title: Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.
abstract: BACKGROUND
  The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).
  
  
  METHODS
  After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations.
  
  
  RESULTS
  Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D).
  
  
  CONCLUSIONS
  Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.
authors: Nephrology, Verdun Hospital, 4000 Lasalle Boulevard, Montreal, Quebec, Canada. marcghannoum@gmail.com
authors: Marc
authors: M
authors: Ghannoum
authors: Thomas D
authors: TD
authors: Nolin
authors: David S
authors: DS
authors: Goldfarb
authors: Darren M
authors: DM
authors: Roberts
authors: Robert
authors: R
authors: Mactier
authors: James B
authors: JB
authors: Mowry
authors: Paul I
authors: PI
authors: Dargan
authors: Robert
authors: R
authors: Maclaren
authors: Lotte C
authors: LC
authors: Hoegberg
authors: Martin
authors: M
authors: Laliberté
authors: Diane
authors: D
authors: Calello
authors: Jan T
authors: JT
authors: Kielstein
authors: Kurt
authors: K
authors: Anseeuw
authors: James F
authors: JF
authors: Winchester
authors: Emmanuel A
authors: EA
authors: Burdmann
authors: Timothy E
authors: TE
authors: Bunchman
authors: Yi
authors: Y
authors: Li
authors: David N
authors: DN
authors: Juurlink
authors: Valery
authors: V
authors: Lavergne
authors: Bruno
authors: B
authors: Megarbane
authors: Sophie
authors: S
authors: Gosselin
authors: Kathleen D
authors: KD
authors: Liu
authors: Robert S
authors: RS
authors: Hoffman
mesh_terms: D000818:Animals; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D000075322:Heavy Metal Poisoning; D006801:Humans; D019216:Metals, Heavy / Q000097:blood; D011041:Poisoning / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D006435:Renal Dialysis / Q000592:standards*; D012720:Severity of Illness Index; D013793:Thallium / Q000493:pharmacokinetics / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D019216:Metals, Heavy; D013793:Thallium