| Objective1.To summarize the epidemiological characteristics,clinical features,diagnosis and treatment of thallotoxicosis patients,and provide the basis for the diagnosis and treatment of acute thallotoxicosis;2.To investigate the therapeutic effect of Prussian blue(PB)and its combined hemoperfusion(HP)treatment on patients with different degrees of acute thallotoxicosis;3.Experience in the diagnosis and treatment of patients with typical acute thallotoxicosis,deepen the understanding of the diagnosis and treatment of acute thallotoxicosis,to improve the success rate of thallotoxicosis treatment.Methods1.The clinical data of 47 patients diagnosed with acute thallotoxicosis and hospitalized in the Poisoning Treatment Center of our hospital from September 2002 to December 2017 were collected.A retrospective analysis of general conditions(geographical,year,gender,age distribution,etc.)of all patients,causes of toxicity,clinical manifestations,degree of toxicity,thallium concentration in blood and urine,thallium concentration in cerebrospinal fluid,biochemistry of cerebrospinal fluid,misdiagnosis and mistreatment,treatment plan,length of stay and the status discharge from hospital was carried out.2.Based on the results of previous experiments,47 patients were analyzed and 29 patients who met the conditions were divided into mild poisoning group,middle and severe intoxication group.The analysis was based on the degree of illness,concentration of toxicants,and treatment methods.3.Combined with the case of misdiagnosis and mistreatment of typical thallotoxicosis,the diagnosis and treatment process is analyzed to find out the specific causes of misdiagnosis and mistreatment.Results1.There were 47 patients in this study,15 were from Shandong;5 patients for each from Gansu,Anhui,Hubei and Hebei;4 from Henan,2 from Inner Mongolia,and 1patient for each from Shanxi,Zhejiang,Hunan,Jiangxi,Xinjiang,and Ningxia.There were 26 male patients(55.32%)and 21 female patients(44.68%).The age range is 3-68 years and the average age is 39±14 years old.The cause of poisoning in 38 patients was unknown,7 cases were poisoned,1 case was poisoned and 1 case was suicide.Forty-four patients had varying degrees of neurological symptoms;32 patients hadvarying degrees of digestive symptoms;46patients had hair loss;5 patients had psychiatric symptoms;3 patients had respiratory failure;3patients had fingernail m Streaks.A total of 23 patients with acute mild thallotoxicosis with a thallium concentration< 150ng/mL and/ or urinary thallium concentration< 1000ng/m L;blood thallium concentration ? 150ng/mL and/or urinary thallium concentration ?1000ng/mL A total of 24 patients were acute and severe thallotoxicosis.The cerebrospinal fluid biochemical and cerebrospinal fluid thallium concentrations were measured in 6 patients.Specimens were collected from 6 to 45 days after the onset of the first symptoms,with an average of 19 days.Thallium was still detectable in cerebrospinal fluid,and cerebrospinal fluid protein was slightly elevated.In the early diagnosis process,18 patients were misdiagnosed as 12 other diseases.The top five diseases with misdiagnosis rates were Guillain-Barré syndrome(6 cases),acute gastroenteritis(4 cases),acute gastroenteritis(4 cases),acute abdomen(2 cases),appendicitis(2 cases),multiple peripheral neuropathy(2 cases).After admission,patients were given conventional potassium supplements,catharsis,protective organs,nutritional nerves,and improved circulation.Based on symptomatic and supportive treatment,PB and PB+ blood purification treatments were performed.Of the 47 patients,46 had good prognosis and hospitalization time was 7 to 95 days,with an average of 24 days.During follow-up,3 patients were found to suffer from neurological impairment,such as memory loss,slow reaction,limb weakness,muscle atrophy,etc.2.For 29 cases of acute thallotoxicosis patients with complete blood and uremic examination in this group,according to the degree of toxicity,two treatments of PB and PB+HP were given respectively.Among them,13 patients with mild poisoning had mild clinical symptoms,The thallium concentration in the blood was< 150ng/mL,the thallium concentration in the urine was< 1000ng/mL,they were treated with PB,and the average length of stay was 17.0(15.0-22.0)days.Except for one case of left limb soft palate left,the rest recovered well;16 patients with moderate to severe symptoms,with severe clinical symptoms,thallium concentration in blood? 150ng/mL,urine Middle thallium concentration ? 1000ng/mL,they were treated with PB+HP,The average hospital stay was 24.0(18.0-31.5)days.Two of the patients were left with nervous system injuries,including limb weakness,muscular atrophy of the lower extremities,inability to move and so on.The results showed that adopting PB+HP treatment for the moderate and severe thallotoxicosis will have the similar efficacy with the single PB treatment in the aspect of poison clearance,time in hospital and efficacy after prognosis.3.Three cases of typical thallotoxicosis patients in this article were all treated with delayed diagnosis and treatment for a long time,resulting in multiple system injuries such as nervous system,liver and so on;the first two patients also caused respiratoryand circulatory system damage.After treatment such as driving thallium,potassium supplementation,protecting organs,symptomatic support,and blood purification,Example 1 died due to a serious condition,a cure was not expected,and the family gave up treatment;Example 2 with sequelae of nervous system injury;Example 3 recovered and discharged without sequelae.Conclusion1.Acute thallotoxicosis patients show a marked increase in the trend,if there is unknown cause of digestive system symptoms,such as nausea,vomiting,abdominal pain,diarrhea,abdominal distension,etc,or sudden symmetry of limb pain,numbness,hyperalgesia,memory loss and other neurological symptoms;Or hair loss,Mie pattern and other symptoms,should be early blood,urinary toxicity testing,to determine the presence of thallotoxicosis,The patients with thallotoxicosis were given PB to remove thallium in time,and according to the severity of the disease,they were given combined blood purification therapy.2.Patients with mild acute thallotoxicosis can get better curative effect if they are treated with PB alone;in patients with moderate or severe acute thallotoxicosis,PB combined with HP will have the similar efficacy with the single PB treatment,it will minimize the damage to tissues and organs and greatly reduce the lethal disability of patients with severe sputum poisoning.3.Keeping in mind the disease characteristics of thallotoxicosis patients and enhancing the high alertness of thallotoxicosis,to collect biological specimens as soon as possible,promptly submit toxicological analysis,accurately determine the degree of poisoning,decisively select precise treatment measures,which can reduce sequelae and improving the success rate of treatment. |
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