Thallium toxicity

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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

Chronic

Differential Diagnosis

Heavy metal 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
    • Crystal lattice structure binds thallium ions, preventing enterohepatic recycling
  • Activated charcoal binds thallium in vitro

Disposition

See Also

References

Authors:

Ross Donaldson