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Potentially life-threatening emergency
Thallium poisoning in Adult
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Thallium poisoning in Adult

Contributors: Laurie Good MD, Whitney A. High MD, JD, MEng, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Thallium poisoning results from toxic exposure to this heavy metal, which is odorless, colorless, and tasteless. The toxicity of this metal results in neurologic, ocular, dermatologic, and gastrointestinal damage. Toxic doses may be ingested, absorbed through the skin, or inhaled as contaminated dust.

Thallium is an ingredient of rodenticides and insecticides. The metal as an ingredient was banned from the United States in the 1960s, but it is still commonly used overseas. Thallium was also a component of older pharmacologic agents used to treat diseases such as ringworm and syphilis, and trace amounts of the metal may still be found in costume jewelry, recreational drugs, radiographic contrast agents (thallium-201) to assess cardiac function, semiconductors, fireworks, and various other products.

Thallium poisoning may be acute, subacute, or chronic in nature. The acute form, which is most common, develops rapidly and is the result of short exposures to high doses. The timeline of symptoms following thallium poisoning is as follows:
  1. Gastrointestinal / renal – Symptoms develop within 1-5 days of ingestion and include vomiting, diarrhea, abdominal pain, stomatitis, and liver and kidney dysfunction.
  2. Neurologic – Symptoms develop from 2 days post-ingestion onward and include burning paresthesias (distal > proximal) and motor weakness. The neuropathies are progressive and often involve cranial nerves. Respiratory paralysis, nystagmus, ophthalmoplegia, and visual loss may develop.
  3. Dermatologic – Symptoms develop from 15 days onward and include alopecia, Mees' lines on the nails, scaling of palmoplantar surfaces, and acne-like lesions. The alopecia is most significant on the scalp but may also involve the lateral eyebrows.
Chronic thallium poisoning is rare and usually results from a low level of exposure sustained over a prolonged duration. Usually only neuropathy develops in these patients.

When appropriate treatment is initiated, patients may experience significant recovery from the effects of thallium poisoning. In some patients, resultant paresthesias may not fully resolve, even with treatment.

Codes

ICD10CM:
T56.811A – Toxic effect of thallium, accidental, initial encounter

SNOMEDCT:
51040009 – Thallium poisoning

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Last Updated:04/18/2021
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Potentially life-threatening emergency
Thallium poisoning in Adult
A medical illustration showing key findings of Thallium poisoning : Abdominal pain, Diarrhea, Vomiting, Distal muscle weakness, Mees lines, Peripheral neuropathy, Paresthesias, Widespread non-scarring alopecia
Clinical image of Thallium poisoning - imageId=2152291. Click to open in gallery.  caption: 'Patchy hair loss on the scalp and thinned eyebrows.'
Patchy hair loss on the scalp and thinned eyebrows.
Copyright © 2024 VisualDx®. All rights reserved.