They conclude that further study on the health impact of thallium on an exposed population is needed, even in areas with moderate thallium concentration. When given orally in the treatment of thallium poisoning, it adsorbs thallium ions during enteroenteral cycling through the gut and exchanges them for potassium ions on the surface of the crystal lattice. This may indicate bioconcentration in aquatic ecosystems. GEORGE KAZANTZIS, in Handbook on the Toxicology of Metals (Third Edition), 2007. However, paralysis of the vagal nerve may possibly be the direct cause of death. In clinical practice, thallium poisoning is very hard to diagnose, because it is a very uncommon disease and its clinical manifestations are extremely complicated. Patient is a UK registered trade mark. Prussian Blue is the treatment of choice for Tl exposure, in that it acts by binding Tl in the gastrointestinal tract, making it unavailable for reabsorption (Altagracia-Martínez et al., 2012; Sun et al., 2012; Riyaz et al., 2013). Hong Kong Med J. Larry J. Thompson, in Handbook of Toxicology of Chemical Warfare Agents (Third Edition), 2020. It is used industrially in the manufacture of coloured glass and lenses. Developmental manifestations: Tl exposure may result in achondroplasia, leg bone curvature, parrot beak deformity, microcephaly, and decreased fetal size. Toxicity. After 1-5 days, systemi… Exposure during pregnancy can lead to fetal abnormalities. Sometimes there is shortness of breath and pleuritic chest pain. Preparation. A brownish black pigmentation close to the hair root is characteristic of thallium exposure and may appear as early as the third or fourth day (Gerdts, 1974; Mathews and Anzarut, 1968). 2009 Sep54(3):386-394.e1. Thompson (1981) in his review considered giving Prussian blue the most effective treatment, with activated charcoal as an alternative. The mean lethal dose of thallium(I) sulfate for an adult is about 1 gram. Kamerbeek et al. 1 INTRODUCTION. This will increase the fecal excretion of Tl and decrease the half-life. Thallium(I) sulfate crystals have a C 2 symmetry. Constipation often occurs for several days after diarrhea has resolved. Treatment should be initiated when 24 h urinary Tl excretion exceeds 0.5 mg. Additionally, a toxic level of Tl in the urine of>300 μg/L has been suggested (Sullivan, 1992). Thallium salts are used in the manufacture of pigments, dyes, luminous paints, artificial gems, window glass, and … ... Thallium sulfate was also used as rat poison, insecticides and ant killer. For details see our conditions. 2002 Mar39(3):307-11. Pelclová et al. Thallium sulfate poisoning, much like the deceptive appearance of the compound itself, has initial symptoms typical of a winter virus. Nevertheless, prolonged exposure may lead to build-up and chronic toxicity. Abdominal pain, nausea and vomiting occur within a few hours of an acute exposure. It is used industrially in the manufacture of coloured glass and lenses. The cardinal features are gastroenteritis, peripheral neuropathy, and then later, alopecia, the last occurring at a stage when treatment is likely to be ineffective. Thallium poisoning is poisoning due to thallium and its compounds which are often highly toxic. The mean lethal dose of thallium(I) sulfate for an adult is about 1 gram. There is atrophy of the hair follicles. If a significant amount (significant poisoning is usually defined as ingesting over 1 gram of thallium, or over 8 milligrams per kilogram of body weight) of thallium enters the body, symptoms of thallium poisoning develop. We use cookies to help provide and enhance our service and tailor content and ads. Moreover, poisoning due to water soluble, ionic thallium is expressed very shortly after the ingestion or absorption of soluble thallium ions through the skin. Van der Merwe (1972) reported a successful outcome in two patients treated with Prussian blue who had each swallowed 700 mg thallous sulfate. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. How to treat constipation and hard-to-pass stools. Large doses of potassium chloride may hasten the excretion of thallium, but may also cause a transient increase in blood levels and redistribution in tissues that may lead to a temporary exacerbation of symptoms (Papp et al., 1969). They also recommended intravenous potassium chloride during the first days of treatment when renal function is normal and the energetic treatment of constipation. Since thallium sulfate is a simple powder with indistinctive properties, it can easily be mistaken for more innocuous chemicals. When thallium compounds must be used, strict safety precautions should be observed to prevent ingestion, inhalation, or skin contact. Use of colorimetric analyses of these specimens can lead to false positives (CDC, 1987). Thallium toxicity due to audultered infusion with thallium sulfate in eight members belonging to the same family nucleus: Autopsy findings and … When thallium compounds must be used, strict safety precautions should be observed to prevent ingestion, inhalation, or skin contact. Activated charcoal may be used in place of Prussian blue (IPCS, 1992; Wainwright et al., 1988). (1971a) reported clinical deterioration with EEG changes, coincident with administration in man caused by a redistribution of thallium with an increased concentration of a lipophilic chelate in the brain. Animals which received the lethal dose of 25 mg. thallium per kg. Salts of thallium have long been used for depilatory purposes and also as a poison for rodents. Most of these salts (particularly thallous sulfate), are odourless, tasteless, and freely soluble in … Upgrade to Patient Pro Medical Professional? They are written by UK doctors and based on research evidence, UK and European Guidelines. Personal hygiene should be ensured; protective clothing and respiratory protective equipment should be worn when inhalation of thallium-containing dust may occur. [4, 5] Thallium was also widely used as a rodenticide. Thallium poisoning is poisoning due to thallium and its compounds which are often highly toxic. Coronavirus: what are moderate, severe and critical COVID-19? Although dithiocarb has been shown to increase urinary thallium excretion in the rat (Schwetz et al., 1967), Kamerbeek et al. Intentional thallium poisoning occurred primarily … For the treatment of acute thallium poisoning, Stevens et al. The doctor may not be aware that the patient has been exposed to thallium and this makes the diagnosis much more difficult. (2013) report of a case of a 36-year-old man who ingested an unknown amount of thallium sulfate grains and died despite early treatment with both Prussian blue and multidose activated charcoal. The optimal therapy for thallium intoxication is currently considered to be the administration of Prussian blue, combined with forced diuresis with furosemide and mannitol, which may be supplemented by hemodialysis. Thallium poisoning is very rare and may occur accidentally, through occupational exposure and because of its potency, it is described as a weapon of intentional poisoning. Personal hygiene should be ensured, and protective clothing and respiratory protective equipment should be worn when inhalation of thallium-containing dust may occur. Li S, Huang W, Duan Y, Xing J, Zhou Y J Forensic Sci 2015 Jan;60(1):247-51. Jha S, Kumar R, Kumar R; Thallium poisoning presenting as paresthesias, paresis, psychosis and pain in abdomen. Larry J. Thompson, in Handbook of Toxicology of Chemical Warfare Agents (Second Edition), 2015. [1] Contact with skin is dangerous, and adequate ventilation should be provided when melting this metal. (1971b) reported increased fecal excretion of thallium with clinical improvement in three cases by giving Prussian blue by mouth. What you need to know about post-viral fatigue. Thallium metal has no commercial use, and thallium compounds have no major commercial application, since thallous sulfate was largely replaced in the 1960s as a rodenticide and insecticide.Thallous compounds have a few limited uses. It was discovered in 1861 by Sir William Crookes who named it after its spectroscopic appearance. Prussian blue is a crystal lattice of potassium ferric ferrocyanide(II) (potassium ferric hexacyanofer-rate [II]). Thallic cations are trivalent or, more commonly, univalent. Haemoperfusion or haemodialysis, if employed, should be performed as early as possible but can be effective even after delayed diagnosis. It is used in the manufacture of electronic components, optical lenses, semiconductor materials, alloys, gamma radiation detection equipment, imitation jewellery, artists' paints, low-temperature thermometers and green fireworks. © Patient Platform Limited. The diagnosis of thallium poisoning may be difficult, because it is often unsuspected. This article also describes some episodes of thallium poisoning arising from … A simple screening test for thallium in urine (see Section 2) may lead to early diagnosis. Technologies for the effective removal of thallium from waters and wastewaters need to be developed, and recycling of waste thallium in industries should be investigated. Children between the ages of 2 and 12 years can be given 1 g orally three times a day. There is peripheral neuropathy with marked leg and foot tenderness and paraesthesia. 2003 Feb79(928):103-5. In chronic poisoning, ataxia and paresthesia may be the outstanding symptoms, which may eventually progress to peripheral neuropathy with weakness and atrophy of the associated musculature (Osorio-Rico et al., 2017). Rauws (1974) from his pharmacokinetic studies in the rat estimated a 70% inhibition of thallium reabsorption from the gut in rats pretreated with Prussian blue. Thallium(I) sulfate (Tl 2 SO 4) or thallous sulfate is the sulfate salt of thallium in the common +1 oxidation state, as indicated by the Roman numeral I. The suggested dosage regime for adults and adolescents is 3 g given orally three times a day. FBC and blood chemistry are required, in case of anaemia from GI haemorrhage and to assess renal function. These result in diffracting light and the appearance of a black stain.25,28 When treated with acid or mechanical pressure gas, bubbles have been noted to escape the hair and the darkened strip disappears.35, Ultimately, the definitive diagnosis of thallium poisoning requires the identification of elevated concentrations of thallium in urine or hair. Thallium Poisoning is a medical condition caused by exposure and ingestion of thallium which is a soft and malleable metal that was usually used to poison rats. In 1973, the World Health Organization recommended against the use of thallium sulfate as a rodenticide because of its toxicity (3). The possibility of thallium poisoning should be borne in mind in obscure neurological illnesses, especially where there is peripheral neuropathy with alopecia; in addition, thallium should be looked for in the urine. Activated carbon has been shown to adsorb thallium in vitro (Hoffman et al., 1999). It may serve as thallium sulfate is utilised as a rat first aid if Prussian blue is not poison, it must be stored in a safe readily accessible. Prussian blue is best given in its soluble or colloidal form. It was used in rat poison, but since it is so similar to other chemicals, it poisoned some people and was outlawed. Epub 2014 Nov 18 doi: 10.1111/1556-4029.12623. Chronic exposure causes hair loss starting 10 days after exposure and complete baldness in about a month. Swaran J.S. Stevens et al. Salts of thallium have long been used for depilatory purposes and also as a poison for rodents. Coronavirus: what are asymptomatic and mild COVID-19? These days, thallium sulfate is much harder to come by, meaning that its use in poisonings is relatively rare. (EPA, 1998) Reactivity Profile. The diagnosis of thallium poisoning was established 1 week after ingestion by the microscopic examination of hair after the application of 10% sodium hydroxide, which revealed dark bands of pigmented material characteristic of the presence of thallium traces (Uges and Huizinga, 1976). Moreover, poisoning due to water soluble, ionic thallium is expressed very shortly after the ingestion or absorption of soluble thallium ions through the skin. Thallium poisoning can come about through inhalation or dermal absorption, but is most commonly consumed orally. Misra UK, Kalita J, Yadav RK, et al; Thallium poisoning: emphasis on early diagnosis and response to haemodialysis. NB: alopecia is a feature that should lead to suspicion of thallium toxicity. Thallium itself and compounds containing the element are highly toxic. The mean lethal dose of thallium(I) sulfate for an adult is about 1 gram. In most people, levels should be at zero, but levels up to 20 μg/specimen may be considered normal. Prussian blue is better than chelating agents such as penicillamine; the latter may cause redistribution of thallium into the central nervous system. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with Guillain-Barré syndrome. Assess airways, breathing and circulation. In the prevention of thallium poisoning in the community, the use of thallium-containing pesticides should be discontinued wherever possible, and restrictions must be placed on their availability (Lancet, 1974). Am J Med Sci. Postgrad Med J. Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. Prussian blue is a crystal lattice of potassium ferric ferrocyanide(II) [potassium ferric hexacyanoferrate (II)]. These invisible like traits make it a good murder weapon. Thallium poisoning was suspected, and finally the patient confessed he had ingested 2 tubes of Zelio paste four days before the onset of his symptoms, after a “quarrel with his girl friend.” (Each tube of Zelio paste contains 28 grams of paste with thallium sulfate in a 2.33 per cent concentration.) (1971a) reported clinical deterioration with electroencephalography changes, coincident with thallium administration in humans, caused by thallium redistribution leading to the increased concentration of a lipophilic chelate in the brain. The final diagnosis of thallium poisoning was confirmed based on high blood and urine thallium levels. The diagnosis of thallium poisoning may be difficult because it is often unsuspected. If Prussian blue is not available, Stevens et al. Prolonged exposure may lead to build-up and chronic poisoning. In the general population, the total intake of thallium, mostly from foodstuffs, is estimated to be < 5 μg/day, and this level does not constitute a threat to health. Since thallium(I) sulfate is a simple powder with indistinctive properties, it can easily be mistaken for more innocuous chemicals. Electrophysiology tests of nerves to the feet may show abnormalities. A simple screening test for thallium in urine (see Section 2) may lead to early diagnosis. However, it is still used for that purpose in many countries. Therefore, water soluble thallium salts, mainly the sulfate, have been used as rat and ant poisons in many countries. Thallium(I) sulfate is soluble in water and its toxic effects are derived from the thallium(I) cation. L'empoisonnement au thallium est principalement provoqué par l'absorption de poison pour les rats, qui contient de grandes quantités de sulfate de thallium. Fluid diuresis and other symptomatic and supportive care should also be provided. Prussian blue is also used in the treatment of radiocesium and acts by the same mechanism (Yang et al., 2008).
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