Child and Chest Health Care Delhi NCR

Peter is a male child of 2 years and 9 months, who was brought to our OPD, by their parents.Parents complained of, they saw their son playing with glass mercury thermometer which was broken.The child was suffering from fever.They took advice from local doctor and the doctor adviced them to give syrup paracetamol when temperature by mouth was more than 99.5 degree F.They measured the temperature and forgot to keep the thermometer at safe place.They could not see the mercury in the thermometer which was broken in the hand of their son and assumed that the child has ingested the mercury.There was no vomiting and the child was not restless after the event.Parents recalled the time lapsed from event to reaching the OPD,was approximately 2-3 hours.On examination the mouth cavity was completely normal with no sign of any cut or abrasion.Vital parameters were within normal limits.Chest on auscultation was clear.On abdominal examination,there was no distension and no tenterness.The child was admitted for observation of any sign of deterioration.Chest X-Ray and abdominal X-Ray were done next day.Abdominal X-Ray showed white dots scattered throughout the abdomen which we thought,was due to mercury particles.The child remained stable throughout the hospital course and the repeat X-Ray abdomen showed the clearance of white dots at the time of discharge.

Mercury is a silver white element which is liquid at room temperature.It is used in mercury thermometer to record temperature and in manual sphygmometer to measure blood pressure .Both are commonly used in houses in India.On ingestion,it is not absorbed by the mucosa of mouth and intestine as long as the mucosae are intact.But abrasion or cut due to any reason in the mucosa breach this barrier and it gets absorbed and affects various organ including kidney and reproductive organs.In our case there was no breach in the continuity of mucosa ,so the mercury could not be absorbed and the course of hospital stay of the child was uneventful.Glass mercury thermometer contains 500-700 mg of mercury,which if get absorbed may harm different organs.

On ingestion,vomiting should not be induced and activated charcol should not be given but close monitoring is essential.

REFERENCES :

1.Yaghmaie B, Jazayeri SB, Shahlaee A.Mercury ingestion from a broken thermometer. Arch Dis Child.2012; 97:852.

2.Caravati EM, Erdman AR, Christianson G, Nelson LS, Woolf AD, Booze LL, et al; American Association of poison control centres.Elemental mercury exposure:an evidence-based consensus guideline for out-of- hospital management. Clin toxicol (Phila).2008; 46:1-21.

3.Saxena R, Kumar A,Satkurunathan Mercury aspiration from a broken thermometer. BMJ case Rep.2009.doi:10.1136/bcr.04.2009.1741.