Case Definition: Thallium
Ingestion of toxic amounts of thallium might cause gastrointestinal signs and symptoms, most commonly abdominal pain. Subacute signs and symptoms (onset of days to weeks following ingestion) after a substantial, acute exposure or chronic exposure to limited amounts of thallium might include those of a severely painful ascending neuropathy as well as ataxia, seizures, alopecia, and neurocognitive deficits (1-4).
Laboratory criteria for diagnosis
- Biologic: A case in which elevated 24-hour urine thallium levels are detected (reference level: <5 µg/L) (3), as determined by a laboratory.
- Environmental: Detection of thallium in environmental samples (6-9).
- Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
- Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for thallium exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
- Confirmed: A clinically compatible case in which laboratory tests of biologic and environmental samples have confirmed exposure.
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.
- Ferguson TJ. Thallium. In: KR Olson, ed. Poisoning & drug overdose. 4th ed. New York , NY: McGraw-Hill; 2004:352-54.
- Mulkey JP, Oehme FW. A review of thallium toxicity. Vet Hum Toxicol 1993;35:445-53.
- Mercurio-Zappala M, Hoffman RS.Chapter 100-Thallium. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE, eds. Goldfrank’s Toxicologic Emergencies. 9th ed. New York, NY: McGraw-Hill; 2011:1326-33.
- Agency for Toxic Substances and Disease Registry. Toxicological Profile for Thallium[online]. 1992. [cited 2013 March 27]. Available from URL: http://www.atsdr.cdc.gov/ToxProfiles/tp54.pdfpdf icon
- NIOSH. NIOSH manual of analytical methods [online]. 2003. [cited 2013 Apr 5]. Available from URL: https://www.cdc.gov/niosh/docs/2003-154/.
- OSHA. Sampling and analytical methods [online]. 2010. [cited 2013 Apr 5]. Available from URL: http://www.osha.gov/dts/sltc/methods/index.htmlexternal icon.
- FDA. Food: Laboratory methods [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.fda.gov/Food/FoodScienceResearch/LaboratoryMethods/default.htmexternal icon.
- EPA. Selected analytical methods: chemical methods query [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.epa.gov/sam/searchchem.htmexternal icon.