Thallium toxicity: Difference between revisions
| Line 27: | Line 27: | ||
**Crystal lattice structure binds thallium ions, preventing enterohepatic recycling | **Crystal lattice structure binds thallium ions, preventing enterohepatic recycling | ||
*[[Activated charcoal]] binds thallium in vitro | *[[Activated charcoal]] binds thallium in vitro | ||
*[[ | *[[Ipecac]] can be given in the prehospital setting if given within first few minutes of exposure | ||
==Disposition== | ==Disposition== | ||
Revision as of 06:54, 10 December 2016
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
Differential Diagnosis
- Aluminum toxicity
- Antimony toxicity
- Arsenic toxicity
- Barium toxicity
- Beryllium toxicity
- Bismuth toxicity
- Boron toxicity
- Cadmium toxicity
- Cesium toxicity
- Chromium toxicity
- Cobalt toxicity
- Copper toxicity
- Gold toxicity
- Iron toxicity
- Lead toxicity
- Lithium toxicity
- Manganese toxicity
- Mercury toxicity
- Nickel toxicity
- Phosphorus toxicity
- Platinum toxicity
- Selenium toxicity
- Silver toxicity
- Thallium toxicity
- Tin toxicity
- Vanadium toxicity
- Zinc toxicity
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