Acute Thallium Poisoning: Series of Ten Cases

Hammouri, Fawzi Al; Darwazeh, Ghaleb; Said, Anas; Ghosh, Raed Abu

doi:10.1007/s13181-011-0165-3

Cited by 48 publications

(30 citation statements)

References 12 publications

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“…The available human literature on Tl mainly consists of case reports from the results of acute poisoning, accidental ingestion, or suicide attempts (Hammouri et al, 2011). Although the acute classic syndrome of Tl poisoning involves gastroenteritis, polyneuropathy, and alopecia, not all these effects are observed in every case.…”

Section: Toxicitymentioning

confidence: 99%

Thallium

Thompson¹

2015

Handbook of Toxicology of Chemical Warfare Agents

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Section: Toxicitymentioning

confidence: 99%

Thallium

Thompson¹

2015

Handbook of Toxicology of Chemical Warfare Agents

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“…Hence, the quality of evidence for all recommendation statements is "very poor" (Table 5) (55). There were 11 deaths; in all cases, exposure was massive or ECTR was initiated at least 48 hours after exposure (48,(56)(57)(58)(59)(60). Occasionally, there were anecdotal reports of striking clinical improvement in patients treated within 24 hours of exposure, although the evidence is inconclusive (41,44,45,(61)(62)(63).…”

Section: Recommendationsmentioning

confidence: 99%

Extracorporeal Treatment for Thallium Poisoning

Ghannoum¹,

Nolin²,

Goldfarb³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).Methods After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations.Results Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is .1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is ,0.1 mg/L for a minimal duration of 72 hours (2D).Conclusion Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.

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“…Cases of intoxication manifest gastrointestinal signs and symptoms (diarrhea and vomiting), dermatologic alterations (alopecia, eruptions of the face, Mee´s stripes in nails, eczematous lesions, anhidrosis, palmar erythema, stomatitis, and painful glossitis), cardiac (tachycardia and hypotension) and neurological dysfunctions (Disorientation, lethargy, ataxia, convulsion, psychosis, insomnia and coma) [2,14,17]. In severe cases of intoxication, individuals died less than a week after thallium ingestion [12,15,18].…”

Section: Introductionmentioning

confidence: 99%

Metallothionein alone or in combination with Prussian blue attenuates acute thallium systemic toxicity in rats.

Anaya-Ramos

Dı́az-Ruiz

Rı́os

et al. 2020

Preprint

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Background: Acute Thallium (Tl) toxicosis is still a health problem, worldwide. Oral administration of Prussian blue (PB) is the antidotal treatment of election. On the other hand, metallothionein (MT) is a low-molecular-weight protein, with high content of cysteines (25–30%). MT is able to chelate metals as an efficient endogenous mechanism of detoxification. It is also a potent antioxidant. Methods: In this study, we tested the ability of MT at two doses (100 and 600 µg/rat), administered alone or in combination with Prussian blue (PB) (50 mg/kg) to decrease thallium (Tl) toxicity. A sublethal dose of Tl (16mg/kg) was injected i.p. to male Wistar rats. Antidotes were administered twice-daily, starting 24h after Tl injection, for 4 days. Tl concentrations were analyzed in body organs and brain regions, 5 days after Tl injection. Results: Results showed a diminution (p<0.05) of Tl concentrations in all organs by effect of PB alone or in combination with MT-100 and MT-600, whereas MT-100 only decreased Tl concentrations in testis, spleen, lung and liver. Likewise, Tl in brain regions was also diminished (p<0.05) by effect of PB and both MT-100 alone or in combination in most of the regions analyzed (p<0.05). The greatest diminution of Tl was achieved when the antidotes were combined. Plasma markers of renal damage, increased after Tl administration. Both PB and MT, either alone or in combination, prevented the raise of renal markers of Tl Toxicity. Conclusions: Our findings demonstrate that the combined treatment of PB + MT is a good antidotal option against thallotoxicosis.

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Acute Thallium Poisoning: Series of Ten Cases

Cited by 48 publications

References 12 publications

Thallium

Thallium

Extracorporeal Treatment for Thallium Poisoning

Metallothionein alone or in combination with Prussian blue attenuates acute thallium systemic toxicity in rats.

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