REPEATED INGESTION WITH SUICIDAL INTENT O F POTENTIALLY FATAL AMOUNTSOF THALLIUM

30 minutes after drinking half a cup of rat poison a 16-year-old girl was admitted to hospital. In addition to various enteric detoxificatio n measures forced dialysis was instituted and, after the urinary thall ium level had become known (9 mg/l), haemodialysis was begun and ferri c ferrocyanide (Prussian blue) administered (0.5 mg daily for six days ). She had no symptoms at any time. After 10 days she was discharged. Five days after discharge she was again admitted, with colic-like abdo minal pain, vomiting, paraesthesias of the hands and feet, and in a st ate of agitation. She had once again ingested rat poison, about one cu p. Physical examination revealed little of consequence, except diffuse alopecia. Urinary thallium concentration was 37 mg/l. In the electroc ardiogram the P-R interval was shortened to 0.11 s and T waves inverte d in leads III and V1. Electronmicroscopy of cardiac and skeletal biop sies revealed Lipid droplets, increased sarcoplasm and widening of som e of the tubules. Treatment consisted of haemodialysis, forced diuresi s (1 l urine/h), administration of ferric ferrocyanide, orthograde int estinal infusions and potassium substitution (serum level: 5 mmol/l). After 28 days the patient was discharged into psychiatric care.