Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM)
Pediatric Environmental Health Diagnosis
Chronic elemental mercury exposure in children can cause a severe form of poisoning called
acrodynia (i.e., painful extremities; also called pink disease) weeks or months after exposure. This condition is
rare. Acrodynia is characterized by pruritus; paresthesia; generalized pain; pink rash; and peeling hands, nose, and feet (Table 1). Other cases of acrodynia in the literature are discussed in
Environmental Health Perspectives (2000) and Paulson (2001).
The most common manifestations of long-term exposure to mercury vapor are effects on the central and peripheral nervous systems. Early nonspecific signs of exposure include insomnia, forgetfulness, loss of appetite, and mild tremor, and symptoms might be misdiagnosed as psychiatric illness. Continued exposure leads to progressive tremor, erethism (which is characterized by red palms, emotional lability, and memory impairment), distal paresthesia, motor and sensory conduction delay, and limb weakness. Other accompanying signs include salivation, excessive sweating, and hemoconcentration. Mercury can also accumulate in kidney tissues, with resulting renal toxicity (including proteinuria or nephrotic syndrome), alone or in addition to other signs of mercury exposure. Differences between adult and childhood manifestations of mercury poisoning are discussed in Weiss (2000).
