Though extremely rare, thallium intoxication can be lethal despite early administration of MDAC and use of Prussian blue therapy. His last blood thallium concentration was 5369 mcg/L, a spot urine thallium >2000 mcg/L, and a 24- hour urine thallium was >2000 mcg/L. The patient died shortly after his transfer. The patient required vasopressors and was transferred to a tertiary care center to undergo continuous renal replacement therapy (CRRT). On hospital day three, the patient developed hypotension that did not respond to fluids. The patient continued to be tachycardic and hypertensive and subsequently developed renal failure. He received MDAC during his initial ED management and was started on PB 18 hours post arrival he was intubated on the following day for airway protection. On examination he was agitated with a blood pressure of 141/60 mmHg and a heart rate of 146 beats per minute (bpm). He presented to an emergency department (ED) 45 minutes later with abdominal pain and vomiting.
We report a fatal suicidal ingestion of thallium sulfate rodenticide in which multi-dose activated charcoal (MDAC) and Prussian Blue (PB) were both used without changing the outcome.Ī 36 year old man ingested an unknown amount of thallium sulfate grains from an old rodenticide bottle. Accidental poisonings also occur, but are increasingly rare owing to restricted use and availability of thallium. Thallium is a highly toxic compound and is occasionally involved in intentional overdoses or criminal poisonings.
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