What is the treatment for mercury poisoning from a broken thermometer?

Treatment for Mercury Poisoning from a Broken Thermometer

For a broken household thermometer, asymptomatic patients require proper cleanup and home observation only—no medical treatment is needed unless symptoms develop or the mercury was heated, vacuumed, or the exposure was in an enclosed space. 1

Immediate Assessment and Triage

When to Send to Emergency Department Immediately

• Any respiratory symptoms (cough, dyspnea, chest pain) regardless of exposure amount 1
• Mercury was recently heated (stove, oven, furnace) in an enclosed area—all exposed persons need ED evaluation due to high toxicity risk 1
• Ingestion of more mercury than contained in a household fever thermometer or any abdominal pain after ingestion 1
• Mercury deposited or injected into soft tissue (requires surgical evaluation) 1, 2
• Suspected self-harm or malicious administration 1

When Outpatient Evaluation is Appropriate

• Chronic toxicity symptoms (rash, tremor, weight loss) warrant non-urgent healthcare evaluation 1
• Asymptomatic patients with concern for high-dose or chronic exposure can be evaluated as outpatients 1
• Pregnant asymptomatic patients should see their obstetrician or primary care provider as outpatients—immediate ED referral is not required 1

Safe for Home Observation

• Asymptomatic patients with brief, unintentional, low-dose vapor exposures from a simple broken thermometer 1

Immediate Decontamination

Dermal Exposure

• Remove all jewelry immediately and wash affected area with mild soap and water 1
• Remove all contaminated clothing and place in sealed plastic double-bag for proper disposal 1

What NOT to Do

• Do not induce emesis for ingestions 1
• Do not administer activated charcoal (ineffective for mercury) 1
• Do not use brooms or vacuum cleaners for cleanup—this aerosolizes mercury and dramatically increases exposure risk 1, 3

Environmental Cleanup (Critical to Prevent Ongoing Exposure)

Small Spills (Household Thermometer)

• Must be properly cleaned up—even small amounts require appropriate handling 1
• Follow EPA guidelines at www.epa.gov/epaoswer/hazwaste/mercury/faq/spills.htm 1
• Never discard in household trash, drains, or sewers 1

Large Spills or Vacuumed Mercury

• Contact health department for environmental assessment if mercury was vacuumed or swept 1
• Professional cleanup required for spills larger than a thermometer (professional company, state health department, or EPA) 1
• Consider healthcare referral for those with documented high air mercury concentrations 1

Chelation Therapy Indications

When Chelation is Indicated

• Symptomatic patients with confirmed mercury intoxication (elevated blood/urine mercury levels) 4, 3
• Chelation agents include: dimercaptosuccinic acid (DMSA/succimer), dimercaptopropane-1-sulfonate (DMPS), British anti-Lewisite (BAL), or penicillamine 4, 5
• DMSA and DMPS are preferred over dimercaprol due to less toxicity and oral administration 5

When Chelation is NOT Indicated

• Asymptomatic patients with simple thermometer exposure 1
• Exceptional indication only when mercury deposits remain after surgical removal 2

Monitoring and Follow-up

Laboratory Testing

• Blood and urine mercury levels should be obtained when mercury intoxication is suspected 4, 3
• Important caveat: Blood mercury levels are unreliable in predicting severity of toxicity 4
• Symptomatic children had significantly higher blood mercury levels than asymptomatic children (P = 0.003) 3

Clinical Monitoring

• Watch for progression of symptoms: Initial flu-like illness can progress to severe pulmonary, neurological, renal, hepatic, hematological, and dermatological dysfunction 4
• Specific complications include encephalopathy, nephrotic syndrome, and polyneuropathy 4

Critical Pitfalls to Avoid

• Underestimating heated mercury exposure: Heating dramatically increases vapor toxicity—all exposed persons need evaluation 1
• Using vacuum cleaners: This is the most common error and converts a minor exposure into a major one by aerosolizing mercury throughout the environment 1, 3
• Delayed removal from contaminated environment: The priority is immediate removal from exposure source before any other intervention 4, 3
• Exposure time matters: Longer exposure correlates with higher toxicity (symptomatic children had 3.5 hours vs. 2 hours for asymptomatic, P = 0.003) 3