Occupational Mercury Exposure among Oil

Technicians in Libya
Dr. Tahar A. Suliman
Department of Forensic Medicine & Toxicology
Faculty of Medicine – Zawia
Zawia University
Abstract :
The aim of this study is to determine blood mercury levels among
Libyan technicians who use mercury for analysis of crude oil.
Occupational exposures to mercury can occur where mercury is
produced, used in processes, or incorporated in products. The susceptible
subpopulations for mercury toxicity include those who are more sensitive
to the effects of mercury and those who are exposed to higher levels of
mercury.
The mean blood mercury level in the study group is 5.86µg/L, which

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is 3 times higher than the mean blood mercury level (1.7µg/L) in the
control group.
Regulations and precautions must be taken by the workers to avoid
mercury poisoning.
Key words: mercury, occupational, exposure, toxicity, blood levels.
Introduction :
Mercury toxicity has been recognized since the time of Hippocrates1.
At the end of 18th century, mercury toxicities were caused by the mercury-
containing antisyphilitic agents. At the time being, the risk of mercury
toxicity is high as it has many uses. Medically, it is still used as dental
amalgams and as antiseptic agents. Occupational mercury exposure is
another important cause for its toxicity. Environmental pollution by
mercury is a major global concern because of increased usage of fuels and
agricultural products2.
There are three primary categories of mercury and its compounds:
elemental mercury; inorganic mercury and organic mercury compounds.
Mercury toxicity may occur with all forms. Occupational exposures occur
mainly by inhalation of elemental mercury2. The toxicokinetics have an
important role in determining the toxic effects of elemental mercury; nearly
80% of inhaled elemental mercury is absorbed through the lungs by rapid
diffusion. In contrast, only 0.01% of elemental mercury is absorbed
through the gastrointestinal tract. Dermal absorption of elemental mercury
is limited3. Elemental mercury is highly diffusible and lipid soluble.

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Elemental mercury can cross the blood-brain barrier and blood-placenta

barrier as well as the lipid bilayers of cellular and intracellular organellar
membranes. Though elemental mercury vapor is rapidly oxidized to ionic
mercury, it remains as vapor in the blood for a short time, which is long
enough for a significant amount of mercury vapor to penetrate the blood-
brain barrier before it is oxidized to the mercuric form (Hg++) and
accumulate in the brain4. The primary organs of mercury deposition
following inhalation exposure to elemental mercury vapor are the brain and
kidney5. Elemental mercury is bound strongly to selenium or SH-groups
after oxidation in the brain4. With time after exposure, the greater
proportion of the body burden of mercury is found in the kidney5. Urine
and feces are the main pathways of excretion, although a small amount of
inhaled mercury can be eliminated in the breath, sweat, and saliva5. The
biological half-life of mercury is estimated to be approximately 30 to 60
days in the body5. The half-life of mercury in the brain is not entirely clear,
but is estimated to be as long as approximately 20 years5.
Mercury may cause different organ toxicities. Human exposure to
toxic levels of mercury vapor in adults causes the classic triad of erethism
(bizarre behavior, eg, excessive shyness or aggression), tremor, and
gingivitis6. The cardinal neurologic sign of toxic vapor exposure is tremor
that may be accompanied by a variety of neuropsychological effects
ranging from emotional lability at high exposure levels to subtle
performance deficits at lower levels6,7.

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The neurotoxic effects of organic and inorganic mercury are

different. Organic mercury toxicity may cause prominent neuronal loss and
gliosis in the calcarine and parietal cortices and cerebellar folia, as seen in
cases of classic Minamata disease8, while inorganic mercury may lead to
cerebral infarctions9. Mercury damages the nervous system through several
ways; it binds to sulfhydryl groups and incapacitates the enzymes involved
in the cellular stress response, protein repair, and oxidative damage
prevention10. It may disrupt the muscarinic cholinergic systems in the
brainstem and occipital cortices11. It may inactivate Na-K-ATPase that
leads to membrane depolarization, calcium entry, and eventual cell death12.
Renal effects are variable from mild transient proteinuria to severe
proteinuria, hematuria, and/or oliguria to acute renal failure, with
degeneration or necrosis of the proximal convoluted tubules13.
Dermal changes may appear after inhalation, oral, or dermal
exposure to elemental mercury vapors or inorganic mercury. Erythematous
and pruritic rashes are the result of irritation or sensitization reactions.
Heavy perspiration and reddened and/or peeling skin on the palms of the
hands and soles of the feet typically associate the acrodynia14.
Respiratory symptoms are a prominent effect of short-term, high-
level exposure to elemental mercury vapors. The most commonly reported
symptoms include cough, dyspnea, and chest tightness or burning pains in
the chest15. In the more severe cases, respiratory distress, pulmonary
edema, lobar pneumonia, fibrosis, and desquamation of the bronchiolar

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Occupational Mercury Exposure among Oil Technicians in Libya ‫ــــــــــــــــــــــــــــــــــــ‬

epithelium have been observed15.

Cardiovascular effects after short-term inhalation of elemental
mercury vapor include increased blood pressure and heart rate15. Risks of
coronary heart diseases increase with mercury toxicity16.
Gastrointestinal effects are stomatitis, abdominal pain, nausea,
and/or diarrhea that may occur following short-term exposure to elemental
mercury vapors, occasionally accompanied by excessive salivation or
difficulty swallowing15.
Toxic effects of mercury on reproductive system are variable.
Menstrual cycle disorders are more frequent among women working in a
mercury vapor17 as well as in animal studies18.
The technicians estimate the amount of crude oil in rock samples by
soaking it in elemental mercury. Mercury evaporates in room temperature
and the technicians are exposed to mercury vapor.
No such studies on mercury poisoning among oil workers were done
in Libya before.
Aim of the Study :
To determine blood mercury levels (BMLs) among a group of
technicians exposed to mercury during their work.

Methods and Material :

The study group consists of 76 technicians (72 males and 4 females.
The range of workers’ age is from 24 years to 52 years with mean age (38

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Dr. Tahar A. Suliman‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬

± 12.4 Yrs). The duration of exposure is from 4 Years to 18 Years, with an

average (9.4 ± 4.7 Yrs). The study was conducted in 2010 in Tripoli, Libya.
The data collected includes complete medical history, duration of
exposure, diet, smoking, alcohol consumption, working time,, vacations,
safety precautions, physical symptoms(table 1). and blood analysis
Detailed physical and neurological examinations were performed on
each technician by specialized doctors. Special attention was focused on
possibility of presence of gingivitis, dysarthria, tremor, finger to nose test,
heel to knee and shin test, gait disturbance, muscle strength, and tendon
reflexes.
Blood samples were collected for the measurement of mercury
levels, sugar, and renal and liver function tests. The blood samples were
analysed for Mercury levels in Germany by atomic absorption spectrometer
in Biosencia laboratory.
Table 1: Potential Mercury-related Symptoms
Body weight loss Numbness
Gum pain Memory impairment
Hypersalivation Bad temper
Hyperhidrosis Back pain
Nightmare/insomnia Blurred vision
Speech problems Tremor
Dizziness Writing difficulty
Fatigue Slow mental response
Inattention Unsteady gait

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The control group consists of 25 volunteers (15 males and 10

females) with ages 23 years to 48 years (average 32 ± 9.76 Years). The
group had been collected randomly with the consent of the involved
individuals. The individuals in the control group are nonsmokers and with
normal Libyan dietary habits. They are eating fish as canned tuna and
sometimes as fresh-cooked fish (1-2 times per month). The selection is
done in this way to minimize the possible effects of diet and smoking as
sources that may increase BMLs.

Results :
In the study group, the BMLs ranged from 0.8-19 µg/L and the mean
blood mercury level is 5.86 µg/L. There are no significant findings in the
clinical examinations.
In the control group, the BMLs ranged from 0.1 – 3.5 µg/L, with
mean blood mercury level 1.7 µg/L.
Analysis of all other data revealed no significant findings.
Discussion :
The mean blood mercury level in the control group is nearly similar
to those in other countries. In the literature review there are different values
for BMLs. Table (2) shows some different BMLs in different countries.19-28

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Table (2) Blood Mercury blood levels in non-exposed populations

Mean
No. of Level
Country level References19-28
Subjects range µg/L
µg/L
Belgium 497 13 0.1-47 Lauwerys et al. (1978)
Italy 110 6.36 Alimonti A. et al (2005)
UK 88 8.8 1.1-42 Sherlock et al. (1982)
Poland 270 11.3 2.5-24 Szucki & Kurys (1982)
Germany 2 Ewers U et al (1999)
1.02 Schober et al. (2003)
USA 1709 0.85-1.2
0.82 Jones et al. (2010)
South 293 8.63 Eun-mi Jo (2010)
1.48 – 45.7
Korea 581 3.92 Kim NY et al. (2012)
Canada 492 1.6 0.8 – 11.2 Dewailly E et al. (2001)
Johansson N et al.
Sweden 106 0.34 0.04 – 1.6
(2002)

In Libya, there are no studies about the reference level of blood

mercury in the Libyan population. This control group is too small to be
considered as a reference population. The reference population should be
sufficiently large to cover a representative part of the general population
and to enable an evaluation of the effect of relevant confounders on the

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level of a toxin in human biological materials (e.g., age, sex, tobacco

smoking, amalgam fillings, special nutritional habits)23.
The range of BMLs among the study group is 0.6–16 µg/L and the
mean level is 5.86 µg/L. According to the blood mercury levels, the study
group is divided into 4 subgroups (Table 3).
Table (3) Subgroups according to MBLs and Clinical Manifestations
Subgroup Blood Mercury Level µg/L Number
NBM 1.7 or less 38
HBM I > 1.7 – 5 22
HBM II > 5 - < 15 without clinical manifestations 14
HBM III > 5 with clinical manifestations/ 15 2
or more
1) Normal Blood Mercury (NBM): a subgroup with “normal value”, in
which the blood mercury levels are considered normal i.e. 1.7 µg/L
or less. In this subgroup there are 38 individuals i.e. 50% of the study
group.
2) High Blood Mercury I (HBM I): this subgroup is considered as a
“check value”, which means an elevated mercury level in blood
above that in the control group and up to 5µg/L, in which other
different possible sources of mercury should be eliminated. At this
level there is no consideration of adverse health effects23. This
subgroup includes 22 individuals (28.59%).
3) High Blood Mercury II (HBM II): where blood mercury levels are

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above 5µg/L and below 15 µg/L but without clinical manifestations

of mercury intoxication. This value is considered as an “observation
value” where the exposure to mercury should be stopped and the
individuals are put under close observation. The level 15 µg/L was
considered by the Commission on Human Biological Monitoring of
the German Federal Environmental Agency23. This subgroup includes
14 individuals (18.4%).
4) High blood Mercury Level III (HBM III): the blood level in this
subgroup is considered as the “intervention value”. It includes those
with BMLs above 5µg/L but with the presence of clinical
manifestation of mercury toxicity, or those with BMLs 15 µg/L23 or
more. The individuals in this subgroup will undergo specific
management one of which is chelation therapy in addition to repeated
investigations of mercury levels in the biological fluids. This
subgroup includes 2 technicians (0.26%); one with BML 15 µg/L and
the other with BML 16 µg/L. All technicians examined in the study
group are without clinical manifestations of mercury intoxication.

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Fig.1 Distribution of BML among study group

40 38

35

30

25
22

20
Number of…
15 14

10

5
2

0
NBM HBM I HBM II HBM III

People using mercury in their work are having the risk of exposure
to mercury from other sources similar to the population they are living
with. These sources should be considered when we are planning for their
safety precautions or when we are managing them to decrease their
mercury blood levels. The workers, as a part of the general population, will
be exposed to mercury through the diet (especially fish), air, water, tobacco
smoking and dental amalgams23. Also, personal use of skin-lightening
creams and soaps, mercury use for cultural purposes can result in
substantial elevations of human mercury exposure.
In order to decrease the exposure to different types of mercury,
several countries

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Dr. Tahar A. Suliman‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬

and international organizations have established levels of daily or

weekly mercury intakes estimated to be safe (or without appreciable risk to
health), based on available information. The Joint FAO/WHO Expert
Committee on Food Additives (JECFA), which also evaluates chemical
contaminants in the food supply, has established provisional tolerable
weekly intakes (PTWIs) for total mercury at 5 µg/kg body weight and for
methylmercury at 1.6 µg/kg body weight.28
Further rules had been established to protect those working with
mercury from its hazardous effects. The most important are the legal
exposure limits for mercury during work. In United States of America, the
Occupational Safety and Health Administration (OSHA-USA) gives
permissible exposure limit for mercury vapor (0.1 mg/m3 of air as a ceiling
limit. The National Institute for Occupational Safety and Health (NIOSH-
USA) has established a recommended exposure limit for mercury vapor of
0.05 mg/m3 as a Time Weighted Average (TWA) for up to a 10-hour
workday and a 40-hour workweek. The American Conference of
Governmental Industrial Hygienists (ACGIH-USA) has assigned mercury
vapor a threshold limit value (TLV) of 0.025 mg/m3 as a TWA for a normal
8-hour workday and a 40-hour workweek.29
All different sources of mercury should be put in consideration when
planning for the safety of workers with mercury including diet where
amount and type of fish must be selected to be lesser than 5 µg/kg body
weight and for methylmercury at 1.6 µg/kg body weight. Another

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important issue is that concerning the prohibition of use of dental

amalgams among people who are with higher risk of mercury to toxicity.
Because of risks of dental amalgams Denmark, Sweden and Norway have
banned the use of dental amalgams and other countries are going to follow
them.30
Conclusion :
1- Mercury blood levels in 38/76 (50%) of Libyan technicians were high.
2- All individuals in the study group are free of clinical minifestations.
3- Control group is too small to be considered as a reference level and
larger groups must be studied to estimate reference level of blood
mercury among Libyan population.
Recommendations :
1) Further studies should be carried in the Libyan population to estimate
reference level of blood mercury.
2) Mercury exposure must be decreased by following standard safety
precautions and recommendations.
3) People who are working in occupations with higher risk of mercury
poisoning must be educated about their diet, habits. and they should not
use dental amalgams containing mercury.
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history of industrial medicine. Ann Med Hist8:27.
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Compounds: Human Health Aspects. WHO (medline).

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Industrial Medicine, 42:488–94.

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transfer of lead, mercury, cadmium, and carbon monoxide in
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20) Alimonti A, Bocca B, Mannelia E, Petrucci F, Zennaro F, Cotchini
R, D’ippolito C, Agresti A, Caimi S, Forte G (2005). Assessment of
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Dr. Tahar A. Suliman‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬

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