OBJECTIVE: To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning. METHODS: Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg×kg^-1×d^-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected. RESULTS: Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. (1) Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. (2) After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury. CONCLUSIONS In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.
Adult ; Female ; Ferrocyanides ; Heavy Metal Poisoning ; Hemoperfusion ; Humans ; Male ; Middle Aged ; Thallium/poisoning*

Poisoning ; drug therapy ; Thallium ; toxicity

Adult ; Autopsy ; Female ; Hair ; metabolism ; Humans ; Liver ; pathology ; Thallium ; poisoning

Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.
Arsenic ; Ataxia ; Carbon Disulfide ; Carbon Monoxide ; Cerebellar Diseases ; Delivery of Health Care ; Developing Countries ; Dimethylamines ; Disease Outbreaks ; Electrophysiology ; Gases ; Hexanes ; Hydrogen Sulfide ; Manganese ; Metals, Heavy ; Nervous System ; Neuroimaging ; Neurologic Manifestations ; Neuromuscular Junction Diseases ; Neurotoxins ; Occupational Diseases ; Occupational Health ; Organophosphate Poisoning ; Organophosphates ; Parkinsonian Disorders ; Polychlorinated Biphenyls ; Quaternary Ammonium Compounds ; Semiconductors ; Sodium Fluoride ; Solvents ; Taiwan ; Thallium ; Tin ; Toluene ; Urethane

Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.
Arsenic ; Ataxia ; Carbon Disulfide ; Carbon Monoxide ; Cerebellar Diseases ; Delivery of Health Care ; Developing Countries ; Dimethylamines ; Disease Outbreaks ; Electrophysiology ; Gases ; Hexanes ; Hydrogen Sulfide ; Manganese ; Metals, Heavy ; Nervous System ; Neuroimaging ; Neurologic Manifestations ; Neuromuscular Junction Diseases ; Neurotoxins ; Occupational Diseases ; Occupational Health ; Organophosphate Poisoning ; Organophosphates ; Parkinsonian Disorders ; Polychlorinated Biphenyls ; Quaternary Ammonium Compounds ; Semiconductors ; Sodium Fluoride ; Solvents ; Taiwan ; Thallium ; Tin ; Toluene ; Urethane

Adult ; Heavy Metal Poisoning ; Humans ; Male ; Poisoning ; Thallium ; poisoning

Adolescent ; Adult ; Child ; Child, Preschool ; China ; Female ; Heavy Metal Poisoning ; Humans ; Infant ; Male ; Middle Aged ; Poisoning ; diagnosis ; Prognosis ; Thallium ; poisoning ; Young Adult

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Heavy Metal Poisoning ; Humans ; Male ; Middle Aged ; Poisoning ; diagnosis ; therapy ; Prognosis ; Thallium ; poisoning ; Treatment Outcome ; Young Adult

Adult ; Heavy Metal Poisoning ; Hemoperfusion ; Humans ; Male ; Poisoning ; therapy ; Thallium ; poisoning

Heavy Metal Poisoning ; Humans ; Nervous System ; drug effects ; Poisoning ; Thallium ; poisoning