Evaluation of mercury exposure level, clinical diagnosis and treatment for mercury intoxication Original paper

What was reviewed?

This review explained how different mercury forms (metallic, inorganic, and organic methylmercury) create different exposure routes, target organs, and clinical patterns, so clinicians should not treat “mercury” as one uniform toxin. It focused on the practical steps needed to evaluate exposure sources (occupational versus environmental), interpret biomarker tests, and decide when symptoms and measured levels justify intervention. The authors emphasized that most modern concern centers on chronic low-to-moderate exposure in the general environment, not only the high-dose disasters historically linked to methylmercury.

Who was reviewed?

The authors reviewed evidence from multiple human and experimental settings rather than one patient group. They summarized occupational case and surveillance data (where inhaled mercury vapor historically dominated), general-population studies where diet drives exposure, and major epidemiologic cohorts that assessed neurodevelopmental risk from low-grade methylmercury exposure. They also incorporated clinical toxicology guidance and reports on chelation, dialysis-based strategies, and supportive care, using these sources to outline how clinicians can evaluate symptomatic patients while acknowledging that symptom–level correlations remain inconsistent across studies.

What were the most important findings?

The review clarified how to match a biomarker to the suspected mercury form and timing. Blood and urine often reflect recent or ongoing exposure, but urine is most informative for metallic and inorganic mercury, while hair best captures chronic methylmercury exposure and can approximate longer-term dose history. The authors stressed that measurement alone rarely proves toxicity because symptoms vary widely and many routine lab abnormalities lack mercury specificity. They highlighted practical thresholds used in published guidance for “vigilance” versus “intervention” while underscoring that universal diagnostic cutoffs do not exist. They presented provocation testing with chelators as a debated tool intended to estimate body burden when symptoms and exposure history remain unclear.

What are the greatest implications of this review?

Clinicians should treat mercury assessment as a structured risk-and-symptom decision rather than a single lab result. This review supports taking a detailed exposure history, identifying and removing the exposure source, and choosing biomarkers that fit the suspected form and exposure window. It also reinforces that chelation can be appropriate in symptomatic poisoning, yet indications remain incompletely standardized, and benefits versus harms depend on mercury form, severity, and clinical stability. Finally, the paper highlights a real practice gap: chronic low-level exposure is common and controversial, so clinicians need clearer, evidence-based standards that link exposure level, symptoms, and outcomes to guide when to treat.