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Mercury aspiration from a broken thermometer

Rohit Saxena¹, Arun Kumar¹, Maheshwaran Satkurunathan²

¹ Department of Paediatrics/Neonatology, Mayday University Hospital, 530 London Road, Croydon, Surrey, CR7 7YE, UK
² Department of Radiology, Mayday University Hospital, 530 London Road, Croydon, CR7 7YE, UK

Correspondence to:
Rohit Saxena, rohitlibran2002{at}doctors.org.uk

A 3-year-old boy presented to our Accident and Emergency (A&E) department after biting on a glass mercury thermometer. He was clinically stable. A chest x ray revealed small globules of mercury in the lungs (fig 1).

View this figure (152K): in this window | in a new window | PowerPoint for Teaching   Figure 1 An anterior–posterior erect chest and abdominal radiograph shows multiple specks of metallic density over the right middle lobe and lower lobe proximally with a speck overlying the right main bronchus and another speck seen in the left upper zone. Further metallic densities overlying the stomach and proximal small bowel loops on the left (see arrows).

 

He was observed overnight and discharged without any complications. Metallic mercury ingested in a single acute dose, as with a mercury thermometer containing about 500–700 mg of elemental mercury is virtually non-toxic, however, significant exposure may occur through the inhalation of mercury vapours.¹ Acute inhalation of mercury vapour leads to the development of acute symptoms such as cough, breathlessness and chest tightness after a few hours of exposure.² A chest x ray is a useful investigation as inhaled mercury globules are radio opaque and can give an estimate about severity of amount inhaled. Chest x ray will also be useful in assessing other pulmonary manifestations such as pneumonitis, pulmonary oedema, necrotising bronchiolitis, acute respiratory distress syndrome (ARDS) and symptoms from aspiration of accompanying foreign body such as glass, if any. Management of mercury inhalation is essentially supportive with removal from the source of exposure. In case of toxicity, the chelating agent of choice is 2,3-dimercapto-1-propane sulfonic acid, intravenous or oral, as determined by the severity and nature of toxicity. This report highlights the potential risk to children with the continued use of glass mercury thermometers in the UK, mainly by immigrant families who acquire these from abroad. It calls for measures to ensure greater community awareness regarding the hazards and education about safer options.

Competing interests: None.

Patient consent: Patient/guardian consent was obtained for publication.

1. Ozuah, P. Mercury poisoning. Curr Probl Pediatr 2000; 30: 91–9.[CrossRef][Medline]
2. Moxham, JP, & Lee, PK. Broken glass mercury thermometer: a difficult airway foreign body. Otolaryngol Head Neck Surg 2002; 127: 339–41.[CrossRef][Medline]

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