Thallium Toxicity Follow-up

Updated: Feb 19, 2018
  • Author: Chip Gresham, MD, FACEM; Chief Editor: David Vearrier, MD, MPH  more...
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Follow-up

Further Outpatient Care

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  • 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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Further Inpatient Care

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  • 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). [29]

  • 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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Transfer

Consider transferring patients with severe symptomatology if a medical toxicologist is not readily available.

 

 

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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.

Persistent psychiatric symptoms have been reported following thallium exposure, including the following:

  • Agitation
  • Aggression
  • Personality changes
  • Depression

 

 

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Prognosis

If recognized and treated early, thallium intoxication carries a favorable prognosis; however, the course of recovery may be lengthy. [33]

 

 

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Patient Education

For patient education resources, see the First Aid and Injuries Center. Also, see Poisoning and Activated Charcoal.

 

 

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