganic,
or elemental), and the route of exposure (oral ingestion, inhalation, etc.).
2. Discuss the factors and/or variables that would have an effect on the concentration of
the drug in the body.
This is where pharmacokinetics matter, especially. Factors that would have an effect on the
concentration of the drug in the body are:
1. absorption: route of administration (oral, IV, IM), food interactions, and pH level of the
stomach (affects solubility).
2. Distribution: lipid-soluble drugs may accumulate in fat (mercury tends to accumulate in
kidneys and brain), and blood-flow to the organs (the better the flow, the more drug is received).
3. Metabolism: patient’s age and health status affect drug absorption, drug interactions that may
increase or decrease absorption, and patients’ liver enzyme count.
4. Excretion: some drugs are excreted through the feces, so the patients’ renal function plays a
large part in drug clearance.
Microbiology
A 32-year-old woman enters a clinic complaining of vision impairment, itchy skin, a
redness on the cheeks and toes, loss of coordination, and skin peeling off her hands. She
reported that she was on a new diet and had been eating only fish for the past several
months. She was diagnosed with mercury poisoning.
Discussion
1. On the basis of the diagnosis, discuss the avenue of treatment for this type of
poisoning as well as the factors that should be considered in every case of poisoning.
(See the section Toxicity in Chapter 10.)
The treatment avenue is to stop the consumption of fish immediately and
identify/eliminate any other possible sources. In addition, chelation therapy using an
agent that binds mercury and increases excretion, give the patient IV fluids to make sure
they’re hydrated (help in renal clearance), regularly monitor blood and urine mercury
levels, and coordinate a neurological and dermatological follow-up appointment. Factors
that should be considered in every case of poisoning are what organ systems are involved,
the time since exposure, availability of antidotes, whether exposure was chronic or acute,
the patients’ weight, conditions, or possible pregnancy, type of poison (organic, inorganic,
or elemental), and the route of exposure (oral ingestion, inhalation, etc.).
2. Discuss the factors and/or variables that would have an effect on the concentration of
the drug in the body.
This is where pharmacokinetics matter, especially. Factors that would have an effect on the
concentration of the drug in the body are:
1. absorption: route of administration (oral, IV, IM), food interactions, and pH level of the
stomach (affects solubility).
2. Distribution: lipid-soluble drugs may accumulate in fat (mercury tends to accumulate in
kidneys and brain), and blood-flow to the organs (the better the flow, the more drug is received).
3. Metabolism: patient’s age and health status affect drug absorption, drug interactions that may
increase or decrease absorption, and patients’ liver enzyme count.
4. Excretion: some drugs are excreted through the feces, so the patients’ renal function plays a
large part in drug clearance.
