Charcoal binds to thallium, keeping it within the intestinal tract. Jul 07, 2011 thallium is excreted in breast milk and can cross the placental barrier. Extreme caution should be used when handling these materials. Dermatological findings correlated with thallium concentration. Thalliumi sulfate is soluble in water and its toxic effects are derived from the thalliumi cation. Sep 26, 2019 the atsdr toxicological profile succinctly characterizes the toxicologic and adverse health effects information for the hazardous substance described here. Thallium metal forms a brownish black oxide on exposure to air. Soon after its discovery, thallium s toxicity became apparent and it found widespread use as rat poison, but has since been deemed unsafe and. Thallium was the poison of choice for saddam hussein to use on dissidents, which even allowed for them to emigrate before dying. A few years ago the attention of one of the writerswas called. Tl poisoning thallotoxicosis may occur in opioid addicts. Smoking is one of the sources of thallium which is considered as a toxic heavy metal. The fda has approved prussian blue radiogardase as an antidote for thallium toxicity.
Thallium itself and compounds containing the element are highly toxic. Thallium poisoning diagnosis diagnosis is made through undergoing blood tests and urine tests to determine the presence and level of the thallium in the body. It has been considered one of the most toxic heavy metals. Thallium is released into the environment through its use in rat poison in the manufacture of special glass, fluorescent colors and synthetic gemstones. However, the correlation between the dermatological findings and the thallium concentration, the prognosis of peripheral neuropathy, and a cutaneous nerve biopsy study are. Thallium is a naturally occurring trace metalloid element with atomic symbol tl, atomic number 81, and atomic weight 204. It is most often treated by an oral administration of prussian blue. Thalliums similar size to potassium results in early stimulation then inhibition of potassiumdependent processes. The general use of these compounds by pest control companies, and their availability. Thallium poisoning should be considered in any patient with a rapidly progressing. Thallium is used in manufacturing, as well as in some chemical reactions and medical procedures. The time from symptom onset to admission was assessed.
Tl poisoning is an important health issue in many countries in the world. Other signs and symptoms may develop at any stage of toxicity. Thallium has been used in treating ringworm and other skin infections. The high degree of absorption, high bioavailability, and slow excretion contribute to the high toxicity of thallium. The mean lethal dose of thalliumi sulfate for an adult is about 1 gram. The clinical presentation of thallium toxicity can vary. In humans the most characteristic sign of thallium toxicity is alopecia which usually appears in cases when death is delayed for 1520 days. Thallium poisoning is more common in developing countries where thallium rat poisons are still available and where there are less rigorous health and safety workplace practices.
Toxicology tests are done to evaluate thallium concentrations in. Thallium poisoning in the dog iowa state university. The final diagnosis of thallium poisoning was confirmed based on high blood and urine thallium levels. Feb 19, 2018 thallium accumulates in tissues with high potassium concentrations such as muscle, heart, and central and peripheral nerve tissue. Tl toxicity may occur in food and drinking water, occupational exposure, environment air, industrial combustion of coal, water, and plants, arable soils and. A case of severe thallium poisoning successfully treated. The thallium was slipped into bottles of cocacola at the carr and trepal homes. Thallium compounds have been used as rodenticides for many years.
Key enzymes involved in thallium toxicity include pyruvate kinase and succinate dehydrogenase. Thallium is the element rat poison and industrial waste. Features consistent with thallium toxicity were reported in some alopecia in five, dermal effects in. Acute thallium poisoning can cause severe central nervous system damage.
It does not have a known biological use and does not appear to be an essential element for life. Examining of thallium in cigarette smokers springerlink. Acute thallium poisoning is usually due to ingestion of the salts, while chronic. Successful treatment of a patient with severe thallium. Once absorbed, thallium distributes widely, with highest levels in the renal medulla and significant levels present in heart, liver, stomach, and hair. The aim of this study was to determine urinary thallium levels and related variables in smokers, compared to a control group. This is the first report of complete erosion of proximal parts of nails following thallium poisoning. Acute toxicity will produce a thallium concentration many times higher than the reference range of 05 ngml.
This case report describes a patient with thallium poisoning caused by repeated exposure to low doses of thallium. The clinical presentation of thallium toxicity can vary depending on the type, severity, and timeframe of the exposure. Downs wlscott jksteadman ltmaynard ea acute and subacute toxicity studies of thallium compounds. Symptoms are primarily related to the gastrointestinal and nervous system, while diffuse alopecia 3 weeks after ingestion is typical for thallium intoxication. The painful neuropathy, however, starts as early as the day after exposure, and should prompt concern about thallium toxicity. Thallium is highly reactive, readily soluble in acids, and forms monovalent thallous and trivalent thallic salts, the latter being less stable lee, 1971. Thallium also occurs as a trace element in iron pyrite, and thallium is extracted as a byproduct of roasting this mineral for the production of sulfuric acid. Less commonly, hair loss following thallium exposure may occur over a shorter time course.
Thallium poisoning is one of the most complex and serious toxicities known to man. Thallium can also be obtained from the smelting of lead and zinc ores. Use as a pesticide has been banned in the united states due to toxicity from accidental exposure. It is particularly dangerous because compounds containing thallium are colorless, odorless, and tasteless. Small amounts of thallium are released into the air from coalburning power plants, cement factories, and smelting operations. Physical examination revealed diffuse alopecia of the scalp. Since its introduction in medicine, toxic consequences were constantly reported. Gastrointestinal findings may be mild or nonexistent, especially in chronic poisoning. Thallium tl is a trace element associated with base metal mining and processing, but little is known regarding how its toxicity is influenced by water chemistry.
Since thalliumi sulfate is a simple powder with indistinctive properties, it can easily be mistaken for more innocuous chemicals. This presents as excruciating pain and hyperaestheia on the soles of the feet, along with extreme calf tenderness to the point where at times the weight of bedclothes touching the legs can be unbearable. Clinical characteristics and treatment of thallium poisoning. Thalliumi sulfate is soluble in water and its toxic effects are derived from the thallium i cation. Thallium tl is a toxic heavy metal that exists in nature. Because of associated loose motions, skin lesions, and liver and kidney dysfunction arsenic. Jun 23, 2015 few laboratories can perform an assay for thallium. As a result, the symptoms are commonly dismissed by traditional health practitioners altogether and lead to a misdiagnosis of the patients condition 8. Because of this high toxicity, the world health organization who recommends against the use of thallium in rodent and insect poisons. Office of environmental health hazard assessment, berkeley and sacramento, ca. The hair mount, showing a tapered or bayonet anagen hair with black pigmentation at the base, which may be highly diagnostic before the onset of alopecia. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with guillainbarre syndrome. In late 1986, a striking increase in the number of reported cases of presumed thallium intoxication occurred in.
The atsdr toxicological profile succinctly characterizes the toxicologic and adverse health effects information for the hazardous substance described here. In severe cases, paralysis of the respiratory muscles may occur, even leading to coma. Thallium poisoning should be suspected in any patient with neurological symptoms and hair loss. General issues, neurological symptoms, and neurotoxic mechanisms springerlink.
Figure 1 download figure open in new tab download powerpoint. Thallium is present in very low concentrations in the environment. Despite fetal complications ranging from severe toxicity and permanent deficit to normal development, the only consistent effect was increased risk of prematurity and low birth weight. In this document, we evaluate the available data on the toxicity of thallium, with the primary focus on the literature related to oral exposures which may be most appropriate for the establishment of a phg for drinking water. Antimony and thallium toxicity to embryos and larvae of fathead. Sections i health hazard assessments for noncarcinogenic effects and. Thallium poisoning diagnosis diagnosis is made through undergoing blood tests and urine tests to determine the presence and level of the thallium. Thallium is a highly toxic element and salts of tl are colorless, odorless, and tasteless. Thallium has now shown up in my biofeedback test, only thing i can figure is that the hg being moved out by the cutler protocol is unearthing some thallium.
Thallium toxicity in humans following oral exposure. Thallium poisoning causes symptoms within hours after ingestion. Thallium accumulates in tissues with high potassium concentrations such as muscle, heart, and central and peripheral nerve tissue. Thallium tl toxicity is an important clinical disease and its effects on the human body are devastating. Thallium poisoning is known for its diverse manifestations and these can delay the diagnosis if a clear history of poisoning is not forthcoming. We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. Background the extracorporeal treatments in poisoning extrip workgroup was formed to provide recommendations on the use of extracorporeal treatment ectr in poisoning. In 1995, zhu ling was the victim of an unsolved attempted thallium poisoning in. Thallium enters food because it is easily taken up by plants through the roots.
Thallium is a toxic heavy metal that exists in nature. 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. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory. The exact mechanism of thallium toxicity still remains unknown, although impaired.
Other pertinent literature is also presented, but is described in less detail than the key studies. Integrated risk information system iris september 2009. Soon after its discovery, thalliums toxicity became apparent and it found widespread use as rat poison, but has since been deemed unsafe and. Pdf thallium poisoning is one of the most complex and serious toxicities known to man. Toxicity data were found for five of these compounds thallium sulfate, thallium oxide, thallium nitrate, thallium acetate, and thallium carbonate. Thallium is a naturally occurring trace element, widely distributed in the earths crust, but at very low concentrations. In 1995, zhu ling was the victim of an unsolved attempted thallium poisoning in beijing, china. Thallium poisoning an overview sciencedirect topics. 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. Thallium poisoning california poison control system ucsf.
Occasionally, there are reports on thallium poisoning as results of suicide or murder attempt or accident. Thallium i, soluble salts casrn various iris us epa, ord. In the present study, we investigated a case of a 53yearold man who was hospitalized for persistent stabbing pain in the abdomen and lower extremities for 20 days. Thallium s similar size to potassium results in early stimulation then inhibition of potassiumdependent processes. There was dystrophy of nails in the form of whitish lunular stripes. This thallium falls out of the air onto nearby fruit and vegetable gardens. Although its acute biological effects have been widely investigated and are well known, its biological effects on human health and in cell cultures at low doses thallium poisoning.
Thallium oxide has been used to produce glasses with a high index of refraction, and is used in the manufacture of photo cells. On the 18th day, the diagnosis of thallium poisoning was suspected. Thallium can be released into the environment by cement manufacture, the burning of certain coal deposits and the production of nonferrous metals kazantzis, 2000. Ectr is indicated if tl exposure is highly suspected on the basis of history or clinical features. Antimony and thallium toxicity to embryos and larvae of. Background the dermatological features and skin biopsy findings of shortterm thallium intoxication have been described. Oral zinc sulphate in treatment of patients with thallium. Thallium poisoning begins mildly involves nausea, vomiting and diarrhea, followed by a symptomfree period of. Initial complaints are related to the gastrointestinal system and include abdominal pain, nausea, vomiting, hematemesis and diarrhea which often contains blood 12. In humans the most characteristic sign of thallium toxicity is alopecia. The initial symptoms of thallium poisoning may include fever, gastrointestinal problems, delirium, convulsions and. Thallium shares group iiia of the periodic table with indium, gallium, aluminum, and boron.
After pb and pe treatment, as well as other symptomatic supportive. Thallium exists in opioid poisoned patients springerlink. Because no data on acute inhalation toxicity are available on which to base the idlh for the soluble compounds of thallium. Thallium blood levels may be elevated after recent exposures, but it is cleared from the blood relatively quickly. Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. In clinical practice, thallium poisoning is very hard to diagnose, because it is a very uncommon disease and its clinical manifestations are extremely complicated. Thallium poisoning is associated with these environment exposures. A 24hour urine thallium concentration is the most accurate way to assess thallium toxicity but a spot urine level is likely to provide a more rapid and reasonably reliable answer. Batemsn department of chemistry, leland staxiord jr. Pdf thallium is a naturally occurring trace element, widely distributed in the earths crust, but at very low concentrations. This document includes nine of the commonly used thallium compounds.
Thallium toxicity has multiorgan involvement and presents with vague symptoms that are often attributed to other causes. Natural cure for thallium poisoning and alternative treatments. Because of this high toxicity, the world health organization who recommends against the use of thallium. Acute thallium poisoning is primarily characterized by gastrointestinal, neurological, and dermatological symptoms, while neurologic findings predominate with chronic exposure and tend to progress, even despite decreasing blood thallium levels. Thallium toxicity has not been studied extensively in all.
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