Treatment of Severe Thallium Intoxication

Malbrain, Manu L. N. G.; Lambrecht, Guy; Zandijk, Erik; Demedts, Paul; Neels, Hugo; Lambert, Willy; Leenheer, A.P. De; Lins, Robert; Daelemans, R.

doi:10.3109/15563659709001173

Cited by 31 publications

(14 citation statements)

References 9 publications

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“…Early detection of cases of thallium poisoning and the initiation of management has shown to improve survival, reduce the duration of illness and minimize the extent of neurological damage [12]. Prussian blue, the antidote for thallium poisoning and hemodialysis are the cornerstones in acute thallium poisoning management.…”

Section: Discussionmentioning

confidence: 99%

Acute Thallium Poisoning: Series of Ten Cases

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Acute Thallium Poisoning: Series of Ten Cases

et al. 2011

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“…In one case report, a patient was treated with Prussian blue for 46 days as well as with forced diuresis using furosemide, and with hemodialysis, and the three methods were somewhat efficacious in removing thallium with Prussian blue removing the largest amount [14]. In another case report, a patient with severe acute poisoning resulting in serum thallium levels of 5,249 mcg/L received Prussian blue and hemodialysis promptly and had a favorable outcome [15]. The literature suggests the hemodialysis should be considered early in massive toxicities; our patient did not receive CRRT until the fifth day.…”

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Thallium Toxicity: Challenges in Management

et al. 2012

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Background Thallium is a highly toxic compound and is occasionally involved in intentional overdoses or criminal poisonings. Accidental poisonings also occur, but are increasingly rare owing to restricted use and availability of thallium. We report a fatal suicidal ingestion of thallium sulfate rodenticide in which multi-dose activated charcoal (MDAC) and Prussian Blue (PB) were both used without changing the outcome. Case report A 36 year old man ingested an unknown amount of thallium sulfate grains from an old rodenticide bottle. He presented to an emergency department (ED) 45 minutes later with abdominal pain and vomiting. On examination he was agitated with a blood pressure of 141/ 60 mmHg and a heart rate of 146 beats per minute (bpm). He received MDAC during his initial ED management and was started on PB 18 hours post arrival; he was intubated on the following day for airway protection. The patient continued to be tachycardic and hypertensive and subsequently developed renal failure. On hospital day three, the patient developed hypotension that did not respond to fluids. The patient required vasopressors and was transferred to a tertiary care center to undergo continuous renal replacement therapy (CRRT). The patient died shortly after his transfer. His last blood thallium concentration was 5369 mcg/L, a spot urine thallium >2000 mcg/L, and a 24-hour urine thallium was >2000 mcg/L. Conclusion Though extremely rare, thallium intoxication can be lethal despite early administration of MDAC and use of Prussian blue therapy. Rapid initiation of hemodialysis can be considered in cases of severe thallium poisoning, to remove additional thallium, to correct acid-base disturbance, or to improve renal function.

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“…This is based on substantial in vitro binding data (Lehmann and Favare, 1984;Hoffman et al, 1999), diverse animal investigations (Heydlauf, 1969;Kravzov et al, 1993;Meggs et al, 1997;Rios and Monroy-Noyola, 1992), and numerous human case reports and series demonstrating safety and efficacy (Atsmon et al, 2000;Malbrain et al, 1997;Meggs et al, 1994;Pai, 1987;Pedersen et al, 1978;Stevens et al, 1974;Kamerbeek et al, 1971). PB was first prepared in 1704 as a potential dye (Buser et al, 1977).…”

Section: Introductionmentioning

confidence: 99%

Quantitative determination of thallium binding to ferric hexacyanoferrate: Prussian blue☆

Yang

Faustino

Progar

et al. 2008

International Journal of Pharmaceutics

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Ferric hexacyanoferrate, (Fe 4 III [Fe II (CN) 6 ] 3 ), also known as insoluble Prussian blue (PB), is the active pharmaceutical ingredient (API) of Radiogardase which is the first approved drug product (DP) for treatment of thallium and radiocesium poisoning. The aim of this study is (1) to determine the in vitro thallium binding capacity and binding rates of insoluble PB; and (2) to evaluate the effect of physiological pH conditions, PB particle size and storage conditions on the binding to PB. Experimental pH levels from 1.0 to 7.5 were used to cover the range of pH levels that PB may encounter when traveling through the gastrointestinal (GI) tract in humans. Measurements of thallium binding were made between 1 and 24 h, to cover gastric and intestinal tract residence time. PB was found to have a binding capacity of approximately 1400 mg/g at pH 7.5. When the pH decreased, the binding decreased as well. The results indicated that the hydration state of PB influences the thallium binding process. It was also found that there exits a direct correlation between the moisture loss in PB and the thallium binding rate constant. The PB with 17 mol of water had a binding rate constant of 0.52, which was reduced to 0.32 when PB was dehydrated to 2.5 mol of water. Significant differences were observed in both binding capacity and binding rate constant among PB fractions with different particle size ranges. PB fraction with particle size of 220-1000 m had a binding rate constant of 0.43, which increased to 0.64 when the particle size was reduced to 32-90 m. Batch-to-batch variation in thallium binding was also observed among the APIs and the DPs and this was related to particle size and hydration state. These findings can be utilized to evaluate and predict drug product quality under certain manufacturing and dry storage conditions. Published by Elsevier B.V.

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Treatment of Severe Thallium Intoxication

Cited by 31 publications

References 9 publications

Acute Thallium Poisoning: Series of Ten Cases

Acute Thallium Poisoning: Series of Ten Cases

A Fatal Case of Thallium Toxicity: Challenges in Management

Quantitative determination of thallium binding to ferric hexacyanoferrate: Prussian blue☆

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