Thallium toxicity
Revision as of 21:55, 9 December 2016 by Ostermayer (talk | contribs)
Background
- Soft metal used in jewelry and semiconductors
- No longer used as a rodenticide in the US
- Quickly oxidizes with exposure to air
Mechanism of Toxicity
- Unknown: seems to affect various enzyme systems
- Lethal dose 12-15 mg/kg
Clinical Features
- Acute:
- 12 hours: Abdominal pain, nausea, vomiting, diarrhea, shock
- 2-3 days: delirium, respiratory failure, seizures, death
- Chronic:
- 2-4 weeks: peripheral neuropathy, chorea, stomatitis, hair loss
Evaluation
- Urine thallium concentration >20mcg/L indicates toxicity
- Blood levels are not considered reliable except in large exposures
- Plain films may be useful in acute ingestion because thallium is radiopaque
Management
- Prussian blue is mainstay of therapy in Europe
- Crystal lattice structure binds thallium ions, preventing enterohepatic recycling
- Activated charcoal binds thallium in vitro
- Ipecac can be given in the prehospital setting if given within first few minutes of exposure