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Thallium
- 1. THALLIUM Dr Nikita Prabhakaran Junior resident Dept of Forensic Medicine GMC,Tvm
- 2. Characteristics • Soft and pliable • Metal • Ideal homicidal poison
- 3. Salts sulphate*** acetate Chloride Iodide Nitrate Carbonate • Odourless • Tasteless • Freely soluble in water
- 4. Uses • Glass and dye industry • Rodenticide • Depilatory • Fireworks • Cardiac perfusion imaging
- 5. Mode of action- 1 • Cellular toxin • //r to K+ • Na+ K+ ATPase pump • Low levels: replaces K+ • High levels:competitively inhibits
- 6. Mode of action- 2 • Affinity for SH group Sulphydryl Crosslinking Of keratin Alopecia Nail growth affected
- 7. Fatal dose • Average : 10-15 mg/kg • Reported adult dose : 1 gm of absorbed thallium
- 8. Absorption • Inhalation • Ingestion • Intact skin
- 9. Clinical features- Acute • abdominal pain • gastroenteritis(haematemesis + haematochezia) • tachycardia • headache confusion paraesthesia hallucination convulsion • Retrobulbar neuritis ophthalmoplegia • DEATH ~ respiratory failure (due to motor neuropathy)
- 10. • Occasionally hepatic or renal failure • Bone marrow depression • Scalp hair – dark pigmented band 3-4 days • Urine –first voided greenish
- 11. Clinical features-Chronic Alopecia- 10 days after Total loss (1 month) Lateral half of eyebrows – falls Survives – regrowth occurs Skin rash butterfly distribution on the face acneiform eruptions occasionally Nails dystrophy Mee’s lines
- 13. CNS • Peripheral neuropathy- sensorimotor • -primarily of the soles and foot • -unsteady gait ~ 1st to be noted • -2 to 6 days • Ataxia • Other CNS cranial nerve palsy • optic neuropathy • choreoathetosis • tremor • encephalopathy • psychotic behaviour
- 14. • Ophthalmic – ptosis, ophthalmoplegia, nystagmus • keratitis, lens opacities • abnormal colour vision and reduced acuity • CVS – Htn, cardiomyopathy, arrythmias, bradycardia, ECG changes • OTHERS: testicular toxicity • hypokalemia • renal failure • hepatic dysfn
- 15. • Bluish line in the gums: 3 to 4 weeks post-ingestion • Thallium Triad: alopecia + skin rash • peripheral neuropathy • mental confusion + lethargy • Earliest symptom complex: • painful neuropathy+ gastroenteritis • Sequelae: lasts for 30 yrs • (ataxia + tremor + flaccid paralysis + retardation)
- 16. Diagnosis • opacities in the GIT /liver • Decreased colour sensitivity • Optic neuropathy • ECG changes • Decreased nerve conduction • Hair microscopy: dark pigmn at the roots
- 17. urine 3 drops bromine water 3 drops Sulfosalicylic acid 1 drop HCl 2 drops rhodamine B in HCl I ml of benzene Centrifuge bright yellow/fluorescent red colour
- 18. • Spectroscopy • Urine excretion: 10-20 mg in 24 hrs ~diagnostic • Blood levels- >100 mg/dL potential poisoning • Hypocalcemia
- 19. Treatment • Stomach wash with Prussian Blue (precipitate) • Maintanence : a duodenal tube 125 mg/kg + 15 ml of 15 % mannitol • twice a day till urine 0.5 mg/day • Activated charcoal enhances elimination
- 20. • Forced diuresis with K Cl • Haemodialysis • Diethyldithiocarbamate not recommended
- 21. • Physiotherapy- prevent muscle contractures • Shaving the head- to reduce stress of hair fall • Oral hygiene
- 23. • Fatty degeneration of heart( Tabby cat striation of the ventricles) • Fatty degeneration of liver
- 24. • Renal damage • Pulmonary oedema • Cerebral oedema
- 25. Forensic Issues: • Accidental poisoning: industrial/occupational exposure • children: rodenticide • Suicidal –rare in India • common in western countries till 1960 • USA banned it in 1975 • Lot of cases for murders in western countries
- 26. Thank you