title: Management of thallium poisoning in patients with delayed hospital admission.
abstract: OBJECTIVE
  To describe the clinical features and management of thallium poisoning in patients with delayed hospital admission.
  
  
  METHODS
  Fourteen patients (median age 36 years) were admitted 9-19 days after ingesting food poisoned with thallium. Clinical and laboratory data, including blood and urine thallium concentrations, were collected. Patients were treated with oral Prussian blue, a chelating agent sodium dimercaptosulfonate, and hemodialysis.
  
  
  RESULTS
  All patients experienced a triad of symptoms of acute gastrointestinal upset, painful combined polyneuropathy, and hair loss after consuming poisoned food. Fatigue and skin pigmentation were observed in all patients. Abnormal liver function tests were found in 6 (42.9%) and delirium and coma were identified in 4 (28.6%). Two weeks after the poisoning, the blood and urine thallium concentration ranged from 219.0 to 1414.4 μg/L (median: 535.3) and 956.5 to 11285.0 μg/L (median: 7460.0), respectively. One patient (7.1%) with a previous history of pulmonary fibrosis died of respiratory failure in hospital. Symptoms were improved and blood or urine thallium levels were normalized in the remaining 13 patients before discharge. After a 6.5 ± 1-month follow-up, 1 patient (7.1%) developed deep venous thrombosis in the left lower limb. In another patient (7.1%), numbness in the lower limbs remained.
  
  
  CONCLUSIONS
  Acute thallium poisoning is commonly manifested by gastrointestinal upset, painful polyneuropathy, and significant hair loss. Treatment strategies included Prussian blue and hemodialysis, which were associated with a good outcome in this case series.
authors.affiliation: Emergency Department, Zhengzhou University First Hospital ,  Zhengzhou ,  China.
authors.forename: Tong-Wen
authors.initials: TW
authors.lastname: Sun
authors.forename: Qing-Yan
authors.initials: QY
authors.lastname: Xu
authors.forename: Xiao-Juan
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Qiong
authors.initials: Q
authors.lastname: Wu
authors.forename: Zhang-Suo
authors.initials: ZS
authors.lastname: Liu
authors.forename: Quan-Cheng
authors.initials: QC
authors.lastname: Kan
authors.forename: Cheng-Ye
authors.initials: CY
authors.lastname: Sun
authors.forename: Lexin
authors.initials: L
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000009:adverse effects; D005260:Female; D005295:Ferrocyanides / Q000627:therapeutic use; D005506:Food Contamination; D005517:Foodborne Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013793:Thallium / Q000097:blood / Q000506:poisoning* / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D005295:Ferrocyanides; D013793:Thallium; C000170:ferric ferrocyanide