Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
New Jersey Poison Information and Education System, Newark, NJ, USA.
J Med Toxicol. 2024 Oct;20(4):416-421. doi: 10.1007/s13181-024-01034-9. Epub 2024 Aug 22.
Thallium is a highly toxic metal, with most publications demonstrating poisoning from thallium salts. We report on a patient with elevated serum and urine thallium concentrations from an intentional ingestion of elemental thallium purchased from the internet for self-harm.
The regional poison center was contacted about an 18-year-old man who ingested a fragment from a 100-gram bar reported to be elemental thallium. Serial serum and urine thallium concentrations were obtained. Prussian blue was started on hospital day (HD) 2. A metal fragment was seen on abdominal x-ray and removed via colonoscopy on HD3. The ingested fragment was analyzed via inductively coupled plasma mass spectrometry (ICP-MS) and found to be 87.0% elemental thallium. The initial serum thallium concentration obtained on HD1 was 423.5 mcg/L (reference range < 5.1 mcg/L), which subsequently decreased to 4.5 mcg/L, 29 days after the ingestion. An initial random urine thallium concentration obtained on HD 3 was 1850.5 mcg/g creatinine (reference range < 0.4 mcg/g creatinine). The patient remained hospitalized for 23 days and, when seen in follow-up, had not developed any signs or symptoms of thallium toxicity.
Elemental thallium ingestion is a rare toxicologic exposure, with limited published clinical and analytical experience to guide management. This case report describes a patient with ingestion of elemental thallium who developed elevated serum and urine thallium concentrations and was treated with Prussian blue. Despite having elevated serum and urine thallium concentrations consistent with previous fatal exposures, more evidence is needed to understand the differences between elemental thallium and thallium salts.
铊是一种剧毒金属，大多数出版物都表明铊盐中毒。我们报告了一例患者，因故意摄入从互联网上购买的用于自残的元素铊，导致血清和尿液中铊浓度升高。
地区中毒中心接到一名 18 岁男子的咨询，该男子摄入了据报道为元素铊的 100 克棒的一小片。连续检测了血清和尿液中的铊浓度。入院第 2 天（HD）开始使用普鲁士蓝。腹部 X 光片发现金属碎片，入院第 3 天通过结肠镜取出。对摄入的碎片进行电感耦合等离子体质谱（ICP-MS）分析，发现 87.0%为元素铊。入院第 1 天（HD1）获得的初始血清铊浓度为 423.5 mcg/L（参考范围<5.1 mcg/L），随后降至摄入后 29 天的 4.5 mcg/L。入院第 3 天（HD3）获得的随机尿液铊初始浓度为 1850.5 mcg/g 肌酐（参考范围<0.4 mcg/g 肌酐）。患者住院 23 天，随访时未出现铊毒性的任何迹象或症状。
元素铊的摄入是一种罕见的中毒暴露，临床和分析经验有限，难以指导管理。本病例报告描述了一名摄入元素铊的患者，其血清和尿液中的铊浓度升高，并接受普鲁士蓝治疗。尽管血清和尿液中的铊浓度与以往致命暴露一致，但需要更多证据来了解元素铊和铊盐之间的差异。
