Citation

Brodersen HP, Theilmeier A, Korsten S, Arendt U, Larbig D, Reis HE. Intensiv- und Notfallbehandlung 1992; 17(4): 204-207.

Copyright

(Copyright © 1992, Dustri-Verlag)

DOI

unavailable

PMID

unavailable

Abstract

Thallium is a water-soluble heavy metal, which in the past was used as rat-poison and for depilation. It was removed from the market, because is was frequently used for murder or suicide. The lethal dose amounts to about 1 g for adults, this corresponds to serum levels of 0.5-10 mg/dl. For detoxication current literature recommends enteral elimination with Berlin Blue and forced diarrhoe as well as forced diuresis with furosemide and hemodialysis. A thirty-seven-year-old woman ingested about 1.4 g thallium sulfate intending to commit suicide 18.5 hours before admission to our hospital. One hour after ingestion she vomited mucus. When admitted to our hospital the patient showed no signs of sickness, she only complained about peripheral paresthesia of the legs, which increased within the next hours. In addition to that she developed arterial hypertension, which required treatment. For 22 days we conducted a forced diuresis including the administration of furosemide with a total 302 l of urine. In addition to that, she was given 0.5 g 'Antidotum Thallii' Heyl orally every four hours for over 26 days in combination with mannit orally. Furthermore, the patient underwent permanent hemodialysis for 112 hours. 26 days after admission the patient was discharged in good condition and no other signs of intoxication, including the initial poison-induced polyneuropathy. 370 mg of a total dose of 1.4 g thallium sulfate were eliminated by hemodialysis as well as 578 mg by forced diuresis. In accordance with the present literature about 35% (estimated 400 mg) were eliminated with the feces. As evidenced by the cumulative elimination over 95% of the total dose eliminated by forced diuresis and hemodialysis were removed within 100 hours. Using all three procedures of elimination we achieved a good clinical result in spite of the potentially fatal dose of thallium sulfate.

Language: de

Keywords

adult; human; suicide; female; case report; hemodialysis; article; hemodynamics; antidote; diuresis; furosemide; nifedipine; thallium; antidotes; forced diuresis; kinetics of elimination; thallium intoxication