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Mercury and the Health Care Provider: Uncommon but Potentially Significant Exposures to New Jersey Residents

The New Jersey Department of Health is developing a website for health care providers on your patientsí potential exposures to mercury from cultural practices, consumer products, and other uncommon sources. These may be significant exposures to relatively small populations in NJ. While the full site is being developed, we are providing several of the background documents for your use.

Information on Mercury:

Case Studies in Environmental Medicine

Overview of Case studies in Environmental Medicine:  These are developed by the Agency for Toxic Substances and Disease Registry/National Center for Environmental Health (ATSDR):  The Case Studies in Environmental Medicine (CSEM) are a series of self-instructional modules designed to increase the primary care provider's knowledge of hazardous substances in the environment and to aid in the evaluation of potentially exposed patients. Continuing medical education (CME) for physicians, continuing nursing education (CNE) for nurses, continuing education units (CEU) for other professionals, and continuing education contact hours (CECH) for certified health education specialists (CHES) are offered in support of this series.

Case Study in Environmental Medicine:  Mercury Toxicity [pdf 1m].  PLEASE NOTE:  the “Standards and Regulations” portion of this case study is no longer current.  For information on treatment, please contact the New Jersey Poison Information and Education System at 1-800-222-1222.

Pediatric Environmental Health:  Mercury as a case study

Case Studies in Environmental Medicine (Complete set)

Medical Management Guidelines

Overview:  The Medical Management Guidelines (MMGs) for Acute Chemical Exposures were developed by ATSDR to aid emergency department physicians and other emergency healthcare professionals who manage acute exposures resulting from chemical incidents. The MMGs are intended to aid healthcare professionals involved in emergency response to effectively decontaminate patients, protect themselves and others from contamination, communicate with other involved personnel, efficiently transport patients to a medical facility, and provide competent medical evaluation and treatment to exposed persons.

Medical Management Guidelines:  Mercury
Medical Management Guidelines:  Complete set

ToxFAQs CABS (Chemical Agent Briefing Sheets)

Overview:  The ToxFAQs™ CABS provide current and relevant scientific information on specific high profile chemicals for public officials, business leaders, concerned citizens, and others to use in their work. The series presents a detailed overview of high profile hazardous materials that people may encounter during daily activities. The information provided in the ToxFAQs™ CABS can facilitate factual review and public discussion about these chemicals so that appropriate protective actions and potential research can be considered or undertaken to safeguard the physical environment and the public's health.

ToxFAQs CAB Mercury
ToxFAQs CABS (Complete set)

Toxicological Profiles

Overview of Toxicological Profiles:  By Congressional mandate, the Agency for Toxic Substances and Disease Registry produces "toxicological profiles" for hazardous substances found at National Priorities List (NPL) sites. For the mercury toxicological profile, chapters 1 and 2 may be of particular interest to health care providers.   

Toxicological Profile:  Mercury 
Toxicological Profiles  (complete set)

Information on Cultural Uses of Mercury

Mercury may be used in certain religious and cultural practices, including Hindu and Asian traditional healing, and Afro-, Latin-, Caribbean-, and Brazilian-based traditions, including Santeria, Palo, Voodoo, and Espiritismo.  Exposures to mercury can occur not only among individuals who use mercury in these practices, but to household members and others who live in the same buildings. 

For information on religious and cultural practices that may use mercury, there are studies and websites that can provide you with more detailed information.  A few of these are listed below.

Especially for Northern NJ health care providers:  A survey of mercury levels in air was conducted in apartment buildings in Union City and West New York, Hudson County, NJ.  The hallways of 34 multi-family buildings located within ½ mile of a botanica were tested for the presence of mercury in air.  In two of the buildings the indoor air concentration exceeded the USEPA’s guidance, and the source of these mercury levels is likely to have been a spill or intentional use of mercury in certain apartments.  In five other buildings there was a suspicion of mercury use or spillage.  Although this study cannot identify actual exposures to individuals, it does indicate the potential for exposures to residents of these buildings.  

Reports and websites:

Assessing Elemental Mercury Vapor Exposure from Cultural and Religious PracticesEnvironmental Health Perspectives • VOLUME 109 | NUMBER 8 | August 2001

Cultural Uses of Mercury in New Jersey .   Summary Report.  Environmental Assessment and Risk Analysis Element, NJDEP.  May 2003.

Religious Items/Ritual Uses of MercuryThe Northeast Waste Management Officials' Association (NEWMOA) website.

Task Force on Ritualistic Uses of Mercury Report.  USEPA; Dec. 2002

The Use of Mercury for Cultural and Religious Purposes.  Fact Sheet, National Association for County and City Health Officials.

The Mercury Poisoning Project.  compendium of relevant documents, resources, and links that describe the environmental health risks from mercury exposure associated with its cultural uses.

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