Wainwright A P, Kox W J, House I M, Henry J A, Heaton R, Seed W A
Department of Anaesthesia, Charing Cross Hospital, London.
Q J Med. 1988 Nov;69(259):939-44.
Severe acute thallium poisoning in a young man is described. He presented with transient loss of consciousness and paraesthesiae of finger tips and lips, with a blood thallium concentration of 5750 micrograms/l (levels above 200 micrograms/l are toxic). He rapidly lost limb sensation and power and later required temporary mechanical ventilation and nasogastric feeding. The neurological sequelae one year afterwards are a flaccid paraparesis, cerebellar ataxia and mental impairment. Immediate cardiovascular complications included hypertension, sinus tachycardia, ECG abnormalities and an episode of ventricular fibrillation. We were able to assess the relative merits of different methods advocated for enhancing thallium excretion. Oral Prussian blue, forced diuresis and haemodialysis were found to be the most effective: 2000 mg of thallium were eliminated over 20 days, 820 mg over 46 days and 225 mg over 25 days respectively by these methods. Haemofiltration was ineffective. Diethyldithiocarbamate, a chelating agent, brought about a rise in serum thallium concentration accompanied by clinical deterioration and its use should be abandoned.
本文描述了一名年轻男性的严重急性铊中毒病例。他出现短暂意识丧失以及指尖和嘴唇感觉异常，血液铊浓度为5750微克/升（超过200微克/升即有毒）。他很快出现肢体感觉和力量丧失，随后需要临时机械通气和鼻饲。一年后的神经后遗症为弛缓性截瘫、小脑共济失调和智力障碍。即刻心血管并发症包括高血压、窦性心动过速、心电图异常及一次室颤发作。我们能够评估所倡导的不同促进铊排泄方法的相对优点。发现口服普鲁士蓝、强制利尿和血液透析最为有效：通过这些方法分别在20天内排出2000毫克铊、46天内排出820毫克铊和25天内排出225毫克铊。血液滤过无效。螯合剂二乙基二硫代氨基甲酸盐导致血清铊浓度升高并伴有临床病情恶化，应摒弃其使用。
