Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1993 Jun 5;306(6891):1527–1529. doi: 10.1136/bmj.306.6891.1527

Thallium poisoning. Diagnosis may be elusive but alopecia is the clue.

D Moore 1, I House 1, A Dixon 1
PMCID: PMC1677968  PMID: 8518684

Abstract

Thallium is a heavy metal whose salts are used in some rodent poisons and in the manufacture of optical lenses, semiconductors, scintillation counters, low temperature thermometers, and switching devices, green coloured fireworks, and imitation jewelery, and as chemical catalysts. In clinical practice thallium isotopes are used in cardiac scanning, but the use of thallium salts to treat scalp ringworm was abandoned earlier this century because of their toxicity. The sale of thallium in Britain is strictly licensed because of its toxicity and potential for use in murder, which is helped by the fact that thallous salts are colourless, tasteless, and odorless. The more water soluble salts (such as thallium sulphate, acetate, or carbonate) have higher toxicity, and although the toxic dose is variable most deaths occur after the ingestion of 10-15 mg/kg of soluble salt. Most cases of thallium toxicity occur after oral ingestion but severe toxicity has been reported after inhalation of contaminated dust from pyrite burners, in zinc and lead smelting, and in the manufacture of cadmium, after dermal absorption through protective rubber gloves, and after snorting what was thought to be cocaine. The elimination half time of thallium is between 1.7 and 30 days depending on the time since, and chronicity of, ingestion. The elimination time phases are apparent and because of the long terminal elimination half time thallium may act as a cumulative poison. We present two cases of thallium poisoning with intent to kill.

Full text

PDF
1527

Images in this article

1528FIG 3
on p.1528

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bank W. J., Pleasure D. E., Suzuki K., Nigro M., Katz R. Thallium poisoning. Arch Neurol. 1972 May;26(5):456–464. doi: 10.1001/archneur.1972.00490110090009. [DOI] [PubMed] [Google Scholar]
  2. Cavanagh J. B. What have we learnt from Graham Frederick Young? Reflections on the mechanism of thallium neurotoxicity. Neuropathol Appl Neurobiol. 1991 Feb;17(1):3–9. doi: 10.1111/j.1365-2990.1991.tb00687.x. [DOI] [PubMed] [Google Scholar]
  3. Davis L. E., Standefer J. C., Kornfeld M., Abercrombie D. M., Butler C. Acute thallium poisoning: toxicological and morphological studies of the nervous system. Ann Neurol. 1981 Jul;10(1):38–44. doi: 10.1002/ana.410100108. [DOI] [PubMed] [Google Scholar]
  4. Dumitru D., Kalantri A. Electrophysiologic investigation of thallium poisoning. Muscle Nerve. 1990 May;13(5):433–437. doi: 10.1002/mus.880130510. [DOI] [PubMed] [Google Scholar]
  5. FRETWURST F., LOCHMANN F. W. Akute Thalliumvergiftung. Arch Toxikol. 1955;15(6):327–333. [PubMed] [Google Scholar]
  6. Grisham C. M., Gupta R. K., Barnett R. E., Mildvan A. S. Thallium-205 nuclear relaxation and kinetic studies of sodium and potassium ion-activated adenosine triphosphatase. J Biol Chem. 1974 Nov 10;249(21):6738–6744. [PubMed] [Google Scholar]
  7. Heyl T., Barlow R. J. Thallium poisoning: a dermatological perspective. Br J Dermatol. 1989 Dec;121(6):787–791. doi: 10.1111/j.1365-2133.1989.tb08223.x. [DOI] [PubMed] [Google Scholar]
  8. Hughes M. N., Man W. K., Whaler B. C. The toxicity of thallium(I) to cardiac and skeletal muscle. Chem Biol Interact. 1978 Oct;23(1):85–97. doi: 10.1016/0009-2797(78)90043-1. [DOI] [PubMed] [Google Scholar]
  9. Insley B. M., Grufferman S., Ayliffe H. E. Thallium poisoning in cocaine abusers. Am J Emerg Med. 1986 Nov;4(6):545–548. [PubMed] [Google Scholar]
  10. Papp J. P., Gay P. C., Dodson V. N., Pollard H. M. Potassium chloride treatment in thallotoxicosis. Ann Intern Med. 1969 Jul;71(1):119–123. doi: 10.7326/0003-4819-71-1-119. [DOI] [PubMed] [Google Scholar]
  11. REED D., CRAWLEY J., FARO S. N., PIEPER S. J., KURLAND L. T. Thallotoxicosis. Acute manifestations and sequelae. JAMA. 1963 Feb 16;183:516–522. [PubMed] [Google Scholar]
  12. Rauws A. G. Thallium pharmacokinetics and its modification by Prussian Blue. Naunyn Schmiedebergs Arch Pharmacol. 1974;284(3):294–306. doi: 10.1007/BF00500348. [DOI] [PubMed] [Google Scholar]
  13. Saddique A., Peterson C. D. Thallium poisoning: a review. Vet Hum Toxicol. 1983 Feb;25(1):16–22. [PubMed] [Google Scholar]
  14. Stevens W., van Peteghem C., Heyndrickx A., Barbier F. Eleven cases of thallium intoxication treated with Prussian blue. Int J Clin Pharmacol. 1974 Jul;10(1):1–22. [PubMed] [Google Scholar]
  15. Villanueva E., Hernandez-Cueto C., Lachica E., Rodrigo M. D., Ramos V. Poisoning by thallium. A study of five cases. Drug Saf. 1990 Sep-Oct;5(5):384–389. doi: 10.2165/00002018-199005050-00006. [DOI] [PubMed] [Google Scholar]
  16. Wainwright A. P., Kox W. J., House I. M., Henry J. A., Heaton R., Seed W. A. Clinical features and therapy of acute thallium poisoning. Q J Med. 1988 Nov;69(259):939–944. [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES