Clinical and Forensic Aspects of Thallium Intoxication in Humans
Examinations for heavy metals are often neglected in routine chemico-toxicological forensic analyses, but acute intoxication can occur. Thallium is one of the most toxic metals, the salts of which are rapidly and almost completely absorbed by any route. Non-specific symptoms at the beginning of intoxication often prevent an early correct diagnosis and the application of appropriate detoxification treatment. In this work, we present some cases of poisoning with thallium compounds by different routes. Among the symptoms, the most frequent were severe polyneuropathy, paresthesia, abdominal and chest pain, leg cramps, and sometimes alopecia. The concentrations of thallium in blood and urine in a case of poisoning (inhalation) at the work place of a 31-year-old man were as follows: 32 and 790 μg/L, and in accidental vaginal irrigation in a 23-year-old woman-22 and 78 μg/L, respectively. In a case of intoxication of a 15-year-old boy (probably via the gastrointestinal tract) examined on the 14th day after the incident, the concentrations in blood and urine were the following: 880 and 2350 μg/L (7742 μg/24 h), respectively; on the 24th day-440 μg/L and 3350 μg/L (9378 μg/24 h); and on the 31st day-360 and 5000 μg/L (8900 μg/24 h); in hair-13.4 μg/g. After ingestion of a thallium compound of unknown origin, in a case of group poisoning (5 non-fatal cases, 3 fatal cases) the highest concentrations of thallium at the beginning of poisoning in blood and urine in the non-fatal cases were 2470 μg/L and 16200 μg/L, the lowest, about one month later-70 and 50 μg/L. The content of thallium in post mortem material was 81.0, 59.2 and 12.1 μg/g in the liver, and 62.5, 38.5, 12.1 μg/g in the kidneys. The concentrations of thallium exceeded the reference levels by many times and were comparable to the toxic thallium concentrations reported by other authors.