Broken Thermometer Research Articles

Subperitoneal pelvic exposure of elemental mercury from a broken thermometer

Subperitoneal pelvic exposure of elemental mercury from a broken thermometer is quite rare. The outcome and intervention for such a situation is uncertain. A 10-month-old boy was exposed to elemental mercury when a mercury thermometer was broken while being used to measure a central temperature rectally. Deposits of mercury were localized in the subperitoneal pelvic cavity, as seen on consecutive abdominal films and CT scan. Serum and urine mercury concentrations were elevated but no systemic symptoms or signs were found. Laparoscopic surgery removed most of the mercury deposits but failed to remove them completely. At the 11-month follow-up, serum and urine mercury concentrations normalized and no systemic toxicity was present.

Fluoroscopy-guided percutaneous aspiration of metallic mercury in soft tissues

Subcutaneous injection of metallic mercury is rare and may produce mercury poisoning. Rapid diagnosis and aggressive treatment are usually required. Removal of mercury deposited in soft tissue is a challenging clinical problem. Surgery is usually performed to remove the mercury together with the affected tissue. 1 Zorrilla P. Morales C. Gómez L.A. et al. Intravenous and subcutaneous injection of mercury: an unusual self-injury. J Trauma. 2009; 66: E32-33 Crossref PubMed Scopus (4) Google Scholar , 2 Kayias E.H. Drosos G.I. Hapsas D. et al. Elemental mercury-induced subcutaneous granuloma. A case report and review of the literature. Acta Orthop Belg. 2003; 69: 280-284 PubMed Google Scholar , 3 Yotsuyanagi T. Yokoi K. Sawada Y. Facial injury by mercury from a broken thermometer. J Trauma. 1996; 40: 847-849 Crossref PubMed Scopus (18) Google Scholar , 4 Zupanc O. Zupanc T. Brvar M. et al. Arthroscopic treatment of knee joint injury for intraarticular mercury form a broken thermometer. Arch Orthop Trauma Surg. 2008; 128: 979-983 Crossref PubMed Scopus (5) Google Scholar , 5 Vernon S.E. Case report: subcutaneous elemental mercury injection-clinical observations and implications for tissue disposal from the histopathology laboratory. Ann Clin Lab Sci. 2005; 35: 86-90 PubMed Google Scholar , 6 Krohn I.T. Solof A. Mobini J. et al. Subcutaneous injection of metallic mercury. JAMA. 1980; 243: 548-549 Crossref PubMed Scopus (40) Google Scholar However, surgical removal is laborious, invasive, and may fail, even under fluoroscopic guidance, because the mercury tends to disperse over a wide area. 1 Zorrilla P. Morales C. Gómez L.A. et al. Intravenous and subcutaneous injection of mercury: an unusual self-injury. J Trauma. 2009; 66: E32-33 Crossref PubMed Scopus (4) Google Scholar In this report, we describe a fluoroscopy-guided percutaneous aspiration technique for removing mercury deposited in soft tissue from a broken thermometer.

Arthroscopic treatment of knee joint injury for intraarticular mercury from a broken thermometer

Intraarticular injection of metallic mercury (Hg) such as those found in thermometers is very rare. According to available data in literature, an arthroscopic presentation and treatment of knee injury that had intraarticular elementary mercury seems not to have been published yet. We report a first case of arthroscopically treated chronic right knee synovitis after accidental intraarticular mercury infusion by a broken thermometer in an 11-year-old boy. Mercury levels in blood and urine were slightly increased, but no systemic mercury intoxication developed. Inflamed synovia as well as synovia with incorporated metal particles was excised. A histological analysis of macroscopically inflamed synovia revealed an unspecific inflammation reaction. The symptoms gradually subsided and the knee regained full function. However, all the metal particles were not successfully removed from the injured knee; therefore a careful follow-up of the patient was provided. It seems that arthroscopic excision and lavage could be suitable treatments for knee injury, infused with elementary mercury, and toxic knee synovitis.

Exposure assessment of household mercury spills

Elemental mercury spills in households still occur with unfortunate regularity. Devices that contain enough mercury to pose exposure concerns are common to many homes. Response to household spills differs substantially from industrial settings and improper response can increase the risk of harmful health effects. Suggested inhalation exposure levels for residential settings are much different than occupational guidelines. The characteristics of the exposed population in homes differ greatly from industrial workplace spills. Exposure assessment in the home requires the use and understanding of non-occupational guidance. The current occupational OSHA permissible exposure limit and ACGIH threshold limit value are 100 μg/m3 and 25 μg/m3, respectively. By contrast, the Agency for Toxic Substances and Disease Registry (ATSDR) Minimum Risk Level (MRL) for elemental mercury vapors is 0.2 μg/m3, well below occupational levels. The derivation of the MRL considers sensitive populations and 24 hour-a-day, seven days-a-week lifetime exposure. Occupancy criteria of 1.0 μg/m3 and 3.0 μg/m3 for residential and commercial settings have been proposed. These low levels dictate sophisticated analytical equipment or laboratory methods of analysis. Two cases illustrate how difficult it may be to assess hazards based solely on spill amount. In both cases a direct reading cold vapor atomic absorption unit was used to measure airborne mercury concentrations. Case A involved a broken thermometer spill (about 0.5 g) in a master bedroom that was cleaned using a household vacuum. Airborne concentrations throughout the home exceeded recommended exposure levels for residential settings (range of 2.5–14 μg/m3). Case B involved a broken thermostat spill (about 3.0 g) cleaned with a shop vacuum. Exposure levels were less than 1 μg/m3 throughout the home (range 0.4–0.7 μg/m3). When vacuums are used to remove mercury, quantities of mercury as small as that associated with a fever thermometer can represent an exposure hazard. The difference in exposure levels between the two cases is thought to be related to the operational differences between vacuum cleaners and the impact they had on vapor production. Unfamiliarity with the hazards posed by seemingly small amounts of mercury in the home and workplace can lead to undesirable and often costly consequences.

Floor of mouth injury by mercury from a broken thermometer

Floor of mouth injury by mercury from a broken thermometer

Migration of metallic mercury in the hand

A case of an unusual injury to the hand involving a broken thermometer, resulting in migration of mercury within the tissues requiring surgical removal, is described.

Facial Injury by Mercury from a Broken Thermometer

The case of a 2-year-old girl with a facial soft-tissue injury from an accident with a mercury thermometer is presented. All tissues containing droplets of metallic mercury should be removed immediately and careful examination for signs of mercury poisoning should be conducted over the long term.

Hypertension artérielle par intoxication au mercure: intérêt diagnostique du captopril

background. - Mercury poisoning is a rare cause of hypertension in children. Urinary excretion sometimes remains low despite severe clinical intoxication. Case report. - A 23 month-old girl was admitted with hypertension, tachycardia, apathy, irritability and excessive sweating. Erythromelalgia and neurologic symptoms permitted the diagnosis of acrodynia. Urine mercury remained normal until chelation. Captopril significantly increased urine mercury concentration but failed to improve clinical manifestations. Clinical improvement required infusions of BAL® for 5 days then oral dimer-captosuccinic acid for 3 months. Metal vapors originated from the mercury which spilled from a broken thermometer onto the carpet. Comments. - Low basal urine mercury could be associated with real mercury poisoning. Small amounts of metal mercury held in a thermometer could produce a high level of mercury vapor leading to intoxication in young children. The binding capacity of metal ions by captopril could be used to increase urine mercury output. Nevertheless, captopril therapy fails to improve acrodynia. Total elimination of mercury requires long-term therapy with BAL® or dimercaptosuccinic acid. Conclusions. - An unexpected mode of intoxication and low basal urine mercury are not decisive arguments against mercury poisoning, which is the only cause of acrodynia.

Cutaneous reaction from a broken thermometer

A cutaneous and soft tissue reaction that resulted from a broken thermometer inside the mouth of a 10-year-old boy is described. Metallic mercury globules and glass pieces were identified in the excised tissue. On histologic examination, a zone of necrosis, polymorphonuclear leukocytes, macrophages, and multinucleated giant cells surrounded metallic mercury that appeared as dark opaque globules. Dense fibrosis and reactive lymphoid hyperplasia were also noted in the dermis and deeper tissues. The gold lysis test, scanning electron microscopy, and energy-dispersive x-ray analysis confirmed the presence of mercury in the tissue. A literature review on cutaneous mercury granuloma illustrates its unpredictable course. The cutaneous reaction may remain localized, but some cases are associated with an elevated mercury level in blood and urine, pulmonary embolism, mercury poisoning, and even with fatal outcome. Various manifestations of mercury poisoning and guidelines for the management of cutaneous mercury granuloma are discussed.

Foreign Bodies in the Tracheobronchial Tree

Between 1972 and 1984, we treated 66 patients with foreign bodies (FBs) in the tracheobronhial tree. Twenty-six patients (39.4 percent) were between one and two years old; 52 (78.8 percent) were under age ten. Forty-four FBs (67 percent) were fruit and vegetable seeds and nuts. Soft organic material (meat, cucumber peels) was found in four patients, chicken bones in six, pins and needles in six, other nonorganic materials (toys, stone, broken thermometer) in six. In 55 patients, the FB was removed at bronchoscopy; three patients coughed up the FB shortly after bronchoscopy. Eight patients were operated on because the impacted FB could not be removed at repeat bronchoscopy trials. In this group, the FB was removed through a bronchotomy in two patients, but in six, pulmonary resection was necessary because of severe bronchiectasis (FBs had been impacted from ten months to 12 years). Stiff bronchoscope was used in all patients. In several cases, the flexible bronchoscope was used initially but proved inadequate. There were three complications, two related to hypoxia, but no deaths. Infants and little children should be prevented from reaching peanuts and seeds. When presence of a FB is suspected, and in children with unresolving pneumonic process, early bronchoscopy is mandatory. Expert anesthesia is essential, and hypoxia must be avoided.

Knee Joint Injury by Mercury From a Broken Thermometer

An 11-year-old boy injured the inner side of his left knee when accidentally breaking a mercury thermometer. He immediately developed an acute synovitis. Soft tissues and synovium containing metallic mercury droplets were completely removed at operation. The patient recovered within five weeks. Symptoms and signs of acute or chronic mercury poisoning were not observed. However, because injury by a mercury thermometer may become very serious if the metal is absorbed by the tissues and disseminated through the circulatory system, immediate local excision of tissue is necessary. Interestingly, the histologic appearance of the synovial membrane was remarkable by the lack of any foreign body giant cell reaction.

Broken Thermometer and Mercury Absorption

To the Editor.— The implication that could be derived from Olivera (236:1936, 1976), that the absorption of mercury from a broken thermometer has no clinical importance, may not be quite correct. We recently had a patient who swallowed the mercury from a broken thermometer, and later it appeared in the urine at a level above the maximal permissible concentration. 1

Soft-tissue injury by mercury from a broken thermometer

Soft-tissue injury by mercury from a broken thermometer

Soft-tissue injury by mercury from a broken thermometer. A case report and review of the literature.

A case of soft-tissue injury to the hand resulting from an accident with a mercury thermometer in which there was no serious untoward effect other than a local fibrous and lymphoreticular reaction is described. Other instances of similar soft-tissue injuries from the literature, illustrating the unpredictable and sometimes fatal consequences of such accidents, are reviewed. Injuries with metallic mercury through iatrogenic means, or by self-administration into arteries, veins, and gastrointestinal tract, are also mentioned.

MERCURIC CHLORID POISONING

The most trying group of poisoned patients encountered at a general hospital is the group that has taken mercuric chlorid. It is taken with suicidal intent in over 90 per cent. of the instances, and the vast majority of the group are young women. The accidental poisonings are infrequent, and occur when a tablet is taken by mistake for a coal tar or other preparation. Occasionally, the patient who has used the solid tablet in the vagina will present herself. Once a child who had swallowed the mercury from a broken thermometer came under treatment. For the most part, the poison is taken by mouth, usually by swallowing the tablets, and occasionally by dissolving them in water before swallowing. One patient ate some diluted mercurial ointment, and another drank a 1 : 10 mercuric chlorid solution which she obtained in a hospital. When the mercury, even in tablet form, enters

Broken Thermometer in Child's Rectum.

Rochester, Minn., Dec. 6, 1906. To the Editor: —I was interested in the report of a broken thermometer in a child's rectum, inThe Journal, Dec. 1, 1906, page 1841, and was surprised to read that no other such case was found recorded. A similar case occurred in my practice about twelve years ago. A child about a year and a half old seemed indisposed and the mother proceeded to take the temperature by rectum. The child made a sudden movement and the instrument broke off at the upper constriction, leaving the bulb in the rectum. I reached the house about an hour afterward. The child was evidently in pain, crying and straining ineffectually. An anesthetic was given, and with the aid of a small bivalve ear speculum the bulb was extracted. It was placed somewhat obliquely; the sharp, jagged end had penetrated the mucous membrane, thus probably frustrating the