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TOXICOLOGY

Arsenic :

Its used as a pesticide

MC form is arsenic trioxide (fatal dose = 0.1-0.2 gms)


Acute Arsenic Poisoning

Chronic Arsenic Poisoning

Mimics cholera

Raia drop pigmentation and

Bloody diarrhea

hyperkeratosis of skin esp on palms and

Presents c garlicky odour

soles
White lines on nails k/a Aldrich mees lines.

Dx:
Marshs test, Reinschs test
Rx:
BAL, DMSA

Post mortem :

Red velvety mucosa of stomach

RTN in chronic poisoning

Delays putrefaction, rigor mortis so not an ideal poison

Can be detected in nails, bones, hairs for years after death

Lead :

Its poisoning is k/a plumbism / saturnism.

Clinical Presentation :

Facial palloris earliest sign, which is d/t Anaemia c punctuate basophilia k/a Basophilic
stippling seen in RBCs

Burtonian lines blue lines on gums

Lead palsy as wrist drop / foot drop

Constipation and colicky pain

Lead encephalopathy

Dx:
Urine test ( pb, ALA, CPU)

Rx:
BAL, EDTA, Penicillamine, DMSA

Mercury :

Chronic poisoning is K/o Hydragyrism

Metallic form is non poisonous, vapour form is dangerous Mercuric compounds are more
dang than mercurous compounds most dang form is mercuric chloride.

C/F : Excessive salivation, membranous colitis, glomerulonephritis coarse tremors k/a


danburry Tremors, Halters / Glassblowers shake Insomnia, Acrodynia, Erethism, blue
black lines on gums

Deposition of Hg on anterior capsule k/a Mercuric lentis

Rx:
BAL, DMSA

Phosphorus :
Types White and Red

White
Translucent, illuminous, waxy.
Burns at env temp so used
In fireworks and gun powder

Red
Non toxic, non transparent
non illuminous, non waky
and amorphous in nature

It effects cell oxidation and leads to Anoxic Necrobiosis by inhibiting glycogen deposition.

Acute poisoning
GI stress mimic vomiting
Diarrhoea, falty liver

Chronic Poisoning
Phossy jaw/ Glass jaw osteomyclitis, loosening
of teeth.

Zinc :
Its also k/a metal fume fever that mimics influenza comes from metal or welding industry.
C/F: Chills, Fever, the temp returns to normal c chills
Rx : Symptomatic

Aluminium :
Most toxic form is AL phosphide also k/a celphos celphos when in contact c moisture release
phosphene gas, this gas reacts c Ag No3 gives black color Its used as a Pesticide,
Insecticide, Rodenticide
C/F: Respiratory distress
Phosphere is cardiotoxic MI, myocardial necrosis
MCC of death is cardiogenic shock

Corrosive Poisons
Sulphuric Acid :
Its the strongest corrosive poison also k/a oil of vitriol
C/F: Dysphagia, swollen black tongue
Teeth are chalky white in color
Stomach is stained black and is like blotting paper
Rx : Gastric lavage is C/I
Acids should be neutralized c water / milk containing Mg O/CaO

Oxallic Acid:
Used as an ink remover, so used in forgery

Coffee coloured vomitus


Hypacalcemia, Uremia
Rx : Any calcium preparation

Hydrochloric Acid :
C/F : Greyish white mucous membrane

Carbolic Acid (Phenol):


C/F : Smoky green coloured urine, ochronosis, Leathery mucous membrane of stomach

Nitric Acid :

Also k/a Aqua fortis / Red spirit

Brown black stomach c no perforation

Hydrocyanic Acid :

Also k/a Prussic Acid

Used as suicide pills or cattle poison

Causes Histotoxic /cytotoxic anoxia

Most rapidly acting poison

Post mortem staining is cheery Red in colour and bitter almonds Smell from the patient.

Rx :
Amyl nitrite, Vit B12, EDTA, Thiosulphate

Vitriolage: Throwing of any acid on another person

Other Poisons
Carbon Monoxide :

Its safety upper limit in air is 0.01%


If 0-10% - No symp, 50% -symp of drunkenness, >70% - fatal

Post Mortem Findings :


Blood cheery red in color, fluidish
Organs are congested, blisters and patches on skin
B/L neurosis of basal ganglia.

Chloral Hydrate :

It is colourless, crystalline, bitter tasting c Pungent odour hypnotic also k/a Dry wine

Its given c food and drinks for the purpose of robbery causing knockout drops

Drink mixed c chloral hydrate and alcohol is x/a Mickeyfinn

Barbituvates Toxicity :
C/F: Drowsiness, stupor, coma, golden colour urine Barbiturate bulla and blisters

Rx : forced alkaline dieresis

Alcohol :
Alcohol

Alcohol

Acetaldehyde

Ace DH

Acetic acid

Dehydrogenase

Methanol
(Danger%) 1x

MDH

Formaldehyde

Formic acid

33x

90x

Toxic amblopia (blindness)

Formula to calc alcohol in blood is WIDMARKS formula

Absolute Alcohol >150-250 ml is fatal


Ethyl alcohol: 20% is absorbed from stomach and 80% from intestine. It is a CNS
depressant

Methyl Alcohol: It causes metabolic acidosis pupil are dilated and fixed. Blindness occurs
d/t optic neuritis.
Rx.:

Ethanol for meltraxol poisoning

In 2013 TOC is fomipizole

Amount of methanol causing blindness 15ml, death 60-240 ml

Gastric lavage is done

NaHCO3 for met disturbances

Folinic acid

If nothing works dialysis is done

Acute toxicity : Sedation, irritability


Chronic toxicity : Thiamine deficiency Wernickes Encephalopalthy
Global Confusion
Opthalmoptegial Ataxia
Korsakoffs psychosis
Confabulations, Amnesia
Rare features of chronic poisoning are McEwans sign, morbid jealousy (Othello synd), Munich
beer heart, Micturation syncope

Opioids :
C/F:
Intoxication

Withdrawal

Hallucinations

- Insomnia

Euphoria

- Disphoria

Pin point pupil

- Excess secretions of all fluids from all arifices

severe constipation
resp. depression

- Pilo erection

stupor, coma
Rx : Naloxone, Nalmefere
Naltrexone, Nalorphine

Rx: Methadone, clonidines


Dextropropoxyphene Buprapion

Chasing the dragon is a method of smoking opioids


Opium is dried juice of pappy plant
Its derivatives are phenanthrene (morphine, codein, Thebane) and soqrcinolone
(papavarine and Narcotene, Artificially derived Heroin)

Delerient Poisons
Cannabis Indica/Sativa :

Weed, in India k/a Bhang/Ganja/Charas/Hashish

Bhang is prep from leaves of this plant

Ganja is prep from flower top of plant

Charas/Itashis from leaves and stem of plant

C/F : Conjunctival congestion, apetite, HR, flashbacks


Amotivation synd Depression suicide
Run Amox Depression attempt to kill people

Cocaine :

Obtained from leaves of plant Erythroxylum Coca

Its a local anesthetic c vasoconstrictive properties


C/F: Delusion of Persecution
Ulceration and Perforation of nasal septum
Magnans symp/Cocaine Bug/ formication
Black teeth, tongue and gums

Dathura :

All plant parts are poisonous. Fruit is k/a Thorn Apple

Types Datura Alba, Datura niger

It contains Hyoscine, L-Hyoscines and has atropine like actions


C/F : Dilated pupils,
Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat

Vegetable Poisons
Abrus Pre cantorium (Rati/sim needle /sui)

Toxin is Abrin

Semi Carpus Anacardium :

Its also k/a Marking nut

Its used by washerwomen to wash clothes

Lesions resembles bruises

Its black in colour

Its used as an abortificent

Snake Poison

Its poisoning is k/a ophistoxemia

Cobra, Krait

Viper

Sea Snakes

CNS, neruotoxic

Vasculotoxic

Musculotoxic

Cobra convulsions

Coagulation
abnormalities

Myoglobinurea

Krait Paralysis

Poisonous

Non-Poisonous

Nocturnal

Not nocturnal

Tail Compressed

Round

Fangs Hollow

Solid

Pit Present

Absent

Scales

Body Scales Throughout the breadth

Small and Central

Head Scales Small

Big

MISCELLANEOUS
Patterns of Mucosa

Arsenic Red and Velvety

Carbolic Acid Brown, thick leathery


(phenol)

Sulphuric Acid Black, Erosions and perforations

Colours of Urine

Phenol Green brown

Barbiturate Golden (Gold urine in LSD)

Nitric acid Brown

Poisons Causing Miosis

Barbiturates

Chloral hydrate

Phenol

OP compounds

Opioids

Pontine H age

Rare Drug

Rohypnol, Roofies

SHB ( Hydroxy butyrate)

Cardiotoxic Poisons

Digitalis

Oliander

Nicotine

Hydrocefanic Acid

Aconite

Quinine

Spinal Poisons
Strychnine

Strychnine

(nux vomica)

Brucine

Uses :

Respiratory stimulants

Kill rodents (Rodenticide)

Cattle Poison

Convulsions are seen


Patient is concious and stable
Rx : Muscle Relaxants

Animal Poison

Spanish fly / Blister beatle produces a poison called canthradin


Its consumption is associated with priapism

Dialysis :

MC used for Alcohol, Methanol, Ethylene glycol, Barbiturate, Lithium, Thiophylline,


Salicylate

Doesnt work for Digitalis, BZD, Kerosene, CuSO4

Diuresis

Alkaline

Forced

Acid

(Alcohol)

Gastric lavage is C/I in all corrosive poisonings except phenols


MC NS is used for gastric lavage

Universal antidote include Mgo with charcoal and Tannic acid (1:2:1)

Antidotes in Vavious Poisonings :

Paracetamol N-acetyl cystein

- Datura Physostigmine

Methanol Ethanol

- OP Atropine

Opiate Nalaxone

Poisoning Resembling Natural Diseases :

Arsenic Cholera

Strychnine Tetanus

Zinc Malaria

- Zinc Influenza

Samples Presrred in various poisoning :

Heart Strychnine, Digitalis

Brain OP, Volatile, Organic, Opioids, CO, Barbiturate

Spinal Cord Strychnine

Bone Arsenic, Antimony, Radium, Thallium

CSF Alcohol

Vitreous humour Alcohol, Chloroform

Uterus Criminal abortions

Fat Pesticides, Insecticides

Spleen Cyanide

Skin Opioids, Cocaine

Lungs Gaseous Poisons