THALLIUM POISONING

SYMPTOMS

The clinical manifestations of thallium differ depending on the kind, degree, and period of exposure. It may manifest as either an acute or chronic poisoning.

Patients who have consumed substantial doses of thallium in a short period of time will exhibit signs and symptoms of acute poisoning. The following are the typical signs of acute thallium poisoning:

• About 3-4 hours of exposure, nausea, vomiting, severe stomach discomfort, and diarrhea occurred.
• About 2-5 days after exposure, painful and rapidly worsening peripheral neuropathies  (tickling sensation, stiffness, and pain, notably on the soles and palms) occur.
• About 2-3 weeks after exposure, there is a sudden loss of hair that develops to widespread alopecia.

Chronic thallium toxicity develops after months or years of thallium exposure. Thallium may enter the body through the skin, respiratory, and gastrointestinal pathways and accumulate to hazardous amounts. Because chronic thallium presents similarly to other illnesses, many instances of industrial thallium exposure may go unnoticed. Chronic poisoning may cause depression, headaches, hallucinations, exhaustion, psychosis, dementia, lack of appetite, leg pains, hair loss, and visual issues.

DIAGNOSIS

Because laboratory investigations are often inconclusive, any unexplained peripheral neuropathy, particularly if accompanied by baldness, should arouse clinical suspicion for thallium poisoning. Begin therapy for individuals with a strong suspicion of thallium poisoning in conjunction with a medical toxicologist while waiting for test confirmation.

The only way to establish a definite clinical diagnosis of thallium poisoning is to show high thallium levels. Thallium may be found in hair, nails, feces, saliva, blood, and urine.

TREATMENT

All individuals with substantial thallium poisoning signs or symptoms must be hospitalized. The following are the goals of thallium poisoning treatment:

• Initial stabilization – check ABCs (Airway, Breathing, Cardiovascular system) and provide oxygen if required; eliminate the cause of contamination or dirty clothes if feasible.
• Decontamination – cause puking if consumed within the past thirty min. Consider using activated carbon and Prussia blue to decontaminate the stomach. When the skin is exposed, wash the affected skin thoroughly using water and soap.
• Follow-up – thallium poisoning in the blood or urine should be measured three to four times a week. Prussian blue treatments should be maintained until the 24-hour urine thallium content recovers to the recommended ranges (0-5 mcg/d).

The essential to recovery from thallium is early detection and therapy. Missed therapy increases the likelihood of chronic nerve damage complaints and neurological and cognitive problems. Recovery might take years, and full recovery is never attained in some situations.