Mercury Exposure from Interior Latex Paint -- Michigan

In August 1989, a previously healthy 4-year-old boy in Michigan was diagnosed with acrodynia, a rare manifestation of childhood mercury poisoning. Symptoms and signs included leg cramps; rash; itching; excessive perspiration; rapid heartbeat; intermittent low-grade fevers; irritability; marked personality change; insomnia; headaches; hypertension; swelling; redness and peeling of the hands, feet, and nose; weakness of the pectoral and pelvic girdles; and nerve dysfunction in the lower extremities. A urine mercury level of 65 ug/L was measured on a 24-hour urine collection. Treatment with intensive chelation therapy increased his urine mercury excretion 20-fold. Examination of his mother and two siblings found urine mercury levels greater than or approximately equal to his; his father had elevated, although lower, levels. Parents and siblings were asymptomatic, although electromyographic abnormalities were detected in one sibling.

The Michigan Department of Public Health (MDPH) identified inhalation of mercury-containing vapors from phenylmercuric acetate contained in latex paint as the probable route of mercury exposure for the family; 17 gallons of paint had been applied to the inside of the family's home during the first week of July. Samples of the paint contained 930-955 ppm mercury; the Environmental Protection Agency (EPA) limit for mercury as a preservative in interior paint is 300 ppm. During July, the house was air-conditioned, and the windows were not opened.

Following 4 months of hospitalization with repeated courses of chelation therapy and intensive rehabilitation, the patient's symptoms abated except for residual lower extremity weakness. Although electroneuromyographic abnormalities persist, he is able to walk and continues to improve.

In October, the Michigan Department of Agriculture prohibited further sales of the inappropriately formulated paint,* and the MDPH advised persons not to apply the paint, to thoroughly ventilate freshly painted areas, and to consult a physician if unexplained health problems occurred. In November, the MDPH and CDC began an ongoing investigation in selected communities in southeastern Michigan to assess mercury levels in the air of homes in which this paint has been applied and in urine samples from persons living in these homes. Reported by: R Aronow, MD, Poison Control Center, Children's Hospital, Detroit; C Cubbage, PhD, Michigan Dept of Agriculture; R Wiener, State Health Director, B Johnson, MD, J Hesse, J Bedford, PhD, Michigan Dept of Public Health. Health Studies Br, Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Phenylmercuric acetate is routinely added by some paint manufacturers to interior latex (water-based) paint as a fungicide and bactericide to prolong the paint's shelf-life. EPA permits interior latex paint to contain less than or equal to 300 ppm elemental mercury and exterior latex paint to contain less than or equal to 2000 ppm. However, neither the presence nor the concentration of mercury in the paint is required to be labeled on the paint can. Mercury may not lawfully be used in oil-based paint (1,2).

One case of acrodynia associated with the use of interior latex paint has been reported previously (3). Acrodynia may occur at urine mercury levels as low as 50 ug/L (4). Because the Reinsch test, a urine screening for heavy metals, is not sufficiently sensitive to detect low mercury levels, urine should be tested for mercury content by cold vapor atomic absorption (5).

Little information is available about background urine mercury levels, especially in children. Data are largely limited to a 1961 World Health Organization multicountry survey of adults, which found that 95% of adults had urine mercury concentrations less than 20 ug/L, and 89%, less than 10 ug/L (6).

In adults, chronic exposure to mercury vapors can cause nerve-conduction delays, tremor, insomnia, loss of appetite, and irritability (4,7). In 1965, mercury vapor exposure from paint may have been the cause of a cluster of neuromyasthenia cases (with symptoms including headache, weakness, tremor, unsteady gait, and depression) in workers in an electronics factory (8). However, the long-term health effects in clinically asymptomatic persons with elevated urine mercury levels and the potential adverse health effects to children and fetuses have not been well established.

Because alternative paint preservatives are available, EPA is determining the distribution of mercury-containing paints and is reviewing the use of mercury as a paint preservative. To prevent mercury exposure from paint, proper ventilation should be assured both during and after painting. Cases of mercury poisoning considered to be associated with interior latex paint should be reported through state health departments to the Health Studies Branch, Division of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC; telephone (404) 488-4682.

References

1. Train RE. Decision of the Administrator on the cancellation of pesticides containing mercury. Environmental Protection Agency, February 17, 1976: FIFRA dockets no. 246 et al. Fed. Reg. 41 76(1976).

2. Train RE. Decision of the Administrator on reconsideration. Environmental Protection Agency, May 27, 1976: FIFRA dockets no. 246 et al.

3. Hirschman SZ, Feingold M, Boylen G. Mercury in house paint as a cause of acrodynia: effect of therapy with N-acetyl-D,L-penicillamine. N Engl J Med 1963;269:889-93.

4. Clarkson TW, Friberg L, Nordberg GF, Sager PR, eds. Biological monitoring of toxic metals. New York: Plenum Press, 1988.

5. Foulds DM, Copeland KC, Franks RC. Mercury poisoning and acrodynia (Letter). Am J Dis Child 1987;141:124-5.

6. Friberg L, Vostal J, eds. Mercury in the environment: an epidemiological and toxicological appraisal. Cleveland, Ohio: CRC Press, 1972.

7. Rosenman KD, Valciukas JA, Glickman L, Meyers BR, Cinotti A. Sensitive indicators of inorganic mercury toxicity. Arch Environ Health 1986;41:208-15.

8. Miller G, Chamberlin R, McCormack WM. An outbreak of neuromyasthenia in a Kentucky factory--the possible role of a brief exposure to organic mercury. Am J Epidemiol 1967;86:756-64. *The manufacturer sold this paint only in Michigan.

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