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Thallium Toxicity and the Role of Prussian Blue in Therapy

Toxicological Reviews volume 22, pages 29–40 (2003)Cite this article

Abstract

Thallium salts have been used as medicinal agents, as key ingredients in a variety of manufacturing processes, and as a potent rodenticide. Additionally, environmental concerns are growing, as thallium is a waste product of coal combustion and the manufacturing of cement. Thallium salts are rapidly and nearly completely absorbed by virtually all routes, with gastrointestinal exposure being the most common route to produce toxicity. Thallium enters cells by a unique process governed by its similarity in charge and ionic radius to potassium. Although the exact mechanism of toxicity has not been established, thallium interferes with energy production at essential steps in glycolysis, the Krebs cycle, and oxidative phosphorylation. Additional effects include inhibition of sodium-potassium-adenosine triphosphatase and binding to sulfhydryl groups.

The major manifestations of toxicity consist of a rapidly progressive, ascending, extremely painful sensory neuropathy and alopecia. Unlike exposure to most metal salts, gastrointestinal symptoms of thallium toxicity are relatively minor, and constipation is more characteristic than diarrhoea. Many other findings such as an autonomic neuropathy, cranial nerve abnormalities, altered mental status, motor weakness, cardiac, hepatic, and renal effects are described, but are less specific. Thallium also crosses the placenta freely and produces abnormalities in animals as well as fetal demise, overt toxicity and congenital abnormalities in humans.

There are no controlled trials of treatments in thallium-poisoned patients. Thus, the literature is predominated by very small animal studies and case reports with very limited data. Strong evidence speaks against the use of traditional metal chelators such as dimercaprol (British Anti-Lewisite) and penicillamine, and the latter may cause redistribution of thallium into the central nervous system. Likewise, forced potassium diuresis appears harmful. The use of single- or multiple-dose activated charcoal is supported by in vitro binding experiments and some animal data, and charcoal haemoperfusion may be a useful adjunct. Multiple animal studies give evidence for enhanced elimination and improved survival with Prussian blue. Unfortunately, despite the fact that many humans have been treated with Prussian blue, the data presented are insufficient to comment definitively on its efficacy. However, Prussian blue’s safety profile is superior to that of other proposed therapies and it should be considered the drug of choice in acute thallium poisoning.

Public health efforts should focus on greater restrictions on access to, and use of, thallium salts.

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Fig. 1.

Notes

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References

  1. Dmowski K, Kozakiewicz A, Kozakiewicz M. Small mammal populations and community under conditions of extremely high thallium contamination in the environment. Ecotoxicol Environ Saf 1998; 41: 2–7

    PubMed  CAS  Article  Google Scholar 

  2. Ewers U. Environmental exposure to thallium. Sci Total Environ 1988; 71: 285–92

    PubMed  CAS  Article  Google Scholar 

  3. Heim M, Wappelhorst O, Markert B. Thallium in terrestrial environments: occurrence and effects. Ecotoxicology 2002; 11: 369–77

    PubMed  CAS  Article  Google Scholar 

  4. Lynche GR, Lond MB, Scovell JMS. The toxicology of thallium. Lancet 1930; II: 1340–4

    Article  Google Scholar 

  5. Munch JC, Ginsburg HM, Nixon CE. The 1932 thallotoxicosis outbreak in California. JAMA 1933; 100: 1315–9

    Article  Google Scholar 

  6. Munch JC. Human thallotoxicosis. JAMA 1934; 102: 1929–33

    CAS  Article  Google Scholar 

  7. Neal JB, Appelbaum E, Gaul LE, et al. An unusual occurrence of thallium poisoning. N Y State Med J 1935; 35: 657–9

    Google Scholar 

  8. Léonard A, Gerber GB. Mutagenicity, carcinogenicity and teratogenicity of thallium compounds. Mutat Res 1997; 387: 47–53

    PubMed  Article  Google Scholar 

  9. Rangel-Guerra R, Martinez HR, Villarreal HJ. Thallium poisoning: experience with 50 patients [in Spanish]. Gac Med Mex 1990; 126: 487–94

    PubMed  CAS  Google Scholar 

  10. Chakrabarti AK, Ghosh K, Chaudhuri AK. Thallium poisoning: a case report. J Trop Med Hyg 1985; 88: 291–3

    PubMed  CAS  Google Scholar 

  11. Questel F, Dugarin J, Dally S. Thallium-contaminated heroin [letter]. Ann Intern Med 1996; 124: 616

    PubMed  CAS  Google Scholar 

  12. Insley BM, Grufferman S, Ayliffe HE. Thallium poisoning in cocaine abusers. Am J Emerg Med 1986; 4: 545–8

    PubMed  CAS  Article  Google Scholar 

  13. Meggs WJ, Hoffman RS, Shih RD, et al. Thallium poisoning from maliciously contaminated food. J Toxicol Clin Toxicol 1994; 32: 723–30

    PubMed  CAS  Article  Google Scholar 

  14. Pai V. Acute thallium poisoning: prussian blue therapy in 9 cases. West Indian Med J 1987; 36: 256–8

    PubMed  CAS  Google Scholar 

  15. Rusyniak DE, Furbee RB, Kirk MA. Thallium and arsenic poisoning in a small midwestern town. Ann Emerg Med 2002; 39: 307–11

    PubMed  Article  Google Scholar 

  16. Atsmon J, Taliansky E, Landau M, et al. Thallium poisoning in Israel. Am J Med Sci 2000; 320: 327–30

    PubMed  CAS  Article  Google Scholar 

  17. Schaumburg HH, Berger A. Alopecia and sensory polyneuropathy from thallium in a Chinese herbal medication. JAMA 1992; 268: 3430–1

    PubMed  CAS  Article  Google Scholar 

  18. Hirata M, Taoda K, Ono-Ogasawara M, et al. A probable case of chronic occupational thallium poisoning in a glass factory. Ind Health 1998; 36: 300–3

    PubMed  CAS  Article  Google Scholar 

  19. Rauws AG. Thallium pharmacokinetics and its modification by Prussian Blue. Naunyn Schmiedebergs Arch Pharmacol 1974; 284: 294–306

    PubMed  CAS  Article  Google Scholar 

  20. De Groot G, van Heijst ANP. Toxicokinetic aspects of thallium poisoning: methods of treatment by toxin elimination. Sci Total Environ 1988; 71: 411–8

    PubMed  Article  Google Scholar 

  21. Sharma AN, Nelson LS, Hoffman RS. Cerebral spinal fluid (CSF) analysis in fatal thallium poisoning. J Toxicol Clin Toxicol 2001; 39: 237–8

    Google Scholar 

  22. Bank WJ, Pleasure DE, Suzuki K, et al. Thallium poisoning. Arch Neurol 1972; 26: 456–64

    PubMed  CAS  Article  Google Scholar 

  23. Leung KM, Ooi VE. Studies on thallium toxicity, its tissue distribution and histopathological effects in rats. Chemosphere 2000; 41: 155–9

    PubMed  CAS  Article  Google Scholar 

  24. Aoyama H. Distribution and excretion of thallium after oral and intraperitoneal administration of thallous malonate and thallous sulfate in hamsters. Bull Environ Contam Toxicol 1989; 42: 456–63

    PubMed  CAS  Article  Google Scholar 

  25. Aoyama H, Yoshida M, Yamamura Y. Acute poisoning by intentional ingestion of thallous malonate. Hum Toxicol 1986; 5: 389–92

    PubMed  CAS  Article  Google Scholar 

  26. Lund A. The effect of various substances on the excretion and the toxicity of thallium in the rat. Acta Pharmacol Toxicol 1956; 12: 260–8

    CAS  Article  Google Scholar 

  27. Thompson DF. Management of thallium poisoning. J Toxicol Clin Toxicol 1981; 18: 979–90

    CAS  Article  Google Scholar 

  28. Bulkley BH, Rouleau J, Strauss HW, et al. Idiopathic hypertrophic subaortic stenosis: detection by thallium 201 myocardial perfusion imaging. N Engl J Med 1975; 293: 1113–6

    PubMed  CAS  Article  Google Scholar 

  29. Hologgitas J, Ullucci P, Driscoll J, et al. Thallium elimination kinetics in acute thallotoxicosis. J Anal Toxicol 1980; 4: 68–75

    PubMed  CAS  Google Scholar 

  30. De Groot G, van Heijst AN, van Kesteren RG, et al. An evaluation of the efficacy of charcoal haemoperfusion in the treatment of three cases of acute thallium poisoning. Arch Toxicol 1985; 57: 61–6

    PubMed  Article  Google Scholar 

  31. Piazolo P, Franz HE, Brech W, et al. Therapy of thallium poisoning using hemodialysis [in German]. Dtsch Med Wochenschr 1971; 96: 1217–8

    PubMed  CAS  Article  Google Scholar 

  32. Gehring PJ, Hammond PB. The uptake of thallium by rabbit erythrocytes. J Pharmacol Exp Ther 1964; 145: 215–21

    PubMed  CAS  Google Scholar 

  33. Gehring PJ, Hammond PB. The interrelationship between thallium and potassium in animals. J Pharmacol Exp Ther 1967; 155: 187–201

    PubMed  CAS  Google Scholar 

  34. Melnick RL, Monti LG, Motzkin SM. Uncoupling of mitochondrial oxidative phosphorylation by thallium. Biochem Biophys Res Commun 1976; 69: 68–73

    PubMed  CAS  Article  Google Scholar 

  35. Villanueva E, Hernandez-Cueto C, Lachica E, et al. Poisoning by thallium: a study of five cases. Drug Saf 1990; 5: 384–9

    PubMed  CAS  Article  Google Scholar 

  36. Inturrisi CE. Thallium-induced dephosphorylation of a phosphorylated intermediate of the (sodium+thallium-activated) ATPase. Biochim Biophys Acta 1969; 178: 630–3

    PubMed  CAS  Article  Google Scholar 

  37. Britten JS, Blank M. Thallium activation of the (Na+-K+)-activated ATPase of rabbit kidney. Biochim Biophys Acta 1968; 159: 160–6

    PubMed  CAS  Article  Google Scholar 

  38. Kaye JF. Thallium activation of pyruvate kinase. Arch Biochem Biophys 1971; 143: 232–9

    Article  Google Scholar 

  39. Hasan M, Chandra SV, Dua PR, et al. Biochemical and electrophysiologic effects of thallium poisoning on the rat corpus striatum. Toxicol Appl Pharmacol 1977; 41: 353–9

    PubMed  CAS  Article  Google Scholar 

  40. Cavanagh JB, Fuller NH, Johnson HRM, et al. The effects of thallium salts, with particular reference to the nervous system changes: a report of three cases. Q J Med 1974; 43: 293–319

    PubMed  CAS  Google Scholar 

  41. Appenroth D, Winnefeld K. Is thallium-induced nephrotoxicity in rats connected with riboflavin and/or GSH?: reconsideration of hypotheses on the mechanism of thallium toxicity. J Appl Toxicol 1999; 19: 61–6

    PubMed  CAS  Article  Google Scholar 

  42. Spencer PS, Peterson ER, Madrid R, et al. Effects of thallium salts on neuronal mitochondria in organotypic cord-ganglia-muscle combination cultures. J Cell Biol 1973; 58: 79–95

    PubMed  CAS  Article  Google Scholar 

  43. Deshimaru M, Miyakawa T, Sumiyoshi S, et al. Electron microscopic study of experimental thallotoxicosis. Folia Psychiatr Neurol Jpn 1977; 31: 269–75

    PubMed  CAS  Google Scholar 

  44. Yoshida M, Igeta S, Kawashima R, et al. Changes in adenosine triphosphate (ATP) concentration and its activity in murine tissue after thallium administration. Bull Environ Contam Toxicol 1997; 59: 268–73

    PubMed  CAS  Article  Google Scholar 

  45. Mulkey JP, Oehme FW. A review of thallium toxicity. Vet Hum Toxicol 1993; 35: 445–53

    PubMed  CAS  Google Scholar 

  46. Woods JS, Fowler BA. Alteration of hepatocellular structure and function by thallium chloride: ultrastructural, morphometric, and biochemical studies. Toxicol Appl Pharmacol 1986; 83: 218–29

    PubMed  CAS  Article  Google Scholar 

  47. Cavanagh JB. What have we learnt from Graham Frederick Young?: reflections on the mechanism of thallium neurotoxicity. Neuropathol Appl Neurobiol 1991; 17: 3–9

    PubMed  CAS  Article  Google Scholar 

  48. Grunfeld O, Hinostroza G. Thallium poisoning. Arch Intern Med 1964; 114: 132–8

    PubMed  CAS  Article  Google Scholar 

  49. Saddique A, Peterson CD. Thallium poisoning: a review. Vet Hum Toxicol 1983; 25: 16–22

    PubMed  CAS  Google Scholar 

  50. Hasan M, Ali SF. Effects of thallium, nickel, and cobalt administration of the lipid peroxidation in different regions of the rat brain. Toxicol Appl Pharmacol 1981; 57: 8–13

    PubMed  CAS  Article  Google Scholar 

  51. Galvan-Arzate S, Martinez A, Medina E, et al. Subchronic administration of sublethal doses of thallium to rats: effects on distribution and lipid peroxidation in brain regions. Toxicol Lett 2000; 116: 37–43

    PubMed  CAS  Article  Google Scholar 

  52. Hultin T, Naslund PH. Effects of thallium (I) on the structure and functions of mammalian ribosomes. Chem Biol Interact 1974; 8: 315–28

    PubMed  CAS  Article  Google Scholar 

  53. Reed D, Crawley J, Faro SN, et al. Thallotoxicosis: acute manifestations and sequelae. JAMA 1963; 183: 516–22

    PubMed  CAS  Article  Google Scholar 

  54. Dumitru D, Kalantri A. Electrophysiologic investigation of thallium poisoning. Muscle Nerve 1990; 13: 433–7

    PubMed  CAS  Article  Google Scholar 

  55. Barroso-Moguel R, Mendez-Armenta M, Villeda-Hernandez J, et al. Experimental neuromyopathy induced by thallium in rats. J Appl Toxicol 1996; 16: 385–9

    PubMed  CAS  Article  Google Scholar 

  56. Moeschlin S. Thallium poisoning. J Toxicol Clin Toxicol 1980; 17: 133–46

    CAS  Article  Google Scholar 

  57. Moore D, House I, Dixon A. Thallium poisoning: diagnosis may be elusive but alopecia is the clue. BMJ 1993; 306: 1527–9

    PubMed  CAS  Article  Google Scholar 

  58. Feldman J, Levisohn DR. Acute alopecia: clue to thallium toxicity. Pediatr Dermatol 1993; 10: 29–31

    PubMed  CAS  Article  Google Scholar 

  59. Burnett JW. Thallium poisoning. Cutis 1990; 46: 112–3

    PubMed  CAS  Google Scholar 

  60. Chamberlain PH, Stavinoha WB, Davis H, et al. Thallium poisoning. Pediatrics 1958; 12: 1170–82

    Google Scholar 

  61. Lovejoy FH. Thallium. Clin Toxicol Rev 1982; 4: 1–2

    Google Scholar 

  62. Desenclos J-C, Wilder MH, Coppenger GW, et al. Thallium poisoning: an outbreak in Florida, 1988. South Med J 1992; 85: 1203–6

    PubMed  CAS  Article  Google Scholar 

  63. Wainwright AP, Kox WJ, House IM, et al. Clinical features and therapy of acute thallium poisoning. Q J Med 1988; 69: 939–44

    PubMed  CAS  Google Scholar 

  64. Andersen O. Clinical evidence and therapeutic indications in neurotoxicology, exemplified by thallotoxicosis. Acta Neurol Scand 1984; 100: 185–92

    CAS  Google Scholar 

  65. Bank WJ. Thallium. In: Spencer PS, Schaumburg HH. Experimental and clinical neurotoxicology. Baltimore (MD): Williams & Wilkins, 1980: 570–7

    Google Scholar 

  66. Nordentoft T, Andersen EB, Mogensen PH. Initial sensorimotor and delayed autonomic neuropathy in acute thallium poisoning. Neurotoxicology 1998; 19: 421–6

    PubMed  CAS  Google Scholar 

  67. McMillan TM, Jacobson RR, Gross M. Neuropsychology of thallium poisoning. J Neurol Neurosurg Psychiatry 1997; 63: 247–50

    PubMed  CAS  Article  Google Scholar 

  68. Brown DR, Callahan BG, Cleaves MA, et al. Thallium induced changes in behavioral patterns: correlation with altered lipid peroxidation and lysosomal enzyme activity in brain regions of male rats. Toxicol Ind Health 1985; 1: 81–98

    PubMed  CAS  Google Scholar 

  69. Appenroth D, Gambaryan S, Winnefeld K, et al. Functional and morphological aspects of thallium-induced nephrotoxicity in rats. Toxicology 1995; 96: 203–15

    PubMed  CAS  Article  Google Scholar 

  70. Schmidt D, Bach M, Gerling J. A case of localized retinal damage in thallium poisoning. Int Ophthalmol 1997; 21: 143–7

    PubMed  CAS  Article  Google Scholar 

  71. Tabandeh H, Crowston JG, Thompson GM. Ophthalmologic features of thallium poisoning. Am J Ophthalmol 1994; 117: 243–5

    PubMed  CAS  Google Scholar 

  72. Tabandeh H, Thompson GM. Visual function in thallium toxicity [letter]. BMJ 1993; 307: 324

    PubMed  CAS  Article  Google Scholar 

  73. Appenroth D, Tiller S, Gambaryan S, et al. Ontogenetic aspects of thallium-induced nephrotoxicity in rats. J Appl Toxicol 1996; 16: 235–43

    PubMed  CAS  Article  Google Scholar 

  74. Tromme I, Van Neste D, Dobbelaere F, et al. Skin signs in the diagnosis of thallium poisoning. Br J Dermatol 1998; 138: 321–5

    PubMed  CAS  Article  Google Scholar 

  75. Heath A, Ahlmen J, Branegard B, et al. Thallium poisoning: toxin elimination and therapy in three cases. J Toxicol Clin Toxicol 1983; 20: 451–63

    PubMed  CAS  Article  Google Scholar 

  76. Luckit J, Mir N, Hargreaves M, et al. Thrombocytopenia associated with thallium poisoning. Hum Exp Toxicol 1990; 9: 47–8

    PubMed  CAS  Article  Google Scholar 

  77. Chandler HA, Archbold GP, Gibson JM, et al. Excretion of a toxic dose of thallium. Clin Chem 1990; 36: 1506–9

    PubMed  CAS  Google Scholar 

  78. Wakid NW, Cortas NK. Chemical and atomic absorption methods for thallium in urine compared. Clin Chem 1984; 30: 587–8

    PubMed  CAS  Google Scholar 

  79. Gibson JE, Becker BA. Placental transfer, embryotoxicity, and teratogenicity of thallium sulfate in normal and potassium-deficient rats. Toxicol Appl Pharmacol 1970; 16: 120–32

    PubMed  CAS  Article  Google Scholar 

  80. Hall BK. Critical periods during development as assessed by thallium-induced inhibition of growth of embryonic chick tibiae in vitro. Teratology 1985; 31: 353–61

    PubMed  CAS  Article  Google Scholar 

  81. Nikiforov A, Slozina N, Neronova E, et al. Cytogenetic investigation of thallium-poisoned people: pilot study. J Toxicol Environ Health A 1999; 58: 465–8

    PubMed  CAS  Article  Google Scholar 

  82. Hantson P, Desoir R, Léonard ED, et al. Cytogenetic observations following thallium poisoning. J Toxicol Environ Health 1997; 50: 97–100

    PubMed  CAS  Article  Google Scholar 

  83. Hoffman RS. Thallium poisoning during pregnancy: a case report and comprehensive literature review. J Toxicol Clin Toxicol 2000; 38: 767–75

    PubMed  CAS  Article  Google Scholar 

  84. Dolgner R, Brockhaus A, Ewers U, et al. Repeated surveillance of exposure to thallium in a population living in the vicinity of a cement plant emitting dust containing thallium. Int Arch Occup Environ Health 1983; 52: 79–94

    PubMed  CAS  Article  Google Scholar 

  85. Brockhaus A, Dolgner R, Ewers U, et al. Intake and health effects of thallium among a population living in the vicinity of a cement plant emitting thallium containing dust. Int Arch Occup Environ Health 1981; 48: 375–89

    PubMed  CAS  Article  Google Scholar 

  86. Brockhaus A, Dolgner R, Ewers U, et al. Excessive thallium absorption among a population living near a thallium emitting cement plant. Dev Toxicol Environ Sci 1980; 8: 565–8

    PubMed  CAS  Google Scholar 

  87. Kravzov J, Rios C, Altagracia M, et al. Relationship between physicochemical properties of Prussian blue and its efficacy as antidote against thallium poisoning. J Appl Toxicol 1993; 13: 213–6

    PubMed  CAS  Article  Google Scholar 

  88. Dvorak P. Colloidal hexacyanoferrates (II) as antidotes in thallium poisoning [in German]. Z Gesamte Exp Med 1969; 151: 89–92

    PubMed  CAS  Article  Google Scholar 

  89. Kamerbeek HH, Rauws AG, ten Ham M, et al. Prussian blue in therapy of thallotoxicosis: an experimental and clinical investigation. Acta Med Scand 1971; 189: 321–4

    PubMed  CAS  Article  Google Scholar 

  90. Lehmann PA, Favari L. Parameters for the adsorption of thallium ions by activated charcoal and Prussian blue. J Toxicol Clin Toxicol 1984; 22: 331–9

    PubMed  CAS  Article  Google Scholar 

  91. Leloux MS, Nguyen PL, Claude JR. Experimental studies on thallium toxicity in rats: II. The influence of several antidotal treatments on the tissue distribution and elimination of thallium, after subacute intoxication. J Toxicol Clin Exp 1990; 10: 147–56

    PubMed  CAS  Google Scholar 

  92. Hoffman RS, Stringer JA, Feinberg RS, et al. Comparative efficacy of thallium adsorption by activated charcoal, Prussian blue, and sodium polystyrene sulfonate. J Toxicol Clin Toxicol 1999; 37: 833–7

    PubMed  CAS  Article  Google Scholar 

  93. Lee D, Greene T, Dougherty T, et al. Does thallium bind to sodium polystyrene sulfonate (Kayexalate) [abstract]? Acad Emerg Med 1997; 4: 456

    Google Scholar 

  94. Lehmann PA, Favari L. Acute thallium intoxication: kinetic study of the relative efficacy of several antidotal treatments in rats. Arch Toxicol 1985; 57: 56–60

    PubMed  CAS  Article  Google Scholar 

  95. Heydlauf H. Ferric-cyanoferrate (II): an effective antidote in thallium poisoning. Eur J Pharmacol 1969; 6: 340–4

    PubMed  CAS  Article  Google Scholar 

  96. Rěos C, Monroy-Noyola A. D-Penicillamine and Prussian blue as antidotes against thallium intoxication in rats. Toxicology 1992; 74: 69–76

    Article  Google Scholar 

  97. Kravzov J, Rios C, Altagracia M, et al. Efficacy of Prussian blue against thallium poisoning: effect of particle size. Proc West Pharmacol Soc 1991; 34: 61–3

    Google Scholar 

  98. Meggs WJ, Cahill-Morasco R, Shih RD, et al. Effects of Prussian blue and N-acetylcysteine on thallium toxicity in mice. J Toxicol Clin Toxicol 1997; 35: 163–6

    PubMed  CAS  Article  Google Scholar 

  99. Kamerbeek HH, Rauws AG, ten Ham M, et al. Dangerous redistribution of thallium by treatment with sodium diethyldithiocarbamate. Acta Med Scand 1971; 189: 149–54

    PubMed  CAS  Article  Google Scholar 

  100. Meggs WJ, Goldfrank LR, Hoffman RS. Effects of potassium in a murine model of thallium poisoning. J Toxicol Clin Toxicol 1995; 33: 558–9

    Article  Google Scholar 

  101. De Backer W, Zachee P, Verpooten GA, et al. Thallium intoxication treated with combined hemoperfusion-hemodialysis. J Toxicol Clin Toxicol 1982; 19: 259–64

    PubMed  Article  Google Scholar 

  102. Pedersen RS, Olesen AS, Freund LG, et al. Thallium intoxication treated with long-term hemodialysis, forced diuresis and Prussian blue. Acta Med Scand 1978; 204: 429–32

    PubMed  CAS  Article  Google Scholar 

  103. Stevens W, Van Peteghem C, Heyndrickx A, et al. Eleven cases of thallium intoxication treated with Prussian blue. Int J Clin Pharmacol 1974; 10: 1–22

    PubMed  CAS  Google Scholar 

  104. van der Merwe CF. The treatment of thallium poisoning: a report of two cases. S Afr Med J 1972; 46: 560–1

    PubMed  Google Scholar 

  105. Vergauwe PL, Knockaert DC, Van Tittelboom TJ. Near fatal subacute thallium poisoning necessitating prolonged mechanical ventilation. Am J Emerg Med 1990; 8: 548–50

    PubMed  CAS  Article  Google Scholar 

  106. Hurlbut KM, Dart RC, Sullivan JB, et al. Use of DMSA in severe thallium toxicity [abstract]. Vet Hum Toxicol 1990; 32: 363

    Google Scholar 

  107. Henderson P, Hale TW, Shum S, et al. N-acetylcysteine therapy of acute heavy metal poisoning in mice. Vet Hum Toxicol 1985; 27: 522–5

    PubMed  CAS  Google Scholar 

  108. Mulkey JP, Oehme FW. Are 2,3-dimercaptopropanesulfonic acid or Prussian blue beneficial in acute thallotoxicosis in rats? Vet Hum Toxicol 2000; 42: 325–9

    PubMed  CAS  Google Scholar 

  109. Schwetz BA, O’Neil PV, Voelker FA, et al. Effects of diphenylthiocarbazone and diethyldithiocarbamate on the excretion of thallium by rats. Toxicol Appl Pharmacol 1967; 10: 79–88

    PubMed  CAS  Article  Google Scholar 

  110. Sunderman FW. Diethyldithiocarbamate therapy of thallotoxicosis. Am J Med Sci 1967; 253: 209–20

    CAS  Article  Google Scholar 

  111. Mullins LJ, Moore RD. The movement of thallium ions in muscle. J Gen Physiol 1960; 43: 759–73

    PubMed  CAS  Article  Google Scholar 

  112. Gastel B. Clinical conferences at Johns Hopkins Hospital: thallium poisoning. Johns Hopkins Med J 1978; 142: 27–31

    Google Scholar 

  113. Papp JP, Gay PC, Dodson VN, et al. Potassium chloride treatment in thallotoxicosis. Ann Intern Med 1969; 71: 119–23

    PubMed  CAS  Google Scholar 

  114. Roby DS, Fein AM, Bennett RH, et al. Cardiopulmonary effects of acute thallium oisoning. Chest 1984; 85: 236–40

    PubMed  CAS  Article  Google Scholar 

  115. Koshy KM, Lovejoy Jr FH. Thallium ingestion with survival: ineffectiveness of peritoneal dialysis and potassium chloride diuresis. J Toxicol Clin Toxicol 1981; 18: 521–5

    CAS  Article  Google Scholar 

  116. Malbrain MLNG, Lambrecht GLY, Zandijk E, et al. Treatment of severe thallium intoxication. J Toxicol Clin Toxicol 1997; 35: 97–100

    PubMed  CAS  Article  Google Scholar 

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    Robert S. Hoffman

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Hoffman, R.S. Thallium Toxicity and the Role of Prussian Blue in Therapy. Toxicol Rev 22, 29–40 (2003). https://doi.org/10.2165/00139709-200322010-00004

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Keywords

  • Thallium
  • Activate Charcoal
  • Prussian Blue
  • Maximal Adsorptive Capacity
  • Faecal Elimination