Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.


BACKGROUND 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). METHODS 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. RESULTS 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). CONCLUSION Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.

DOI: 10.2215/CJN.01940212

7 Figures and Tables

Cite this paper

@article{Ghannoum2012ExtracorporealTF, title={Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.}, author={Marc Ghannoum and T Nolin and David S . Goldfarb and Darren M. Roberts and Robert A. Mactier and James B. Mowry and Paul Ivor Dargan and Robert E Maclaren and Lotte Christine Groth Hoegberg and Martin Lalibert{\'e} and Diane P. Calello and Jan T Kielstein and Kurt Anseeuw and James F. Winchester and Emmanuel de Almeida Burdmann and Timothy Edward Bunchman and Yi Li and David N Juurlink and Val{\'e}ry Lavergne and Bruno M{\'e}garbane and Sophie Gosselin and Kathleen D. Liu and Robert S Hoffman}, journal={Clinical journal of the American Society of Nephrology : CJASN}, year={2012}, volume={7 10}, pages={1682-90} }