Thallium elimination kinetics in acute thallotoxicosis

This is a presentation of an acute fatal case of thallotoxicosis. The symptomatology of this ingestion and the absorption, distribution, and excretion of thallium will be discussed. Reliable pharmacokinetic information, monitoring the disappearance of thallium, will be correlated to the clinical events. This paper makes a contribution to the toxicology of thallotoxicosis in terms of kinetics of thallium and pharmacokinetics in acute ingestion. Values obtained on multiple, sequential, whole blood concentration, urine, fecal and bile contents, and eventually coronary sinus blood and organ analysis obtained at necropsy of brain, kidney, liver, and lungs and residual material obtained from the ileum and colon, are reported. The kinetics of elimination were determined from the values previously mentioned. Prussian Blue was found to be ineffective in preserving life in this case, although increased urine and fecal excretion of thallium occurred with its use. Kayexalate did not appear to contribute to the therapy in this case. Earlier and more aggressive treatment is recommended. Kinetic events in relation to neurological effects, as well as other signs and symptoms, are discussed. The histological necropsy findings from this fatal ingestion will also be presented. Recommendations in clinical, toxicological, and therapeutic areas are made.