Extracorporeal Treatment for Thallium Poisoning: Recommendations from the EXTRIP Workgroup

• Published in: Clinical journal of the American Society of Nephrology Vol. 7; no. 10; pp. 1682 - 1690
• Main Authors: Ghannoum, Marc, Nolin, Thomas D, Goldfarb, David S, Roberts, Darren M, Mactier, Robert, Mowry, James B, Dargan, Paul I, Maclaren, Robert, Hoegberg, Lotte C, Laliberté, Martin, Calello, Diane, Kielstein, Jan T, Anseeuw, Kurt, Winchester, James F, Burdmann, Emmanuel A, Bunchman, Timothy E, Li, Yi, Juurlink, David N, Lavergne, Valery, Megarbane, Bruno, Gosselin, Sophie, Liu, Kathleen D, Hoffman, Robert S
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.10.2012
• Subjects: Animals; Cardiology and cardiovascular system; Consensus; Delphi Technique; Emerging diseases; Evidence-Based Medicine; Heavy Metal Poisoning; Human health and pathology; Humans; Infectious diseases; Life Sciences; Metals, Heavy - blood; Poisoning - blood; Poisoning - diagnosis; Poisoning - therapy; Pulmonology and respiratory tract; Renal Dialysis - standards; Severity of Illness Index; Thallium - pharmacokinetics; Thallium - poisoning; Toxicology; Treatment Outcome
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.01940212

The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D). Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.