Toxicokinetic aspects of thallium poisoning. Methods of treatment by toxin elimination

Groot, Gerard de; Heijst, A. N. P. van

doi:10.1016/0048-9697(88)90213-6

Cited by 30 publications

(23 citation statements)

References 21 publications

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“…*Actual Thallium level was far above from the lab reporting limit for Blood >1000 mcg/L and Urine >2000 mcg/L thallium's prolonged half-life, which can be up to 15 days in patients with massive ingestions [9,10]. Elimination of thallium occurs via feces (66 %) and urine (33 %) [9]. Treatment options in cases of acute thallium toxicity include, in addition to supportive care and multi-dose activated charcoal, the use of Prussian blue and extracorporeal drug removal including hemodialysis and hemoperfusion [6].…”

Section: Discussionmentioning

confidence: 99%

“…The second slow-exchange compartment involves the central nervous system, and the third compartment consists of the large and small intestine. This last compartment is responsible for extensive entero-enteric circulation between all parts of the intestines [9] and contributes to the Lab normal values of spot urine, <0.4 mcg/L; 24 h urine, <2 mcg/L; random blood, <5 mcg/L. *Actual Thallium level was far above from the lab reporting limit for Blood >1000 mcg/L and Urine >2000 mcg/L thallium's prolonged half-life, which can be up to 15 days in patients with massive ingestions [9,10].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Thallium Toxicity: Challenges in Management

et al. 2012

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“…Reported differences in the rate and extent of Tl distribution probably stem from variations in modeling procedures used to characterize its toxicokinetics, particularly regarding timing of assessment (i.e., before or during terminal or steady-state distribution). It is rapidly distributed into the intracellular space, exhibiting an initial apparent half-life of 5 minutes (6,10). Distribution into other peripheral compartments, including the central nervous system (CNS), occurs over 24 hours (6,10,11).…”

Section: Tl Toxicokineticsmentioning

confidence: 99%

“…It is rapidly distributed into the intracellular space, exhibiting an initial apparent half-life of 5 minutes (6,10). Distribution into other peripheral compartments, including the central nervous system (CNS), occurs over 24 hours (6,10,11). Tl has a large apparent volume of distribution (3-10 L/kg) (5,6,8,9).…”

Section: Tl Toxicokineticsmentioning

confidence: 99%

“…Tl distributes widely throughout the body in a multicompartment fashion; two-and three-compartment kinetic models have been previously fit to Tl concentration-time data (6,(8)(9)(10). Reported differences in the rate and extent of Tl distribution probably stem from variations in modeling procedures used to characterize its toxicokinetics, particularly regarding timing of assessment (i.e., before or during terminal or steady-state distribution).…”

Section: Tl Toxicokineticsmentioning

confidence: 99%

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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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Thallium

Bertram¹,

Bertram²

2004

Elements and Their Compounds in the Environment

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Toxicokinetic aspects of thallium poisoning. Methods of treatment by toxin elimination

Cited by 30 publications

References 21 publications

A Fatal Case of Thallium Toxicity: Challenges in Management

A Fatal Case of Thallium Toxicity: Challenges in Management

Extracorporeal Treatment for Thallium Poisoning

Thallium

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