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

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.

Keywords

• Thallium poisoning, oral zinc sulphate, treatment, Iraq

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

Öz

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

Anahtar Kelimeler

• Talyum zehirlenmesi, oral çinko sülfat, tedavi, Irak

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