Lin Guodong, Yuan Luo, Peng Xiaobo, Long Jianhai, Wang Chunyan, Bai Lili, Lu Xiaoxia, Dong Jianguang, Liu Yanqing, Wang Yongan, Qiu Zewu
Poisoning Treatment Department, Affiliated Hospital Academy of Military Medical Sciences, Beijing.
State Key Laboratory of Toxicology and Medical Countermeasures, Institutes of Pharmacology and Toxicology, Academy of Military Medical Sciences, People's Republic of China.
Medicine (Baltimore). 2019 Jul;98(29):e16471. doi: 10.1097/MD.0000000000016471.
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.
铊具有高毒性，其影响会累积。铊中毒的临床症状不具有特异性，从而导致入院和治疗延迟。本研究旨在总结铊中毒延迟入院患者的临床特征及治疗经验。
我们对2008年至2018年在我院发生铊中毒且延迟入院的患者进行了回顾性描述性分析。评估了从症状出现到入院的时间。将患者分为3组，并对其临床特征进行描述性分析，包括患者基本信息、症状、实验室检查结果、检查发现、治疗方法、结局及随访信息。
共纳入34例铊中毒患者：8例早期或轻度延迟入院，9例中度延迟入院，17例严重延迟入院。从发病到入院的时间为13（四分位间距，7.5 - 26）天。部分延迟入院患者出现与中枢神经系统损害相关的显著症状，磁共振成像和脑电图也有变化。入院后，所有患者均接受普鲁士蓝治疗，部分血铊浓度较高的患者接受了血液净化治疗。治疗后，所有患者的血铊和尿铊浓度均显著下降，症状得到缓解。
我们的结果表明，铊中毒患者延迟入院与中枢神经系统损害风险增加有关。使用普鲁士蓝联合血液净化治疗可能改善患者病情。
