Thallium Poisoning
From Anvita Health Wiki
Contents |
Epidemiology
- used in the manufacture of electronic components optical lenses, semiconductor materials, alloys, gamma radiation detection equipment, imitation jewelry, artist's paints, low temperature thermometers, & green firework
- trace amounts of Tl[201] are used in myocardial perfusion & viability scintigraphy
- thallium exposure may occur at smelters in the maintenance & cleaning of ducts & flues
- contamination of cocaine, heroin, & herbal products
Pathology
- can be absorbed through the skin, ingested or inhaled
- ingestion of 1 gram or 8 mg/kg is toxic
- Tl+ mimicks K+ but additionally binds thiols
- riboflavin sequestration
- inhibits pyruvate kinase & succinate dehydrogenase
- impaired glucose metabolism
- disruption of the Kreb cycle
- ribosomal inhibition
- myelin sheath injury
Clinical-manifestations
Laboratory
-
- anemia, leukocytosis, eosinophilia have been reported after thallium exposure
- electrolyte & glucose abnormalities, hypocalcemia, & impaired renal function & liver function have been reported after thallium exposure
- 24 hour urine thallium
- pregnancy test for all women of child-bearing age [3]
Diagnostic-procedures
-
- axonal sensorimotor peripheral neuropathy
- nerves innervating the feet most affected
- electroencephlogram may show nonspecific slow-wave activity in severe cases
- delayed visual evoked response
- changes tend to occur before clinical symptoms Radiography:
- abdominal radiograph may reveal thallium metal after ingestion ( thallium is radiopaque)
Management
- ABCs
- oxygen as necessary
- intravenous access
- remove contaminated clothing as soon as possible
- avoid self-exposure & wear protective clothing appropriate to the type & degree of contamination
- wear air-purifying or supplied-air respiratory equipment as necessary
- goals
- initial stabilization
- prevention of absorption
- enhanced elimination
- antidotal therapy
- activated charcoal should be considered in patients presenting within 1 hour of ingestion with an intact or protected airway
- whole-bowel irrigation with polyethylene glycol electrolyte lavage solution may be useful
- potassium ferrihexacyanoferrate ( Prussian blue, Radiogardase)
- hemodialysis may be useful early prior to tissue distribution
More General Terms
Additional Terms
References
- Wikipedia: Thallium poisoning [1]
- Facts About Thallium Poisoning [2]
- Duabert GP eMedicine (Medscape): Thallium Toxicity [3]
