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Images in paediatrics
Images in paediatrics Mercury ingestion from a broken thermometer A 3-year-old boy was presented to our emergency department after biting on a glass mercury thermometer. His parents had removed the thermometer along with some glass particles immediately after realising the problem. There was no history of choking, coughing or cyanosis. On admission, the patient was conscious, clinically stable and afebrile with no signs of respiratory distress, tachypnoea or tachycardia. Blood pressure recordings were normal. Chest auscultation was clear with no adventitious sounds present. There were no ulcerations on examination of the oral mucosa and pharynx. Laboratory fi ndings were normal. A chest x-ray showed no features of inhaled foreign material in the respiratory tract. On closer observation, there were a number of small round radio opaque densities overlying the patient’s abdomen. Radiology consult suggested that the mercury ingestion could give rise to such an appearance. Another abdominal x-ray was obtained (fi gure 1) which showed various sizes of globules of mercury throughout the bowel. No glass components were observed. The patient was observed overnight for signs of peritonitis or gastrointestinal bleeding and was discharged without any further complications. Similar cases of mercury exposure by a broken thermometer have been reported. In a clinically stable patient, acute mercury aspiration with small globules of mercury in the lungs were noted.1 Signs and symptoms of toxicity usually result from an inhalation of vaporised elemental mercury, which is absorbed by the alveolar membrane.2–4 In our case, the mercury was ingested rapidly and not aspirated or inhaled. Therefore, the patient showed no signs of intoxication. Glass related injuries were also considered 5 and ruled out.
Bahareh Yaghmaie,1 Seyed Behzad Jazayeri,1 2 Abtin Shahlaee1 2 1Children’s
Medical Center, Tehran University of Medical Sciences, Tehran, Iran Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
2Student
Correspondence to Abtin Shahlaee, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
[email protected] Contributors BY managed the case and provided the images; AS and SBJ converted the images to digital format, reviewed the literature, and wrote the paper, and all authors read and approved the final manuscript.
Figure 1 Plain abdominal x-ray shows multiple globular densities of various sizes scattered throughout the digestive tract. Patient consent Obtained. Ethics approval This study was approved by the ethics committee of Tehran University of Medical Sciences. Provenance and peer review Not commissioned; externally peer reviewed. Received 1 May 2012 Accepted 9 May 2012
REFERENCES 1. 2. 3. 4. 5.
Saxena R, Kumar A, Satkurunathan M. Mercury aspiration from a broken thermometer. BMJ Case Rep 2009;2009. Velzeboer SC, Frenkel J, de Wolff FA. A hypertensive toddler. Lancet 1997;349:1810. Baudouin V, Bocquet N, Rybojad M, et al. Clinical quiz. Mercury poisoning in children. Pediatr Nephrol 1997;11:263–4. Ozuah PO. Mercury poisoning. Curr Probl Pediatr 2000;30:91–9. Aprahamian N, Lee L, Shannon M, et al. Glass thermometer injuries: it is not just about the mercury. Pediatr Emerg Care 2009;25:645–7.
Competing interests None.
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Arch Dis Child 2012;97:852–852. doi:10.1136/archdischild-2012-302281
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Downloaded from adc.bmj.com on October 13, 2012 - Published by group.bmj.com
Mercury ingestion from a broken thermometer Bahareh Yaghmaie, Seyed Behzad Jazayeri and Abtin Shahlaee Arch Dis Child 2012 97: 852 originally published online June 27, 2012
doi: 10.1136/archdischild-2012-302281
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