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Oral zinc sulphate in treatment of patients with thallium poisoning: A clinical therapeutic trial

Year 2011, Volume: 2 Issue: 2, 133 - 137, 01.06.2011
https://doi.org/10.5799/ahinjs.01.2011.02.0226

Abstract

Objectives: Thallium poisoning is usually associated with typical dermatological features simulating that of zinc deficiency. The aim of this study was to evaluate the role of oral zinc sulphate in the treatment of patients with thallium poisoning. Materials and methods: This clinical therapeutic trial study was conducted in Departments of Dermatology of Baghdad and Basrah Teaching Hospitals from February 2008 - February 2010, where a total of 37 patients with thallium poisoning were enrolled. A detailed history was taken from all patients and complete clinical examination was performed. All patients received zinc sulphate in a dose of 5 mg/kg three times a day few days before confirming the diagnosis of thallium poisoning. Thallium in urine had been measured using the colorimetric method and was positive in all patients. After confirming the diagnosis of thallium poisoning, thallium antidotes Prussian blue was given to 32 patients. Results: Age range of 37 patients was 5-33 (mean, 24±5.3) years. The dermatological findings were mainly, anagen hair loss affected the scalp and limbs. Also, dusky ecchymotic red dermatitis like rash was observed on the face and dorsum of hands and legs. Neurologic manifestations, mainly of peripheral neuropathy, were reported in 21 (55%) patients. All patients but two responded promptly to a trial of zinc sulphate within few days. Conclusion: Oral Zinc sulphate appears to be an effective and safe treatment for thallium poisoning particularly for skin and hair features and in reducing its lethal progression and complications.

References

  • Peter ALJ, Viraraghavan T. Thallium: A review of pub- lic health and environmental concerns. Environ Int 2005;31(4):493-501.
  • Desenclos JC, Wilder MH, Coppenger GW, Sherin K, Til- ler R, Vanhook RM. Thallium poisoning: An outbreak in Florida,1988. South Med J 1992;85(11):1203-6.
  • Meggs WJ, Hoffman RS, Shin RD, Weisman RS, Goldfrank LR. Thallium poisoning from maliciously contaminated food. J Toxicol Clin Toxicol 1994;32(6):723-30.
  • Galvan-Arzate S, Santamaria A. Thallium toxicity. Toxicol Lett 1998;99(1):1-13.
  • Baldwin DR, Marshall WJ. Heavy metal poisoning and its laboratory investigation. Ann Clin Biochem 1999;36:267- 300.
  • Insley BM, Grufferman S, Ayliffe HE. Thallium poisoning in cocaine abusers. Am J Emerg Med 1986;4(4):545-548.
  • Moore D, House I, Dixon A. Thallium poisoning: di- agnosis may be elusive but alopecia is the clue. BMJ 1993;306(12):1527-9.
  • Rusyniak DE, Furbee RB, Kirk MA. Thallium and arsenic poisoning in a small Midwestern town. Ann Emerg Med 2002;39(2):307-11.
  • BBC News/Middle East/Poison cake kills Iraqi children (Iraqi Air Force Club), http://news.bbc.co.uk/2/hi/middle_ east/7237086.stm
  • Sharquie KE, Ibrahim GA, Noaimi AA, Hamudy HK. Out- break of Thallium poisoning among Iraqi Patients: A case descriptive study. J Saudi Soc Dermatol Dermatol Surg 2010;7(2):112-7.
  • Kuo HC, Huang CC, Tsai YT, Chu CC, Hsieh ST, Chu NS. Acute painful neuropathy in thallium poisoning. Neurology 2005;65(3):302-4.
  • Feldman J, Levisohn DR. Acute alopecia: Clue to thallium toxicity. Pediatr Dermatol 1993;10(1):29-31.
  • Prick JJG. Thallium poisoning: Vinken DJ, Bruyn GW, eds. Handbook of Clinical Neurology: intoxications of the nervous system. Amsterdam: North-Holland Pub Co., 1979;239–78.
  • Lu CI, Huang CC, Chang YC, Tsai YT, et al. Short-term Thallium intoxication. Arch Dermatol 2007;143(1):93-8.
  • Sharquie KE, Najim RA, Al-Timimi DJ, Farjou IB. Oral zinc sulphate in the treatment of acute cutaneous leishma- niasis. Clin Exp Dermatol 2001;26(1):21-6.
  • Al-Gurairi F, Al-Waiz MM, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: Randomized pla- cebo controlled trial. Br J Dermatol 2002;146(3):423-31.
  • Sharquie KE, Najim RA, Al-Dori WS, Hayani RK. Oral zinc sulphate in the treatment of Behcet’s disease: A double blind cross-over study. J Dermatol 2006;33(4):541-6.
  • Sharquie KE, Najim RA, Al-Salman HN. Oral zinc sulphate in the treatment of rosacea: A double blind, placebo con- trolled study. Int J Dermatol 2006;45(7);857-61.
  • James WD, Berger TG, Elston DM. Acne. In: Andrews’ Diseases of the Skin Clinical Dermatology 10th ed. Phila- delphia: Saunders Elsevier 2006:244-245.
  • Sharquie KE, Najim RA, Hayani RK, Al-Nuaimy AA, Maroof DM. The therapeutic and prophylactic role of oral zinc sulphate in management of recurrent aphthous stom- atitis (RAS) in comparison with dapsone. Saudi Med J 2008;29(6):734-48.
  • Sharquie KE. No man is an island, Thallium poisoning with skin manifestations. Virtual Grand Round in Derma- tology 2.0, http://vgrd.blogspot.com/2008/04/iraqi-reality. html?showComment=1209569400000.
  • Vallee BL, Falchuk KH. The biochemical basis of zinc physiology. Physiol Rev 1993;3(1):79-118.
  • Prasad AS. Zinc Disorders. In: Ston J (ed.): Dermatol- ogy, immunology and allergy CV Mosby and Co St Louis, 1995:759-65.
  • Handjiski BK, Eichmuller S, Hofmann U, Czarnetzki BM, Paus R. Alkaline phosphatase activity and localization dur- ing the murine hair cycle. BJD 1994;131(3):303-10.
  • Paus R, Peker S. Biology of hair and nail. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. London: Mosby Wolfe, 2003:1007-1032.

Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması

Year 2011, Volume: 2 Issue: 2, 133 - 137, 01.06.2011
https://doi.org/10.5799/ahinjs.01.2011.02.0226

Abstract

Amaç: Talyum zehirlenmesi genellikle çinko eksikliğini taklit eden tipik cilt lezyonları ile birliktedir. Bu çalışmanın amacı talyum zehirlenmesi bulunan hastaların tedavisinde oral çinko sülfatın rolünü değerlendirmektir. Gereç ve yöntem: Bu klinik tedavi çalışması, Bağdat ve Basra Eğitim hastanelerinde Şubat 2008- Şubat 2010 tarihleri arasında, talyum zehirlenmesi olan 37 hasta dahil edilerek gerçekleştirildi. Hastaların tümünden detaylı anamnez alındı ve tam bir klinik muayene gerçekleştirildi. Hastaların tümü, Talyum zehirlenmesi tanısı doğrulanıncaya kadar, 5 mg/kg günde üç kez oral çinko sülfat aldı. İdrarda Talyum kalorimetrik yöntemle ölçüldü ve hastaların tümünde pozitif bulundu. Talyum zehirlenmesi tanısı kesinleştirildikten sonra Talyum antidotu Prusya Mavisi 32 hastaya verildi. Bulgular: Otuz yedi hastanın yaş ortalaması 24±5.3 yıl (5-33 yaş arası) idi. Ana dermatolojik bulgu saçlı deri ve ekstremiteleri tutan anagen saç kaybı idi. Ayrıca hastaların ayak sırtı ve bacaklarında ve yüzlerinde kirli kırmızı ekimotik döküntü benzeri lezyonlar görüldü. Başlıca periferik nöropati olarak nörolojik belirtiler 21 (%55) hastada görüldü. İki hasta dışında hastaların tümü oral çinko sülfat tedavisine bir kaç gün içinde cevap verdi. Sonuç: Oral çinko sülfat talyum zehirlenmesinde özellikle deri ve saç bulguları için ve komplikasyonları ve ölüme gidişi azaltmada etkili ve güvenli bir tedavi gibi gözüküyor. Anahtar kelimeler: Talyum zehirlenmesi, oral çinko sülfat, tedavi, Irak

References

  • Peter ALJ, Viraraghavan T. Thallium: A review of pub- lic health and environmental concerns. Environ Int 2005;31(4):493-501.
  • Desenclos JC, Wilder MH, Coppenger GW, Sherin K, Til- ler R, Vanhook RM. Thallium poisoning: An outbreak in Florida,1988. South Med J 1992;85(11):1203-6.
  • Meggs WJ, Hoffman RS, Shin RD, Weisman RS, Goldfrank LR. Thallium poisoning from maliciously contaminated food. J Toxicol Clin Toxicol 1994;32(6):723-30.
  • Galvan-Arzate S, Santamaria A. Thallium toxicity. Toxicol Lett 1998;99(1):1-13.
  • Baldwin DR, Marshall WJ. Heavy metal poisoning and its laboratory investigation. Ann Clin Biochem 1999;36:267- 300.
  • Insley BM, Grufferman S, Ayliffe HE. Thallium poisoning in cocaine abusers. Am J Emerg Med 1986;4(4):545-548.
  • Moore D, House I, Dixon A. Thallium poisoning: di- agnosis may be elusive but alopecia is the clue. BMJ 1993;306(12):1527-9.
  • Rusyniak DE, Furbee RB, Kirk MA. Thallium and arsenic poisoning in a small Midwestern town. Ann Emerg Med 2002;39(2):307-11.
  • BBC News/Middle East/Poison cake kills Iraqi children (Iraqi Air Force Club), http://news.bbc.co.uk/2/hi/middle_ east/7237086.stm
  • Sharquie KE, Ibrahim GA, Noaimi AA, Hamudy HK. Out- break of Thallium poisoning among Iraqi Patients: A case descriptive study. J Saudi Soc Dermatol Dermatol Surg 2010;7(2):112-7.
  • Kuo HC, Huang CC, Tsai YT, Chu CC, Hsieh ST, Chu NS. Acute painful neuropathy in thallium poisoning. Neurology 2005;65(3):302-4.
  • Feldman J, Levisohn DR. Acute alopecia: Clue to thallium toxicity. Pediatr Dermatol 1993;10(1):29-31.
  • Prick JJG. Thallium poisoning: Vinken DJ, Bruyn GW, eds. Handbook of Clinical Neurology: intoxications of the nervous system. Amsterdam: North-Holland Pub Co., 1979;239–78.
  • Lu CI, Huang CC, Chang YC, Tsai YT, et al. Short-term Thallium intoxication. Arch Dermatol 2007;143(1):93-8.
  • Sharquie KE, Najim RA, Al-Timimi DJ, Farjou IB. Oral zinc sulphate in the treatment of acute cutaneous leishma- niasis. Clin Exp Dermatol 2001;26(1):21-6.
  • Al-Gurairi F, Al-Waiz MM, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: Randomized pla- cebo controlled trial. Br J Dermatol 2002;146(3):423-31.
  • Sharquie KE, Najim RA, Al-Dori WS, Hayani RK. Oral zinc sulphate in the treatment of Behcet’s disease: A double blind cross-over study. J Dermatol 2006;33(4):541-6.
  • Sharquie KE, Najim RA, Al-Salman HN. Oral zinc sulphate in the treatment of rosacea: A double blind, placebo con- trolled study. Int J Dermatol 2006;45(7);857-61.
  • James WD, Berger TG, Elston DM. Acne. In: Andrews’ Diseases of the Skin Clinical Dermatology 10th ed. Phila- delphia: Saunders Elsevier 2006:244-245.
  • Sharquie KE, Najim RA, Hayani RK, Al-Nuaimy AA, Maroof DM. The therapeutic and prophylactic role of oral zinc sulphate in management of recurrent aphthous stom- atitis (RAS) in comparison with dapsone. Saudi Med J 2008;29(6):734-48.
  • Sharquie KE. No man is an island, Thallium poisoning with skin manifestations. Virtual Grand Round in Derma- tology 2.0, http://vgrd.blogspot.com/2008/04/iraqi-reality. html?showComment=1209569400000.
  • Vallee BL, Falchuk KH. The biochemical basis of zinc physiology. Physiol Rev 1993;3(1):79-118.
  • Prasad AS. Zinc Disorders. In: Ston J (ed.): Dermatol- ogy, immunology and allergy CV Mosby and Co St Louis, 1995:759-65.
  • Handjiski BK, Eichmuller S, Hofmann U, Czarnetzki BM, Paus R. Alkaline phosphatase activity and localization dur- ing the murine hair cycle. BJD 1994;131(3):303-10.
  • Paus R, Peker S. Biology of hair and nail. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. London: Mosby Wolfe, 2003:1007-1032.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Khalifa E. Sharquie This is me

Khalil İ. Al-hamdi This is me

Adil A. Noaimi This is me

Ahmed A. Al-mohammadi This is me

Publication Date June 1, 2011
Published in Issue Year 2011 Volume: 2 Issue: 2

Cite

APA Sharquie, K. E., Al-hamdi, K. İ., Noaimi, A. A., Al-mohammadi, A. A. (2011). Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması. Journal of Clinical and Experimental Investigations, 2(2), 133-137. https://doi.org/10.5799/ahinjs.01.2011.02.0226
AMA Sharquie KE, Al-hamdi Kİ, Noaimi AA, Al-mohammadi AA. Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması. J Clin Exp Invest. June 2011;2(2):133-137. doi:10.5799/ahinjs.01.2011.02.0226
Chicago Sharquie, Khalifa E., Khalil İ. Al-hamdi, Adil A. Noaimi, and Ahmed A. Al-mohammadi. “Talyum Zehirlenmesi Tedavisinde Oral çinko-sülfat: Bir Klinik Tedavi çalışması”. Journal of Clinical and Experimental Investigations 2, no. 2 (June 2011): 133-37. https://doi.org/10.5799/ahinjs.01.2011.02.0226.
EndNote Sharquie KE, Al-hamdi Kİ, Noaimi AA, Al-mohammadi AA (June 1, 2011) Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması. Journal of Clinical and Experimental Investigations 2 2 133–137.
IEEE K. E. Sharquie, K. İ. Al-hamdi, A. A. Noaimi, and A. A. Al-mohammadi, “Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması”, J Clin Exp Invest, vol. 2, no. 2, pp. 133–137, 2011, doi: 10.5799/ahinjs.01.2011.02.0226.
ISNAD Sharquie, Khalifa E. et al. “Talyum Zehirlenmesi Tedavisinde Oral çinko-sülfat: Bir Klinik Tedavi çalışması”. Journal of Clinical and Experimental Investigations 2/2 (June 2011), 133-137. https://doi.org/10.5799/ahinjs.01.2011.02.0226.
JAMA Sharquie KE, Al-hamdi Kİ, Noaimi AA, Al-mohammadi AA. Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması. J Clin Exp Invest. 2011;2:133–137.
MLA Sharquie, Khalifa E. et al. “Talyum Zehirlenmesi Tedavisinde Oral çinko-sülfat: Bir Klinik Tedavi çalışması”. Journal of Clinical and Experimental Investigations, vol. 2, no. 2, 2011, pp. 133-7, doi:10.5799/ahinjs.01.2011.02.0226.
Vancouver Sharquie KE, Al-hamdi Kİ, Noaimi AA, Al-mohammadi AA. Talyum zehirlenmesi tedavisinde oral çinko-sülfat: Bir klinik tedavi çalışması. J Clin Exp Invest. 2011;2(2):133-7.