A case of severe thallium poisoning successfully treated with hemoperfusion and continuous veno-venous hemofiltration

Abstract

<jats:p> Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. It is most often treated by an oral administration of Prussian blue. Thallium has a long physiological half-life, and Prussian blue cannot sequester thallium outside the digestive tract. Therefore, the first priority in treating severe thallium poisoning is to lower blood levels as soon as possible. We report the case of a patient with supralethal blood levels of thallium treated successfully using combined hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH). Three rounds of HP alone decreased blood thallium levels by 20.2%, 34.8%, and 32.2%, while each of the five subsequent rounds of CVVH reduced thallium blood levels by 63.5%, 64.2%, 42.1%, 18.6%, and 22.6%. The reversal of symptoms and prevention of lasting neurological damage indicates that HP, CVVH, 2,3-dimercaptopropane-1-sulfonate, neuroprotective agents along with supportive therapy were used successfully to treat a case of severe thallium poisoning. </jats:p>

Thallium toxicity due to audultered infusion with thallium sulfate in eight members belonging to the same family nucleus: Autopsy findings and ICP-MS analysis (inductively coupled plasma mass spectrometry) in a triple homicide

“…Thallium is a toxic "heavy metal" [15] that can be found in low concentrations [16] in several minerals of the Earth crust [13] and used in many industries: bijous [17], photography and optical lenses [18], dyeing and pigments [17], concrete industries [6], waxing products [19] and for green fireworks [20] that take advantage of the spectral emissions of this element [21].…”

Clinical characteristics and treatment of thallium poisoning in patients with delayed admission in China

“…In addition to PB treatment, many studies have reported that blood purification is also an important treatment option. [3,4,6,10,11,14,15] Although studies have shown that blood purification has a low clearance rate of thallium salt, it is still superior to other current removal methods and is therefore recommended for the treatment of thallium poisoning, especially severe thallium poisoning. [10] Many experts have reached a consensus that the earlier that blood purification begins, the better the patient outcomes will be.…”

Hair Loss: Evidence to Thallium Poisoning

“…Due to the small molecular size and low binding affinity to protein, thallium is thought to be dialyzable. Therefore, hemoperfusion and hemodialysis should be conducted early in massive toxicities [ 15 ]. In our study, the patient received significant clinical improvement of neurological manifestations and liver function parameters after ten cycles of hemoperfusion and hemodialysis, which was in consistent with the findings revealed in Misra's [ 16 ] and Lu's [ 17 ] researches.…”