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Zewu Qiu - One of the best experts on this subject based on the ideXlab platform.
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clinical characteristics and treatment of Thallium Poisoning in patients with delayed admission in china
Medicine, 2019Co-Authors: Guodong Lin, Luo Yuan, Xiaobo Peng, Jianhai Long, Chunyan Wang, Lili Bai, Jianguang Dong, Yanqing Liu, Yongan Wang, Zewu QiuAbstract:Thallium is highly toxic and its effects are cumulative. The clinical symptoms of Thallium Poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience Thallium Poisoning.We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had Thallium Poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.A total of 34 patients with Thallium Poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5-26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine Thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.Our results show that delayed patient admission in cases of Thallium Poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients' conditions.
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successful treatment of a patient with severe Thallium Poisoning in a coma using prussian blue and plasma exchange a case report
Medicine, 2019Co-Authors: Guodong Lin, Luo Yuan, Lili Bai, Yanqing Liu, Yongan Wang, Zewu QiuAbstract:Rationale This is the first reported severe Thallium Poisoning patient successfully treated with Prussian blue (PB) and plasma exchange (PE). Patient concerns A 42-year-old woman in a coma owing to severe Thallium Poisoning was admitted to our department after day 44 of Poisoning. At admission, blood and urine Thallium concentrations were 380.0 and 2580.0 ng/mL, respectively. Diagnosis The patient was diagnosed with toxic encephalopathy induced by Thallium Poisoning; in addition, she was also diagnosed with bilateral pneumonia, respiratory failure, moderate anemia, hypoproteinemia, and electrolyte imbalance based on her chest X-ray, blood gas analysis, Hb level, albumin levels, and serum electrolyte results. Interventions The patient was intubated and treated with PB (6600 mg/d, 15 days in total) combined with PE (once daily, 5 days in total) as well as other symptomatic supportive care measures. Outcomes After treatments, her blood and urinary Thallium concentrations gradually decreased and on the 13th day after admission, the blood Thallium concentration decreased to 0 ng/mL. The oxygenation index gradually improved, meantime, the patient gradually regained consciousness, and on the 50th day of admission, the patient's consciousness reverted to a clear-headed state. The patient recovered mostly after 37 months of follow-up. Lessons Through this case, we learned that the gradual reduction in blood and urine Thallium concentration and the patient's improved condition is correlated with PB and PE treatment. For patients with severe Thallium Poisoning, this treatment method might be effective; but the exact curative effect is unconfirmed, requiring further research to verify.
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efficacy analysis of prussian blue or its combination with hemoperfusion in the treatment of acute Thallium Poisoning
Chinese critical care medicine, 2018Co-Authors: Junxiu Zhao, Xiaobo Peng, Jianhai Long, Chunyan Wang, Lili Bai, Jianguang Dong, Yanqing Liu, Shufang Feng, Zewu QiuAbstract: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. Key words: Thallium Poisoning; Hemoperfusion; Prussian blue; Efficacy analysis
Robert S Hoffman - One of the best experts on this subject based on the ideXlab platform.
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cerebrospinal fluid analysis in fatal Thallium Poisoning evidence for delayed distribution into the central nervous system
American Journal of Forensic Medicine and Pathology, 2004Co-Authors: Adhi N Sharma, Lewis S Nelson, Robert S HoffmanAbstract:Abstract The neurologic manifestations of Thallium Poisoning include a severely painful ascending peripheral neuropathy, autonomic dysfunction, cranial nerve abnormalities, and a toxic encephalopathy. Although Thallium has a short half-life, these neurologic manifestations commonly progress, even as the blood concentration of Thallium decreases. This suggests either that Thallium persists in neuronal tissues or that it initiates an injury cascade that takes time to fully manifest. As the latter mechanism is consistent with many toxin exposures, the concept of a central nervous system reservoir for Thallium is often discounted. A recent case provided a unique opportunity to evaluate this possibility. A 48-year-old man was acutely and chronically Thallium poisoned by his common-law wife. During his initial exposures, only gastrointestinal symptoms manifested. Following an acute ingestion, hospitalization was required. Over 3 days, his symptoms rapidly progressed from a severely painful neuropathy to slurred speech, ptosis, confusion, coma, respiratory insufficiency, and death. Because of considerations of alternative diagnoses, 2 lumbar punctures were performed, one on admission and another on the day of his death. Serum Thallium concentrations obtained from stored blood samples were paired with spinal fluid concentrations from the same days. On day 1, serum and spinal fluid concentrations were 8700 μ/L and 1200 μ/L, respectively. On day 3, although the serum concentration had fallen to 7200 μ/L, the spinal fluid concentration had increased to 2100 μ/L. This case provides evidence to support the hypothesis that Thallium distributes into the central nervous system more slowly than the blood compartment, and this may in part account for the progression of neurologic findings in the setting of decreasing serum concentrations.
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Thallium Poisoning during pregnancy a case report and comprehensive literature review
Clinical Toxicology, 2000Co-Authors: Robert S HoffmanAbstract:Background: Thallium salts were once used to treat a variety of disorders such as tuberculosis, sexually transmitted diseases, and ringworm of the scalp. Although the clinical manifestations and treatment of patients with Thallium Poisoning are well characterized, little information is available on the outcome of pregnancy in Thallium-poisoned women. A case of Thallium Poisoning that began during the first trimester of pregnancy and resulted in fetal demise is reported. Methods: An extensive literature search identified reported cases of Thallium Poisoning during pregnancy from 1903 until the present time. All articles were obtained, translated, and abstracted using a standardized data collection form. References were hand-searched and abstracted to identify additional cases. Results: From a total of 25 cases identified, only 18 met satisfactory criteria for inclusion. Five exposures occurred during the first trimester, 5 during the second trimester, and 8 during the third trimester. Mothers developed cla...
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Thallium Poisoning from maliciously contaminated food
Clinical Toxicology, 1994Co-Authors: William J Meggs, Robert S Hoffman, Richard D Shih, Richard S Weisman, Lewis R GoldfrankAbstract:Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of Thallium Poisoning. A tentative diagnosis of Thallium Poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate Thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of Thallium Poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.
Hungchou Kuo - One of the best experts on this subject based on the ideXlab platform.
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central nervous system effects in acute Thallium Poisoning
Neurotoxicology, 2006Co-Authors: Yutai Tsai, Hungchou Kuo, Chinchang Huang, Hsuanmin Wang, Wushiun Shen, Tungsheng Shih, Naishin ChuAbstract:We report the central nervous system manifestations, neuropsychological studies and brain magnetic resonance image (MRI) findings of two patients with acute Thallium intoxication. Neurologically the patients suffered from confusion, disorientation, and hallucination in the acute stage, followed by anxiety, depression, lack of attention, and memory impairment, in addition to peripheral neuropathy. Neuropsychological tests revealed an impairment of memory function, including reversed digital span, memory registration, memory recall, memory recognition, similarity, proverb reasoning, and verbal fluency. High concentrations of Thallium were found in the urine, blood, and drinking water of these two patients. Brain MRI showed lesions in the corpus striatum in one patient. During the follow-up periods, the clinical manifestations and neuropsychological studies showed a slowly progressive improvement, and a follow-up brain MRI 1.5 months later demonstrated a resolution of the lesions. We conclude that Thallium intoxication might induce encephalopathy, and brain MRI studies demonstrated the acute-stage brain lesions in a severe intoxicated patient. In addition, neuropsychological tests also confirmed memory deficits, although the brain lesions in the corpus striatum might resolve.
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acute painful neuropathy in Thallium Poisoning
Neurology, 2005Co-Authors: Hungchou Kuo, Chinchang Huang, Y T Tsai, C C Chu, Sungtsang Hsieh, N S ChuAbstract:Dysesthesia, allodynia, distal muscle weakness, and sensory impairment were noted in two patients with acute Thallium intoxication. Two months later, nerve conduction studies showed an axonal degeneration. Sural nerve biopsy disclosed a decreased fiber density in the large myelinated fibers. Quantitative sensory testing also revealed an impairment of pinprick, temperature, and touch sensations. Cutaneous nerve biopsy confirmed a loss of epidermal nerves indicating an involvement of the small sensory nerves.
Naishin Chu - One of the best experts on this subject based on the ideXlab platform.
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central nervous system effects in acute Thallium Poisoning
Neurotoxicology, 2006Co-Authors: Yutai Tsai, Hungchou Kuo, Chinchang Huang, Hsuanmin Wang, Wushiun Shen, Tungsheng Shih, Naishin ChuAbstract:We report the central nervous system manifestations, neuropsychological studies and brain magnetic resonance image (MRI) findings of two patients with acute Thallium intoxication. Neurologically the patients suffered from confusion, disorientation, and hallucination in the acute stage, followed by anxiety, depression, lack of attention, and memory impairment, in addition to peripheral neuropathy. Neuropsychological tests revealed an impairment of memory function, including reversed digital span, memory registration, memory recall, memory recognition, similarity, proverb reasoning, and verbal fluency. High concentrations of Thallium were found in the urine, blood, and drinking water of these two patients. Brain MRI showed lesions in the corpus striatum in one patient. During the follow-up periods, the clinical manifestations and neuropsychological studies showed a slowly progressive improvement, and a follow-up brain MRI 1.5 months later demonstrated a resolution of the lesions. We conclude that Thallium intoxication might induce encephalopathy, and brain MRI studies demonstrated the acute-stage brain lesions in a severe intoxicated patient. In addition, neuropsychological tests also confirmed memory deficits, although the brain lesions in the corpus striatum might resolve.
Yanqing Liu - One of the best experts on this subject based on the ideXlab platform.
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clinical characteristics and treatment of Thallium Poisoning in patients with delayed admission in china
Medicine, 2019Co-Authors: Guodong Lin, Luo Yuan, Xiaobo Peng, Jianhai Long, Chunyan Wang, Lili Bai, Jianguang Dong, Yanqing Liu, Yongan Wang, Zewu QiuAbstract:Thallium is highly toxic and its effects are cumulative. The clinical symptoms of Thallium Poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience Thallium Poisoning.We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had Thallium Poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.A total of 34 patients with Thallium Poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5-26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine Thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.Our results show that delayed patient admission in cases of Thallium Poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients' conditions.
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successful treatment of a patient with severe Thallium Poisoning in a coma using prussian blue and plasma exchange a case report
Medicine, 2019Co-Authors: Guodong Lin, Luo Yuan, Lili Bai, Yanqing Liu, Yongan Wang, Zewu QiuAbstract:Rationale This is the first reported severe Thallium Poisoning patient successfully treated with Prussian blue (PB) and plasma exchange (PE). Patient concerns A 42-year-old woman in a coma owing to severe Thallium Poisoning was admitted to our department after day 44 of Poisoning. At admission, blood and urine Thallium concentrations were 380.0 and 2580.0 ng/mL, respectively. Diagnosis The patient was diagnosed with toxic encephalopathy induced by Thallium Poisoning; in addition, she was also diagnosed with bilateral pneumonia, respiratory failure, moderate anemia, hypoproteinemia, and electrolyte imbalance based on her chest X-ray, blood gas analysis, Hb level, albumin levels, and serum electrolyte results. Interventions The patient was intubated and treated with PB (6600 mg/d, 15 days in total) combined with PE (once daily, 5 days in total) as well as other symptomatic supportive care measures. Outcomes After treatments, her blood and urinary Thallium concentrations gradually decreased and on the 13th day after admission, the blood Thallium concentration decreased to 0 ng/mL. The oxygenation index gradually improved, meantime, the patient gradually regained consciousness, and on the 50th day of admission, the patient's consciousness reverted to a clear-headed state. The patient recovered mostly after 37 months of follow-up. Lessons Through this case, we learned that the gradual reduction in blood and urine Thallium concentration and the patient's improved condition is correlated with PB and PE treatment. For patients with severe Thallium Poisoning, this treatment method might be effective; but the exact curative effect is unconfirmed, requiring further research to verify.
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efficacy analysis of prussian blue or its combination with hemoperfusion in the treatment of acute Thallium Poisoning
Chinese critical care medicine, 2018Co-Authors: Junxiu Zhao, Xiaobo Peng, Jianhai Long, Chunyan Wang, Lili Bai, Jianguang Dong, Yanqing Liu, Shufang Feng, Zewu QiuAbstract: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. Key words: Thallium Poisoning; Hemoperfusion; Prussian blue; Efficacy analysis