Lesson of the week: Mercury poisoning after spillage at home from a sphygmomanometer on loan from hospital

Be aware of the potential for toxicity of mercury spilled from broken medical equipment. When patients are managed at home, they or their carers have to operate medical equipment. This case report highlights important educational and environmental health aspects of issuing hospital equipment for home use, a practice that is likely to become more common in the future. We describe a 9 year old boy who had neurological and renal complications after mercury spillage from a sphygmomanometer three months after it had been provided by the hospital for monitoring blood pressure at home. The family were unaware of the potential risks of mercury exposure before the patient became acutely ill. A 9 year old boy presented to his local hospital with a three week history of abdominal pain, constipation, lethargy, limb pain, and unsteadiness. Physical examination showed mild facial weakness, areflexia, ataxia, and impaired sensation and led to a provisional diagnosis of Guillaine-Barre syndrome. The boy's constant restlessness was considered strange, but his mother described him as hyperactive and regarded this behaviour as normal. It was noted, however, that his handwriting and schoolwork had deteriorated over the preceding month. Features of encephalopathy accompanied by peripheral neuropathy led to a suspicion of …