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Monochromatic excitation X-ray fluorescence (ME-XRF) spectrometry is a novel technique for trace element analysis, characterized by its simplicity, rapidity, and low cost. The objective of this study was to evaluate the applicability of ME-XRF technique for the measurement of thallium in biological samples. Acute and subacute thallium poisoning experiments were conducted to simulate various scenarios, with blood, urine, and 10 distinct organs collected. Detection was initially performed using ME-XRF technique, followed by validation with inductively coupled plasma mass spectrometry (ICP-MS). Excellent agreement between ME-XRF and ICP-MS values was demonstrated by means of paired sample t-tests and intraclass correlation coefficients. Subsequently, the practical implementation of the proposed technique was demonstrated through an actual case study. In conclusion, this study validates ME-XRF as a suitable alternative to ICP-MS for the measurement of trace heavy metals in biological samples. These efforts promote the development of simpler and faster techniques for heavy metal detection, thereby presenting novel avenues for the prevention and diagnosis of heavy metal poisoning.
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BACKGROUND: Thallium poisoning is rare and difficult to recognize. Early diagnosis and treatment of thallium-poisoned patients are essential to prevent morbidity and mortality. AIM: To evaluate the efficacy of treatments and outcomes of five patients with early diagnosis of acute thallium poisoning. METHODS: Five patients who consumed a thallium-contaminated meal were hospitalized in succession, and underwent clinical examinations such as blood tests and electromyography tests. Urine and blood tests confirmed the diagnosis of thallotoxicosis, revealing the occurrence of food poisoning. All patients underwent detoxification treatment, including hemoperfusion (HP) and treatment with Prussian blue (PB). A 24-mo follow-up was performed to evaluate the long-term outcomes on the patients after discharge. RESULTS: Initially, the patients presented with symptoms of acute thallium poisoning including hyperalgesia of the limbs and abdominalgia, which may differ from common peripheral neuropathy. Accompanying symptoms such as hepatic damage and alopecia were observed in all the patients, which further confirmed the diagnosis of poisoning. Treatment with chelating agents was ineffective, while HP and treatment with PB drastically decreased the thallium concentration in the urine and blood. With early diagnosis and intervention, four patients had a good prognosis and no permanent sequelae. One patient developed blindness and disability during the 24-mo follow-up period. CONCLUSION: Identification of incident cluster and characteristic symptoms is extremely important for early diagnosis of acute thallium poisoning. HP plus PB is essential to improve the prognosis of thallium-poisoned patients.
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INTRODUCTION: Thallium poisoning is a rare occurrence. Therefore, thallium poisoning is easily misdiagnosed and is often accompanied by a series of serious sequelae and can even result in death in severe cases. Here, we report long-term follow-up of a case of a patient who was poisoned with thallium on two separate occasions. METHODS: A 43-year-old man was initially misdiagnosed as gastroenteritis, diabetic peripheral neuropathy, and Guillain-Barré Syndrome (GBS) within 21 months. The correct diagnosis was confirmed by blood and urine thallium assays. After Prussian blue treatment, thallium was undetectable in the blood by day 60. Following this investigation, a criminal suspect confessed to two instances of adulterating thallium sulfate in the patient's beverage. A 6-year follow-up was performed after discharge, and a comprehensive literature was review. RESULTS: We found that the original gastrointestinal symptoms, skin lesions, and hair loss were reversed and had recovered, except for residual neurologic damage, even with long-term rehabilitation. DISCUSSION: Thallium intoxication may have been initially identified if neurologic symptoms had occurred concurrently with gastrointestinal and cutaneous symptoms. Neurologic damage represented the main sequelae of thallium poisoning in our present case report.
Subject(s)
Alopecia , Thallium , Adult , Diagnostic Errors , Humans , MaleABSTRACT
The banning of the heavy metal thallium (Tl) in many Countries, because of its toxicity, led to a remarkable reduction of the number of cases of poisoning both accidental and homicidal forcing us to better study the pharmacokinetics of this poison using new technologies. The Authors, in this work, are reporting the case of a collective thallium toxicosis caused by voluntary adulteration of an infusion with thallium sulfate, occurred in 8 members of the same familial nucleus; the administration of Prussian Blu resulted to be ineffective for 3 of these members that died at a later time. The most peculiar aspects of this rare manner of poisoning are discussed; the analytical procedures used, Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in particular, resulted to be fundamental in the forensic diagnosis process of acute poisoning cause by thallium.
Subject(s)
Family , Forensic Medicine , Homicide , Thallium/poisoning , Thallium/toxicity , Aged , Aged, 80 and over , Autopsy , Female , Humans , Male , Mass Spectrometry/methods , Middle Aged , Thallium/administration & dosageABSTRACT
Objective@#To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning.@*Methods@#Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg·kg-1·d-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected.@*Results@#Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. ①Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. ② After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury.@*Conclusion@#In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.
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OBJECTIVE: To investigate the clinical features,treatment methods and prognosis of acute thallium poisoning.METHODS: The clinical data of 2 cases of acute thallium poisoning were analyzed retrospectively to observe its clinical features,therapeutic effect of blood purification and sodium dimercaptosulfonate,and prognosis.RESULTS: The typical triads of clinical features of the two cases of acute thallium poisoning were gastroenteritis,polyneuropathy and alopecia.Before treatment,the blood thallium level was 200.6 and 712.7 μg/L and the urine thallium level was 5 206.4 and 11050.2 μg/24 h respectively.After the combined treatment using blood purification and sodium dimercaptosulfonate,the blood thallium decreased to 31.6 and 14.6 μg/L and the urine thallium decreased to 175.2 and 265.3 μg/24 h.The two patients had a good prognosis.The result of re-examination showed that blood thallium was 7.9 and 0.6 μg/L and the urine thallium was 31.5 and 5.5 μg/24 h respectively in 2 and 5 months later.CONCLUSION: The combined treatment using blood purification and sodium dimercaptosulfonate is effective for acute thallium poisoning therapy.
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Objective To investigate the clinical and electrophysiological features and treatments for thallium poisoning. Methods Twelve cases of thallium poisoning patients were from hospital 307 of PLA between June 2012 and October 2017 and their data were retrospectively analyzed. Twelve sex-and age-matched healthy subjects were selected as control group. Result The clinical manifestations of thallium poisoning were mainly symptoms of nervous and gastrointestinal systems as well as hair loss. Thallium poisoning compromised function of motor nerves including the prolonged distal latency of ulnar and common peroneal nerve, the decreased amplitude and slowed nerve conduction velocity of common peroneal nerve and tibial nerve, which were statistically different from control group (P<0.05). Thallium poisoning also impaired function of sensory nerve including the prolonged distal latency and decreased amplitude of median , ulnar and sural nerve, the slowed nerve conduction velocity of median , ulnar, radial and sural nerve which were statistically different from control group (P<0.05 or P<0.01 ). Electroencephalogram (EEG) of 7 cases revealed mild abnormality EEG in 6 cases and moderate abnormality EEG in one case. Patients received potassium supplementation, diuresis, oral Prussian blue, intramuscular injection of sodium dimercaptopropanesulfonate and other treatment. Severe cases had good outcome after hemoperfusion and plasma exchange. Conclusions Thallium poisoning is rare in clinic and typical clinical features and electrophysiological examination are helpful to the diagnosis and differential diagnosis of diseases. Timely increasing thallium excretion and symptomatic support treatment can effectively improve the prognosis of the patients.
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Thallium is a toxic heavy metal often involved in criminal poisonings and occasionally in accidental poisoning. Here, we report a case of acute, nonintentional thallium poisoning due to thallium-contaminated alternative medicine for its rarity and to create awareness about the combination of rapid, diffuse alopecia with neurologic and gastrointestinal symptoms among practitioners, professionals, public, and policymakers.
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Thallium has been responsible for many intoxications since its discovery; however, toxicological profiles for thallium in human fatalities have not been updated recently. Autopsy, microscopic investigations, and toxicological analyses were performed on a married couple who died from thallium sulfate intended homicidal poisoning. The distribution of thallium was established by inductively coupled plasma mass spectrometry with hair samples showing the highest thallium concentration. Electron microscopy revealed a dystrophic condition of hair with disorganized cuticle and atrophy of the hair bulb. Thallium interacts with cells at different levels, with prominent ultrastructural injuries in the mitochondria and endoplasmic reticulum, and high concentration of electron dense granules observed in the cytoplasm and mitochondria of several organs. Alopecia, toxic encephalopathy, and peripheral neuropathy were diagnosed in the victims and suggested to be crucial implications for thallium poisoning. The analytical procedures used in this case are of considerable forensic importance in the diagnosis of thallium poisoning.
Subject(s)
Thallium/poisoning , Alopecia/chemically induced , Cytoplasm/pathology , Drug Eruptions/pathology , Endoplasmic Reticulum/pathology , Female , Hair/chemistry , Hair/diagnostic imaging , Homicide , Humans , Male , Mass Spectrometry/methods , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Middle Aged , Mitochondria/pathology , Neurotoxicity Syndromes/etiology , Peripheral Nervous System Diseases/chemically induced , Poisoning/diagnosis , Stomatitis/chemically induced , Thallium/analysis , UltrasonographyABSTRACT
Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. It is most often treated by an oral administration of Prussian blue. Thallium has a long physiological half-life, and Prussian blue cannot sequester thallium outside the digestive tract. Therefore, the first priority in treating severe thallium poisoning is to lower blood levels as soon as possible. We report the case of a patient with supralethal blood levels of thallium treated successfully using combined hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH). Three rounds of HP alone decreased blood thallium levels by 20.2%, 34.8%, and 32.2%, while each of the five subsequent rounds of CVVH reduced thallium blood levels by 63.5%, 64.2%, 42.1%, 18.6%, and 22.6%. The reversal of symptoms and prevention of lasting neurological damage indicates that HP, CVVH, 2,3-dimercaptopropane-1-sulfonate, neuroprotective agents along with supportive therapy were used successfully to treat a case of severe thallium poisoning.
Subject(s)
Hemofiltration/methods , Hemoperfusion , Thallium/poisoning , Adult , Humans , Male , Poisoning/therapy , Thallium/blood , Treatment OutcomeABSTRACT
@#ObjectiveTo investigate the clinical manifestations, rehabilitation evaluation and treatment for Thallium poisoning. MethodsA patient with Thallium poisoning was reviewed. ResultsGastroenteritis, peripheral polyneuropathy and alopecia were the typical symptoms of Thallium poisoning. After the shortwave therapy, medium frequency electrotherapy and physical therapy, the index of sensory, extremities perimeter and muscle strength, sitting-stand-walking, ADL, and emotions were apparently improved. ConclusionComprehensive rehabilitation with shortwave therapy, medium frequency electrotherapy and physical therapy might be effective treatments for the patients with Thallium poisoning.
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@#ObjectiveTo investigate the clinical manifestations, rehabilitation evaluation and treatment for Thallium poisoning. MethodsA patient with Thallium poisoning was reviewed. ResultsGastroenteritis, peripheral polyneuropathy and alopecia were the typical symptoms of Thallium poisoning. After the shortwave therapy, medium frequency electrotherapy and physical therapy, the index of sensory, extremities perimeter and muscle strength, sitting-stand-walking, ADL, and emotions were apparently improved. ConclusionComprehensive rehabilitation with shortwave therapy, medium frequency electrotherapy and physical therapy might be effective treatments for the patients with Thallium poisoning.
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As a result of a series of thallium poisoning events, the rare element thallium has attracted wide attention. For nearly a decade, the mechanisms of thallium poisoning and treatment measures have become hot research topics. Preliminary results showed that thallium was absorbed by gastrointestinal tract, respiratory tract and skin, then distributed in the body widely. The thalium concentration in kidneys was the highest, folowed by salivary glands. Thallium ions can replace potassium ion in body and influence the activity of several enzymes. Moreover, thallium can antagonize calcium ions and affect heart function. Clinically, thallium induces peripheral nerve poisoning, gastrointestinal symptoms, mucosal inflammation, hair loss and visual damage. Examination of 24-hour urine thallium concentration is the most accurate way to assess thallium poisoning. If urine thallium concentration is higher than 5 μg/L, it is of diagnostic significance. The clinical treatment measures include reducing the absorption, accelerating elimination and practicing symptomatic treatment. Hemoperfusion has been reported to be effective in eliminating absorbed thallium.
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In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.
