Three cases of chronic mercury poisoning with pain as the main manifestation

Mercury is a toxic heavy metal element that can induce chronic mercury poisoning by long-term inhalation of mercury vapors or exposure to mercury-containing substancesThe clinical manifestations of mercury poisoning mainly include: dental gingivitis, myostosie, gastroenteritis, bronchitis, interstitial pneumonia, neurasthenia syndrome, personality change, kidney damage, central nervous system and peripheral nervous system damageThe Pain Department of Hebei Medical University's Second Hospital admitted three patients with chronic mercury poisoning, mainly pain, and the medical records are reported as followscase 1, a woman, 30 years old, was admitted to hospital on 29 December 2013 due to "two lower limb pains for one month"Patients 1 month ago no obvious trigger for both sides of the calf inner pain, persistent swelling pain accompanied by a sexual tingling and burning pain, but not with the lower limb numbness, fatigue, flat and standing and other changes in the position of the pain have no obvious effectHas been visited by local doctorsCase ReportsHospital, given oral "analgesics" to treat the disease, the effect is not goodPatients had poor sleep and no significant reduction in weight since the onset of the disease, with a score of 6 for the digital pain intensity scale (nRS)body: hands mild tremor, waist 4, 5 echinos gap and left vertebrau tenderness, double lower limb sensation and muscle strength no significant reduction, straight leg elevation test double side 800 cornersLumbar disc CT showed mild expansion of the lumbar disc 4 and 5 vertebral discsAdmission diagnosis: lumbar disc protrusionAfter perfecting the routine physical examination, the blood check routine did not see obvious abnormalities, the urine routine examination showed that the urine protein (plus), the biochemical whole did not see significant abnormality, the lumbar vertebraum MRI showed the lumbar 4, 5 disc mild expansion, the myoelectric illustration was detected in the muscle did not see the characteristic change, the neuroconduction speed measurement showed the left side of the total fibula complex muscle action electricity amplitude decreasedgiven oral oxycodone and acetaminophen 165 mg, 3 times/d, gabapentin 0.3 g, 3 times/d, flupirine maleate 0.1 g, 3 times/d analgesiaAnd in the tube injection 2% hydrocaine hydrochloride injection (lidocaine hydrochloride) 5 ml, 0.9% sodium chloride injection 14 ml and compound betamethasone injection (compoundbetahasone iniection) 1 ml a total of 20 ml, the effect is not goodReanalysis of the disease, the patient's lower limb pain, lumbar 4, 5 ratchet gap tenderness, lumbar vertebraum MRI showed mild intervertebral disk expansion, but the lumbar nerve root stimulation symptoms are not typical, and the effect of tube injection treatment is not good, there may be other pain-inducing factors the medical history found that the patient's long-term external use of a cosmetics, whitening effect is significant, urine mercury, monitoring value of 112 ug/g creatininine (normal reference value is 4 ug/g creatinine), then diagnosed as chronic mercury poisoning Intravenous sodium dipyrisulphonate (sodium dimercaptosulphonate) 3 mg/kg, 1 time/d, medication 3 d, stopped 4 d, 2 weeks after patient pain relief, NRS score of 3 Retest urine mercury monitoring value of 80 ug/g creatininine, discharged Discharged from the hospital was diagnosed with chronic mercury poisoning Patients were discharged from the hospital after continued treatment in occupational disease hospitals, and after 3 months the pain of the patients with telephone follow-up disappeared, with an NRS score of 0, but no data on blood mercury and urine mercury was provided case 2, a 34-year-old woman, was admitted to hospital on 10 October 2016 due to "two-sided thigh and hip pain for one month" Patients 1 month ago no obvious trigger appeared in the back of the thigh and hip pain, showing a burst of sexual, bloating pain, flat bed symptoms relief, after increased activity, affecting walking He was treated at a local hospital and given oral "analgesics" treatment, and the pain was not alleviated The patient's sleep was poor since the onset of the disease, with an NRS score of 5 Check the body: the hands of mild tremor, pear-like muscle and joint area without obvious tenderness, two-sided thigh muscles no tenderness, double lower limbs move freely, straight legs raised the test double-sided 90 degrees angle, "4" word test double-side negative the CT of the joint show: (1) the erosion-like damage of the lower joint of the joint on both sides; Admission diagnosis: arthritis Perfect the relevant examination, in which the blood routine and biochemical whole did not see obvious abnormalities, urine routine prompt urinary protein Given oral aminol oxycodone 165 mg, 3 times/d analgesic, parallel bilateral tibia joint injection, under CT guidance, injection of hydrochloric acid Lidocain injection at the two-sided tibia joint 3 ml and compound pheasant rice pine injection 1 ml, diluted to 10 ml with 0.9% sodium chloride injection the pain in the hips was slightly reduced, but the pain in the thighdid did not ease Again analysis of the disease, the patient's hip and two-sided thigh pain, the tibia CT prompted bone damage, but the treatment effect is not good, and the joint without obvious tenderness, "4" word test double-sided negative, there may be other factors to induce pain Asked about the medical history, the patient complained about the recent use of a whitening product, urine mercury for 171.1ug/g creatinine, diagnosed with chronic mercury poisoning Intravenous sodium dipyrimethyl sulfonate 3 mg/kg, 1 treatment/d treatment, pain relief after 2 weeks of treatment, NRS score 2, retest urine mercury 63 ILLG/g creatinine, to be discharged from the hospital Diagnosis of discharge: (1) chronic mercury poisoning; After 3 months of telephone follow-up patients whose pain disappeared, with an NRS score of 0, and patients who did not provide data on blood mercury and urine mercury case 3, male, 57, was admitted to hospital on 16 May 2017 due to "headache and back pain for 2 months" Patients 2 months ago appear headache and low back pain, headache is burst, throbbing, degree of intensity, accompanied by the onset of exacerbation, not accompanied by fever, pain attack snout withconendos redness, nasal congestion, tears and runny nose, not accompanied by nausea, vomiting, low back pain not accompanied by double lower limb splies radiation pain, not with double lower limb numbness and swelling feeling, no obvious weakness in the limbs He was treated at a local hospital and given oral "analgesics" (specifically unknown) treatment, with poor results The NRS rating is 8 Since the onset of the disease, the patient has poor sleep body: pain is located at the top of the double-sided forehead, local no obvious redness, conjunctiva no congestion, no obvious pain, pain area skin feel no reduction; 10 years of history of "neurodermatitis" Admission diagnosis: (1) headache and back pain cause to be checked; the urine routine after admission to the hospital showed urine protein No abnormalities were observed in blood routine, biochemical whole item, head MRI, electroencephalogram and cerebrospinal fluid examination Experimentally given nerve block, local injection of 2% lidocaine injection on the upper part of the stoic, and oral ammonia oxycodone 165 mg, 3 times/d, sodium bichlorofenate (diclofenacsodium) 75 mg, 1 time/d analgesic, headache and back pain only slightly alleviated Again analysis of the disease, the patient's skull MRI and cerebrospinal fluid examination did not show significant abnormalities, lumbar detection body no obvious positive signs, pain may have other causes to inquire about the medical history, the patient 2 months ago had used a Chinese medicine partial side to treat dermatitis, the site smeared, several times a day, then check urine mercury for 120.3 ug/g creatinine, diagnosed as chronic mercury poisoning Intravenous sodium dipyriatlyoponite 3 mg/kg, 1 treatment/d After 1 week of treatment, the pain relief was provided with an NRS score of 3 and a retest editing of 71 ug/g creatininine for discharge Diagnosis from hospital: (1) chronic mercury poisoning; After 5 months of telephone follow-up patients whose pain disappeared, with an NRS score of 0, no data on urine mercury and blood mercury were provided