PMID- 22865288
OWN - NLM
STAT- MEDLINE
DCOM- 20130806
LR  - 20211021
IS  - 1937-6995 (Electronic)
IS  - 1556-9039 (Print)
IS  - 1556-9039 (Linking)
VI  - 9
IP  - 1
DP  - 2013 Mar
TI  - A fatal case of thallium toxicity: challenges in management.
PG  - 75-8
LID - 10.1007/s13181-012-0251-1 [doi]
AB  - 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.
FAU - Riyaz, R
AU  - Riyaz R
AD  - Emory University Medical Toxicology Fellowship, Atlanta, GA, USA. 
      rizriyaz@gmail.com
FAU - Pandalai, S L
AU  - Pandalai SL
FAU - Schwartz, M
AU  - Schwartz M
FAU - Kazzi, Z N
AU  - Kazzi ZN
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Med Toxicol
JT  - Journal of medical toxicology : official journal of the American College of 
      Medical Toxicology
JID - 101284598
RN  - 0 (Antidotes)
RN  - 0 (Ferrocyanides)
RN  - 0 (Rodenticides)
RN  - 16291-96-6 (Charcoal)
RN  - AD84R52XLF (Thallium)
RN  - TLE294X33A (ferric ferrocyanide)
RN  - U9F9QIR12T (thallium sulfate)
SB  - IM
MH  - Adult
MH  - Antidotes/*therapeutic use
MH  - Charcoal/administration & dosage
MH  - Fatal Outcome
MH  - Ferrocyanides/therapeutic use
MH  - Humans
MH  - Male
MH  - Multiple Organ Failure/chemically induced/pathology/therapy
MH  - Poisoning/*etiology/pathology/*therapy
MH  - Renal Dialysis
MH  - Renal Insufficiency/chemically induced/pathology/therapy
MH  - Rodenticides/*poisoning
MH  - Suicide
MH  - Thallium/blood/*poisoning/urine
PMC - PMC3576490
EDAT- 2012/08/07 06:00
MHDA- 2013/08/07 06:00
PMCR- 2014/03/01
CRDT- 2012/08/07 06:00
PHST- 2012/08/07 06:00 [entrez]
PHST- 2012/08/07 06:00 [pubmed]
PHST- 2013/08/07 06:00 [medline]
PHST- 2014/03/01 00:00 [pmc-release]
AID - 251 [pii]
AID - 10.1007/s13181-012-0251-1 [doi]
PST - ppublish
SO  - J Med Toxicol. 2013 Mar;9(1):75-8. doi: 10.1007/s13181-012-0251-1.