Diagnosis and treatment of persons with acute thallium poisoning

OBJECTIVE: This study aimed to describe organs and systems damages in persons after mass poisoning with thallium and show the results of treatment. METHODS: Forty-four persons (12 males and 32 females) with acute oral thallium poisoning were tested for thallium levels in blood and urine and examined by a toxicologist and a neurologist, and in some –cases, by a gynecologist, an ophthalmologist, and a psychiatrist. Persons were divided into the following three groups depending on the severity of the poisoning: I: This group consisted of 9 persons (blood thallium level 8.3–26.7 μg/L) and treatment applied in the hospital included intestinal lavage, antidote therapy with potassium-ferric hexacyanoferrate, sodium dimercaptopropanesulfonate; II: This group consisted of 21 persons (0.3-6.1 μg/L) who received a similar treatment at home; and III: This group consisted of 14 (normal) persons who did not receive any treatment. RESULTS: The most common combination of several symptoms such as alopecia (on day 17–23), muscle pain of different localization in the debut of the disease (>88.9 % of the persons), sudden unexplained general weakness (>76.2 % of the persons), peripheral paraparesis or tetraparesis (including no complaints), polyneuropathy (88.89 % in group I vs. 54.14 % in group II, p < 0.05), static and dynamic ataxia (33.3 % in group I vs. 19.4 % in group II, p < 0.05), vertigo (1/3 of the persons), postural tremor (1/3 of the persons), and cognitive and emotional disorders (2/3 of the persons). Ovarian dysfunction was observed in all women of group I but in 42.9 % of group II, p < 0.05. The treatment was successful. In group I, plasma and urine thallium level significantly decreased by 69.3 % and 84 %, respectively. Pain, movement and coordination disorders regressed first while tremor, sensory, cognitive and emotional disorders lasted longer. Polyneuropathies later became mononeuropathies. Tremor could increase despite a decreased thallium concentration. DISCUSSION: The Sklifosovsky Institute conducted the largest study in Russian Federation investigating disorders in persons with acute thallium poisoning confirmed by laboratory tests. The clinical symptoms were consistent with those reported in the literature. The applied treatment was successful and led to better results compared to our previous approaches of treating mass thallium poisoning. CONCLUSIONS: This study shows a typical combination of thallium poisoning symptoms and allows us to recommend a complex therapy without the use of extracorporeal detoxification methods.