Thallium Toxicity Follow-up

  • Author: G Patrick Daubert, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 11, 2011
 

Further Inpatient Care

  • Admit all patients with significant signs and symptoms of thallium toxicity.
  • Initially measure thallium concentrations in the urine 3 times per week to confirm a decreasing trend. Prussian blue treatment should be continued until the 24-hour urine thallium concentration returns to the reference range (0-5 mcg/d).[20]
  • Thallotoxicosis also is associated with a severe form of stomatitis; thus, monitor mouth hygiene closely. Shaving the patient's head may reduce the stress induced by hair loss and improve the patient's morale.
  • Physical therapy may be instituted to prevent development of muscle contractures.
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Further Outpatient Care

  • Patients with unintentional intoxication who are asymptomatic with a minimal increase in urine thallium level may be discharged with close follow-up care.
  • Patients with intentional ingestions should have a psychiatric evaluation before discharge from the hospital.
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Transfer

  • Consider transferring patients with severe symptomatology if a medical toxicologist is not readily available.
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Deterrence/Prevention

  • Regular follow-up care is recommended for persons with known thallium exposure.
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Complications

  • Prolonged neurologic damage may persist if detoxification therapy is delayed. Patients have demonstrated persistent signs and symptoms of peripheral neuropathy at least 6 years after intoxication. Reports or persistent findings most commonly involve the feet and lower extremities.
  • Cases of persistent agitation, aggression, personality changes, depression, and other psychiatric symptoms have been reported following thallium exposure.
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Prognosis

  • If recognized and treated early, thallium intoxication carries a favorable prognosis; however, the course of recovery may be lengthy.
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Patient Education

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Contributor Information and Disclosures
Author

G Patrick Daubert, MD  Assistant Professor, Assistant Medical Director, Sacramento Division, California Poison Control System; Director of Clinical and Medical Toxicology Education, Department of Emergency Medicine, University of California, Davis Medical Center

G Patrick Daubert, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM,  Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH, FACMT, FAACT, FACPM, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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