NMT 11

Specific Toxicology
 
Chapter 2
Corrosives

Stomach Skin Smoke (Lung)

Scheme:
1- Effect of Poisoning.
2- F.D
3- F.P
4- Action
5- C/P
6- P.M.P
7- Ttt
(+/-)
8- Source & Uses
9- Kinetics
10-Diagnosis ( Investigations)
11- D.D

Inorganic (Typical) Organic (Atypical)

1- Strong 1- Mild
Local
2- Local 2- Mixed
Remote
3- XXX Emesis/Lavage 3- √√√ Emesis & Lavage
Chapter : Corrosives

4- E.g.: -H2SO4 4- E.g.: -Carbolic acid

-HNO3 Potash -Oxalic acid
- HCL

  1
NMT 11
Specific Toxicology
 

H2SO4 (Acid ) Potash (Alkalies)

1-Source & - Chemicals -Chemicals
Uses: Batteries Cleaning
Laboratories
2-Diagnosis -As before -As before
(Investigation)
3-Condition Child
Of Poisoning: Workers
Accidental Addicts Accidental Children
Therapeutic (Milk)
Suicidal XXX XXX
Face (Revenge)
Homicidal Disfigurement XXX
Blindness
4-Fatal Dose: K2CO3 Na2CO3
4 c.c ×2
15gm 30 gm
5-Action: Local ONLY:
A-Hygroscopic effect: A-Hygroscopic effect
(Absorbs Water From Air) ( Milder)

Stomach Skin Smoke

B- Coagulative necrosis B- Liquefactive necrosis
(Slimy & Soapy appearance)
6-C/P: Laryngeal edema& Asphyxia -√√√ NH3 Fumes.
-Smoke Eschars (Colored ulcers) -Eschars
-Skin H2SO4 Æ Black White
-Stomach 1-Pain & Swelling √
Chapter : Corrosives

4S
2- Swallow (Dysphagia) √
Speech (Dysarthria) √
Shock (Neurogenic) √
Stomach (Perforation) Rare

  2
NMT 11
Specific Toxicology
 
3-Vomiting (Acidic Haematin) 3 Vomiting (Alkaline Haematin)

Café Brown Soapy

4-Constipation 4-Diarrhea
5- √
5-Dehydration

6-Shock 7-Oliguria
6- √ 7- √

-Temp Æ -Temp Æ √
-Pulse Æ Rapid weak -Pulse Æ √
-B.PÆ
-B.P Æ √
-Resp. Æ Shallow rapid
-Resp. Æ √
7-Cause of > In acids
Death & fatal
Period: S A D / P C > In alkalies

Stricture

Shock Asphyxia Dehydration Perforation Cachexia&

(Neurogenic) (Few hrs) (12 Hrs) (Days) Emaciation
(Weaks)
Immediate
8-P.M.P: SUSÆ1- Ulcers & 1- Ulcers
Perforation
+
2- Eschars (White)
SESÆ 2- Eschars (Black)
Chapter : Corrosives

+
Brain

  3
NMT 11
Specific Toxicology
 

+
3- Internal & External signs
of asphyxia
PassagesÆ3- Internal &
External signs +
of asphyxia Narrowing of lower end of
esophagus
+
PM changes.

9- ttt: 1- Supportive & Symptomatic ttt:

Surgical Operations
S A D / P C
+ Pervious + 1- Colon Bypass
Stuff 2- Gastrectomy
+ Morphine 3- Dilatation + >2 weeks
Laprotomy
5-10 mg IV for pain + Friable Tissues
Antibiotic
4-Jej.deposition
5-Cortisone+ Antibiotic

To prevent Stricture
2- E.C.G Æ XXX
3- Local Antidote Æ - Demulcent
-NeutralisationÆ XX due to…..
4- Dialysis, Diuresis & Heamoperfusion Æ XX

5- Physiological Antidote XX Æ Doesn’t reach Blood

Chapter : Corrosives

Syptomatic ttt: Skin ttt:

-Wash by water
-Antibiotics
-Skin Graft

  4
NMT 11
Specific Toxicology
 

Carbolic Acid “ Phenol” (4) Oxalic Acid

“4 Points” (‫)اﺑﻴﺾ‬
Renal Local Coagulative
Failure anaesthesia Necrosis ‫ﻳﺒﻴﺾ‬ Similar to

-CNS Æ ‫اﻟﻨﺤﺎس‬ Ink ‫اﻟﻤﻠﺢ اﻟﺴﻜﺮ‬

-CVS Remover "‫ﺑﻴﺤﺐ اﻟﻠﺒﻦ" أﺑﻴﺾ‬
Ca ‫ﻓﻴﻪ‬
1-Fatal Dose: 4 gm 15gm
2-Fatal -Early Æ 4 Hrs -Rapid Æ 15 min
Period: -Delayed Æ 4 Days - Delayed Æ 15 Days
3-Diagnosis -As Before -As Before
(Investigation)
4-Source & -Coal –tar -Rhubarb
Uses: -Disinfectant -Ink Remover
(Dettol)
5-Condition of 1-Accidental: -Children 1-Accidental -Workers
Poisoning: -Workers -Children

-Cheap
2- Suicidal: -Easily Obtained Similar to Sugar & Salt crystals
-Local
Anaesthesia

3- Homicidal: XXX Due to

characteristic Smell
6-Action: Mild Æ Mixed
Chapter : Corrosives

1-Local: 1-Local:

Coagulative necrosis
1-Stomach Æ 1- Mild Corrosives +
Local anaesthesia Coagulative necrosis.

  5
NMT 11
Specific Toxicology
 
2-Skin Æ Eschars (Brown) Æ2- White Eschars.

3-Smoke ÆCharacteristic Smell Æ3- SmokeÆ……..

2-Remote: 2-Remote: +Ca Ca

1- CNS Æ as before Oxalate
2- CVS Æ as before Ca in Blood Crystals
3- Renal failure Æ as before 1-Contraction of Ms.Æas
before

2- CVS affectionÆ as before

3-Collecting tubules Æ Renal

Failure
7-C/P: 1-StomachÆPain & Vomiting 1-Æ Pain & Vomiting
Rapidly White due to Ca oxalate
Local Anaesthesia XX Crystals

2-Skin ÆChocolate Brown 2- ÆWhite Eschars

Eschars

3-Smoke ÆSmell 3- Æin chronic Toxicity ONLY.

4-CNS Æ as before +Miosis Remote:

5-CVSÆ as before 1-Contraction (as before)

+Arrhythmia
Convulsions” Resp.Ms”
6-Renal FailureÆas before
Peripheral Asphyxia
Chapter : Corrosives

+Urine Green in color

2-CVS(as before)ÆArrhythmia
Once exposed to airÆ Oxidation
3-Collecting TubesÆ + White
Hydroquinone Ca Oxalate Crystals

  6
NMT 11
Specific Toxicology
 
8-ttt: 1-Supportive & Symptomatic 1-Supportive & Symptomatic
ttt: ttt:
As before + -RFÆResp.Failure as before
Met-hemoglobinanaemia -RFÆRenal Failure

Corrected by Diazepam
Vit C Or Methylene Blue 1mg/Kg
2mg
-Convulsion Æ as before

2-Elimination of Poisons From 2-Elimination of Poisons From

GIT: (ECG) GIT: (ECG)
- No Vomiting
-Done -Thickened Stomach Î √√√

So, No fear from perforation

3-Local Antidote: 3-Local Antidote: Milk

(Demulcent)
-DemulcentÆ ‫ﻟﺒﻦ‬
-Alcohol 10% Æ ‫آﺤﻮل‬ Form To precipitate
(Dissolvent) Ca Oxalate Oxalic acid
-MgSO4 Æ ‫ﻣﻠﺢ‬

4-D. & D. & H. 4-D. & D. & H. Æ √√

5-Physiological Antidote: 5-Physiological Antidote: IV Ca

Gluconate

9-Cause of 1-Respiratory FailureÆ Central 1-Respiratory FailureÆ

Chapter : Corrosives

Death: Asphyxia Peripheral Asphyxia

2-Renal FailureÆ Direct 2-Renal FailureÆ Obstructive

3-CVSÆ Cardiac Arrest 3-CVSÆ Arrhythmia

  7
NMT 1
Specific Toxicology
 
10-P.M.P: SUSÆ1-Smell SUSÆ1- Sup.Ulcers
2-Sup.Ulcers + Thickened
Stomach
+ +
SES Æ3-Brown Eschars SES Æ2-White Eschars

+ +
Brain Æ 4-Brain Edema + Brain
Congestion
+ +
PassagesÆ 5-Int.& Ext. Signs of PassagesÆ 3-Int.& Ext. Signs
Asphyxia of Asphyxia
+ +
PM picture PM picture
+ +
C\P Æ 6-Kideny C/P Æ 4-Kideny
Affection
Congested Tense + Ca Oxalate Crystals
Enlarged Capsule 5-Dilated Heart

11-D.D: 3C In Stomach:

Coma Cyanosis Constricted Arsenic Æ White Powder

Pupil
Chapter : Corrosives

Diff. from Ca Oxalate By

1- Morphine Reinsch Test
2- Carbolic Acid
3- Organo-Phosphorus
4- Pontine hge

  8
NMT 11
Specific Toxicology
 

Oral:
Role of Milk:-

H2SO4 Carbolic Acid Oxalic Acid

Demulcent Coagulation Precipitation

To spare stomach proteins

Chapter : Corrosives

  9
 Plant poisons
Alkali+Acid
because
Plants are not called {Alkaloids} Salts
Alkalies because they don't turn litmus paper blue Plants+Acid

Salts
3V
OPIUM (Morphin)
5C
General↓

Characters of plants:
1)Alkaloids Doesn't turn litmus paper blue

2)Flower Far action

3)Local Antidote 1-Charcoal (adsorption)

2-Tannic acid (PPt)
3-H2O2& KMNO2 (Oxidation)

1-Source

Papaver somniferum (Puppy)

white
oxidation
in presence
of air ‫ﺑﻨﻲ‬ N.B. Derived from the capsule not the seeds

Opium Morphin Heroin

Opium Morphine
Smell (meconic.a) XXX
Ingested Injected

10
2-Uses
1-Pain killer
2-Shock
3-Morphin addicts

3-Diagnosis Search for Morphine+

Meconic a
As before

4-C.of poisoning

Children
Workers
Acc
Therapuetic √
Addicts √

Suc Addicts

Homicidal XXX

5-Fetal dose Morphine

100mg

6-Fetal period Mid day

12 hours

11
Action+ C/P

3V Action 5C C/P

↑ & ↓
1-↑Vagus ↓ BP, ↓Pulse, ↓Resp

2-↑Vomiting center Vomiting smell of opium

3-↑VCC (Visual constrictor Center) Pin point pupil (fixed)

4-↓Cortex (sensory) Euphoria Dysphoria(due

to over dose)
5-↓Cough center Pulmonary edema (smell
(Stertorous resp) of opium)
6-↓Center of heat ↓Temp
7-↓Consciousness{CNS} Coma,Cyanosis,Central asphyxia

8-↓Colon & Bladder Constipation,Urine retention

12
P.M.P

SUS 1-Smell of opium

2-No seeds in stomach

SeS 3- Needle

Brain 4-Brain edema

(Pontine Hge) + Pontine Hge

+
Passages 5-Int&Ext
+Pulmonary edema
+

P.M.P XX

C/P XX

13
 Coma
D.D. : 3 C Cyanosis
Constricted pupil

Carbolic acid Morphine O.P Pontine hge.

History History History No History

Smell characteristic Meconic acid Garlic No smell

Low temp. Sub normal low hyperthermia

Irregular pulse Slow & full slow -----------------

Constricted pupil Fixed P.P.P Constricted Constricted

normal normal convulsions quadriplegia

Chemical analysis Chemical analysis Chemical No Chemical

analysis analysis
Urine : Green

TTT :
1) S&S Resp.
2) ECG √√√ - even if injected
- cuffed endotracheal tube (v.imp.)

Due to ↓ cough reflex

avoid asp. pneumonia

3) local antidote:
a) charcoal
b) tannic acid
c) H2O2 , KMNO2

4) D & D & H

5) physiological antidote Antagonists → Atropine (1-2 mg)

Competitors
14
 5) physiological antidote

Competitors

Agonist – Antagonist Antagonist

* levallorphan 1 mg/15min. * Naloxone 0.4mg/kg/15mi.

* Nalorphin 10mg/15min * Naltrexone

Cause of death : Central Asphyxia

Atropine , Hyoscyamine & Hyoscine

Diagnosis: Tropine + Tropic acid

Search for them in similar way as before

Sources: 1) Datura fastiosa

2) Datura stramonium release Atropine
3) Atropa belladona Hyoscine
4) Hyoscyamine Hyoscyamine

Uses: 1) ophthalmology

2) GIT

3) Anaesthesia ↑ R.C
↓ Secretions
4) Toxicology Morphine
O.P. aconite

15
F.D.: Atropine & Hyoscyamine 100 mg

Hyoscine 30 mg

F.P.: Datura Day 24 hrs

Cause of death : central asphyxia

C.of poisoning:

Acc. Suic. Homicidal

- Children - Addicts - Road poison

( hyoscine )
-Therapeutic
- Assaults
-Addicts
MAN
Rape Robbery
Marijuana

Atropine Nutmeg
( hepatotoxic)

+ Jaur

16
Actions :

Atropine & hyoscyamine Hyoscine

1) CNS ↑ ↓
High 1) CNS ↓
2) Peripheral receptors (used in case of mania ,
Motion sickness,parkinsonism,
Obstetric analgesia )
ACH. Muscarinic
2) Peripheral similar to atropine
& hyoscyamine but weaker

Clinical picture:
Plant Poison

1 Dry as bone

2 Red as beet root

3 Hot as hare

4 Blind as bat

5 Mad as wet hen

6 Bladder lose its tone

7 Heart runs alone

17
Peripheral actions :

1) ↓ Secretion Sweat , Saliva , Secretions ( bronchial)

(dysphagia,thirst&haorsness of voice)
2) V.D. Rush

3) ↑ Temp.

4) Mydriasis & Fixd Non reactive Pupil

5) Constipation & Urine retention

6) ↑ Pulse , ↑ B.P. & ↑ Resp.

CNS : CHAIR

* Occupational Delirium

* Drunken Gait Staggering Gait. = Unsteady Gait

P.M.P.:

SUS 1-Seeds
+
SES
+
B 2-Brain edema & congestion

+
P 3-Int. & external signs of asphyxia
(dry air passages)
+
P 4-Putrefaction
**N.B.→ Resist putrefaction
1-Metal
2-O.P
3-Nicotine
4-Strychnine

18
TTT:
4×2

1- S& S→ Resp.
2- ECG + local antidote

· Cold foment→ for atropine fever (v.v.imp.)

· Catheter→ for urine retention (v.v.imp.)

· Sedative & tranquillizers→ in stimulation stage (v.v.imp.)

· Stimulants→ in depression stage

3-D & D
4-physiological antidote A-Pilocarpine 10mg
(peripheral action only)

B-Eserine (physostigmine) 2mg

Easy To Pass BBB peripheral action
So, act centrally & Peripherally central action (it can cross BBB)

19
D.D.

Atropine Ethyl alcohol

1- Smell ----- Characteristic

2- Temp. ↑↑ ↓↓↓
3- Pupil Dilated & fixed Changeable (Mc Ewin′s sign)

4- Skin Hot, dry & flushed Moist & pale

5- Vomiting ----- May occur

6- Delirium Occupational Tremors on withdrawal

7- Chemical analysis +ve +ve

Cocaine

3C 3S

Catecholamines Sympathomometic
CNS then
Cutaneous anathesia 30 mg ‫ﺴﺎﻋﺘﻴﻥ‬
F.d F.p

1- Sources: Leaves of erythroxylon.

2- F.d: Sympathomimetic 30 mg.
3- F.p: ‫ ﺴﺎﻋﺘﻴﻥ‬2 hrs.
4- Diagnosis: as before
+ search for coccaine metabolism in urine.

20
 Theraputic
5- Condition of poisoning: Accidental Addicts
Workers
Children
Suicidal
Homicidal

Action 3 C/P

Stimulation Depression
1. ↑. atecholamine release &
1. C.V.S: ↑. BP,
↓. uptake.
2. NS stimulation then ↑ pulse.
cardiac arrest
depression. (psychosis)
3. utaneous anaesthesia
2. Resp.: ↑. Rate &
depth. Coma, Cyanosis,
3. CNS: CHAIR + Central asphyxia.
psychosis +
Hallucination +
Delusions +
Illusions +
Euphoria +
Alertness

↑. Quality not
Cutaneous
Quantity
anaesthesia.
4. Cutaneous
anaesthetic
effect.

Cause of death:

1- Cardiac arrest (minutes)

2- Central asphyxia (‫)ﺴﺎﻋﺘﻴﻥ‬

21
P.M.P

S U S
+
S E S 1- Site of injection
+
B 2- Brain edema + congestion
+
P 3- Internal + External signs of asphyxia
+
P.M.P 4- Putrefaction
Rapidly destroyed after death.

Treatment: Imp. Correction

of: Hypertension
1- S & S 1- Care of respiration. +
2- Care of C.V.S. Convulsions
2-ECG √√√
3- Local antidote 1- Charcoal.
2- Tannic acid.
3- H2O2 & KMNO2.
4- D & D √√√
5- Physiological antidote
Inhaled Nose Wash with saline.
Injected Wash with ice.

22
 Digitalis

Dysrhythmias
Dye vision
Diarrhea
Drowsiness
Dermatological

1- Source Digitalis Lanata Or

~ ~ purpurae.
A.P Digitalin
Digitoxin.
2- F.d ‫ ﺜﻼﺜﻴﻥ‬30 mg digitalin
5 mg digitoxin.
3- F.p Day 24 hrs.

4- Diagnosis as before + ECG + Electrolytes + Digitalis

search for
5- Uses 1- CHF
2- Atrial arrythmias.
6- C. of poisoning Accidental Theraputic
Children
Suicidal √√
Homicidal

23
Action:

Mode of action Therapeutic

Inhibition of Na-K ATPase enzyme 1. +ve ino. ↑. contractility

2. –ve chrono ↓. HR
Intracellular Extra cellular 3. ↑renal blood supply (diuresis
Na K (acute toxicity) & ↓B.P.)

Ca K (chronic toxicity)

Yeast

Toxic Dose C/P

1. Heart Autoimmunity Dysrythmias (details in next table).

2. Eye Dye vision Green-yellow vision / Photophobia /
blurred.
3. GIT Irritant Nausea, vomiting, colic, diarrhea
4. Skin Allergy Urticaria & Gynecomastia.
5. CNS Drowsiness, confusion, hallucination,
restlessness, frank pyschosis.

C/P of Heart:

Tachycardia Bradycardia

Atrial Ventricular 1. Sinus bradycardia.

2. Sinus arrest.
1. A. tachycardia. 1. Extrasystole. 3. A-V block.
2. A. flutter. 2. V. tachycardia.
3. A. fibrillation. 3. V. fibrillation.

24
P.M.P:
S U S 1- Tablets or leaves or seeds.
2- No ulcers Stomach irritant.
+
S E S
+
B
+
P
+
P.M.P 3- Putrefaction.
+ Dilated
C/P 4- Heart Hypertrophy
Pulmonary congestion
Treatment: of Digitalis toxicity
1- S & S Care of the heart

Anti-arryhthmic drugs Electrolyte

APPL K KCL
Lidocaine K Insulin + glucose
Atropine Phenytoin & Mg / MgSO4
(1-2 mg) Pacemaker Ca Na2EDTA
2- ECG √√√
3- L.A. as before √√ 1- Charcoal.
2- Tannic acid.
3- H2O2 & KMNO2.
4- D. & H √√√
fragment antibody
5- Physiological Antidote Digibind (Fab) 40 mg
1- Preparation ‫ﺨﺭﻭﻑ‬

Digitalis injected Ab Fragment it

formed against digitalis
2- Dose 40 mg/ 20min (IV infusion).
3- Action ↑digitalis excretion & reversed tissue binding.

25
 ashish ( Systems)

F.P
alf day 12 hrs
F.D 2-8 gm
(2 cigarettes)

1- Source: Cannabis/ indica

Hashish Marjwana Banjo

A.P ∆9 T H C

Tetra Hydro Cannabinol

2- Investigations As before
+ ∆9 THC

3- C. of poisoning Accidental Abusers

Suicidal √√√ very rare
Homicidal
Action:

Psychoactive:

CNS &

1- Dose
2- Type
3- Personality (Mood)
4- Previous exposure

26
C/P
Psychological Eye Resp. C.V.S GIT Reproduction
&
Neurological
1- 25 mg/kg Red Eye ↑. HR ↑appetite ↓sperms +
THC (Conjunct. (specially ↓testosterone
cong.) sweets due to
ppt. to PPt. induced
Sense of well cough to hypoglycemia) ↓ovulation
being. angina (not marked as
(Euphoria) in males)

2-250 mg/kg Central

THC asphyxia

Inc. senses:
· Smell
· Sound
· Touch
· Colour

3->250 mg
(details later)

C/P (followed) :

Psychological & neurological

3- >250 mg:
1. Sexual Hallucination.
2. Space & time disorientation.
3. Traffic accidents.
Impaired attention & concentration.

27
Cause of death:

1- Central asphyxia.
2- Car accidents.

P.M.P:

S U S
+ 1- Smell.
S E S
+
B 2- Brain edema & congestion.
+
P 3- Int. & ext. signs of asphyxia.
+
P.M.P
+
C/P
Treatment:
1- S & S Care for respiration.

2- ECG √√√

3- D & D & H √√√

4- Local antidotes 1- Tannic acid

2- Charcoal
3- H2O2 & KMNO2
5- Physiological antidote Caffeine + Tea (strong)
(CNS stimulant)
Because the patient is
nearly comatosed,

28
 Strychnine S

1) Source: Strychnus nux vomica seed (Crushed powder)

2) F.D: Thirty (30 mg)

3) F.P: ‫( ﺳﺎﻋﺘﯿﻦ‬2 hrs)

4) Uses: -Stomachic sense ‫ﻓﺎﺗﺢ ﻟﻠﺸﮭﯿﺔ‬

- ‫ﺳﻢ ﻓﺮان‬

Children
5) Condition of poisoning: -Accidental Workers

Therapeutics

-Suicidal X (Severe Pain)

-Homicidal X (Severe Pain)

6) Investigations: ‫اﻟﺨﻮارج واﻟﺘﻘﻄﯿﻊ‬

7) Action:

1-Spinal Cord à Synaptic resistance

‫( ﻗﺒﻞ ﻧﺎﻇﺮ اﻟﻤﺤﻄﺔ‬Glycine)
2-Stimulus à Contraction of all muscles
(No reciprocal innervations)
3-Stimulation of CNS à 30%

29
 8) Clinical Picture:

Face (Risus Sardoincus) 1-Severe Exhaustion

1-Spasm of Muscles Extensors of body (2) Death
Flexors of U.L.
2-Sensory Stimulus
Contract Stimulus
Stimulus ‫أي‬
Imp: Opisthotonus Position 10 min of Rest ‫ﻓﻲ ال‬
Resp. Ms. à Peripheral asphyxia Contraction
(1) Death

2-Sympathatic Stimulation
- Bl.Pr.
- Pulse
- Resp. + Mydriasis + Bulging
- Temp.

3-Suffer till end à Concious

9) P.M.P:

SUS 1-Powder or Crushed seeds

+
SES
+
Brain 2-Brain Edema & Congestion
+
Passages 3-Int. & Ext. Signs of asphyxia
+
PM Picture 4-Resist Putrefaction
5-Earlier Rigor Mortis (No ATP “ Exhaustion of ATP)
+
C/P

30
 10) D.D:

1) Tetanus 2) Epilepsy
1-History of Wound 1-Loss of conscious
2-Bacterial à Cl. tetani 2-Bitten tongue + froth
3-Deathà Days 3-Normal face not cyanosed as in
4-Trisumus à Lock jaw strychnine + Rising
5-Gradual 4-One attack only (Not Several)
6-In state of relaxation, the
muscles are Tonic

3) Tetanyà Carpopedal Reflex 4) Eclepsia àFemale Pregnant

( Ca) Bl.Pr
1-+ve Trauseau Sign ( ‫)ﺟﮭﺎز اﻟﻀﻐﻂ‬ Triad: Foot edema
2-+ve Chroslek (Facial àTremors) Proteinurea
5) Meningitis
1-Neck rigidity
2-CSF examination

11) TTT A B C

Anaesthesia Barbiturates Calm of dark room

(Ether inhalation 1st
Then IV anaesthesia)

1- S. & S. à Care of Resp.

2- ECG à√ By Cuffed endotracheal tube

Because I give him Anaesthesia

Charcoal
3-Local antidote kM2O4, H2O2
Tannic Acid

4-D. & D. & H. à √

31
5-Physiological antidote à S M M

Succinyl Choline Mephensine MgSO4 (10%)

(10 mg) (1mg)
Glycine

Black Motor End Plate

32
 Metallic poisoning
Scheme:-
Distribution H,N,T,B
1- Kinetics ( Hair , Nail , Tooth , Bone )

Excretion Urine

GIT:
AS…….DS (descending colon)
HG…….Caecum
Antimony……..Stomach
Living
st
1
Dead
2– Diagnosis
Reinch test ( except lead )
2nd
Lead ( X-Ray )

Local ( GIT )

3- Action: Mixed

Remote: (binds to SH Enzymes & Prevent its

action)

Plumbum Mercury Arsenic Antimony Fe&Ph

Blood&Brain Micturition Liver (Napleon) Antimuscles Liver

Of the heart
4- C.P :

A-Local GIT N C Nausea Colic + Metallic taste

V D
Vomiting Diarrhea Salivation
Except Plumbism Æ Conistipation
B- Remote Organ Failure ( as before )

33
5- Fatality 1 Day (local) Dehydration & Shock
Period
(F.P) 1 week (Remote) Organ Failure

6- P.M.P superficial
A- Ulcer + Intact mucosa in between
B- Resist & Delay putrefaction (due to dehydration & bactericidal
effect of Metals)
7- Cause of Death:
A- Dehydration & Shock (1 Day)
B- Organ Failure (1 Week)

8- Treatment:
A- S&S
B- ECG
C- Local Antidote
D- D&D
1- BAL
2- EDTA
E- physiological antidote → Chelators 3-Penicillamine
4- Desferol

C- Local antidote:

Adsorption

Precipitation

‫ﻟﻸﺑﻴﺾ‬ ‫ﻟﺒﻦ أﺑﻴﺾ‬

(Mercury)
Arsenic Fe(OH)3

Antimony Tannic acid

H2O (‫)ﻣﻴﻪ‬ MgSO4 (‫)ﻣﻠﺢ‬

Ph ‫ﻧﺤﺎس‬

Iron (acidosis) NaHCO3

34
 Blood Brain Black offensive Micturation Mucus ‫ﻣﻴﻪ‬
stool
Plum bum Mercury
Kinetics: Distribution: H+N+T+B Distribution: H+N+T+B

Ca M
O
B
Ca Ca I
Vit. D Vit. D L Caecum (excreted)
Alkalies Acids I
Parathormon Z
Deposition T
E

Diagnosis: Living Living

X-Ray Reinch test

Intestine Liver Bone ‫ﻣﺪورة‬

>0.25 mg/dl in Urine >100 mg/dl in Urine

C.of
Poisoning:
- Occupational - Ingestion of soluble
Accidental - Household Salts overdose
- Environmental -Vaginal plugs

Homocidal
Rare
Rare by Insecticide
Suicidal
Ingestion of Corrosives

F.P:
Local 1 Day 1 Day

Remote 1 Week Brain 1 Week Kidney

35
F.D: - TEL (2 drops) ‘Two’ 1 gm ( Mercury Mono )
- Rest 10 gm ‘Ten’
Sources: 1- Environmental:

Air (exhaust fumes) Metals Salts

Food (flies) Non toxic if ingested
H2O (pipes) Skin by injected Toxic
Lung by inhalation
2- Industrial & household:
- Oleute Ovum
- Arsenic Ants Organic Inorganic
- Subacetate S.C ××××
Haematoma Diuretic
- Oxides On iron ××××
(to prevent rust)
- TEL child (immature
Mecuric Macurous
(in petrol) BBB)
Workers
-Chloride Chloride
Calomel
Cleaning

-Fluminate Colon of
children
Firearm
-Cyanide Pink
Disease

Cidal

1- Pink extremeties
2- Painful
3- ‫ﻣﺶ ﻋﺎرف أﻗﺮأهﺎ‬
4- BP
5- Bald (alopecia)
Uses: 1- Bullets 1- Blood Pressure
2- Pencils 2- Batteries
3- Printers 3- Lamps
4- Pipes

36
Action : Local : (GIT) Local: GIT
Remote : Remote: Kidney
Brain
Blood haemolysis

C/P: metallic taste

a)Local: M N V M N V

S C D black &
Offensive stool
salivation S C D
+
Dehydration &Shock mucous
+
blood

b)Remote: (Merconial
1)Brain dysentery)

Encephalopathy (all sympt. of *Kidney Failure

mental deterioration )

2)Blood Haemolysis

R.F
(as before)
P.M.P:

S U S 1) Superficial Ulcers 1)Ulcers

+ Specially Caecum
S E S X X X X X X
+
B
+ 2)Encephalopathy (Brain edema &
Congestion)
P X
X
+
P.M. 3)Resist & Delay Putrefaction 3)Resist & Delay Putrefaction

37
TTT:
1) Care of shock
1) S&S 2) Care of dehydration 1) Care of shock
3) Care of CNS 2) Care of Kidney
4) Care of Kidney

2) ECG √√√ √√√

1) Adsorp Charcoal 1) Adsorption Charcoal

3) L.A

2) Precipitation 2) Precipitation:
Salt MgSO4 ‫اﻷﺑﻴﺾ ﻟﻸﺑﻴﺾ‬
‫ﺑﻴﺎض اﻟﺒﻴﺾ‬
Not milk Death

4) D&D √√ 3) Mercuric
Mobilization followed by Mercurous
immobilization to allow
The chelators to work
efficiently Na Formaldehyde
5) Physiological √√ Sulfoxalate
antidote

Chronic Lead Poisoning

6 Bs Æ Body Organs
Plumbism =Chronic toxicity

• Purely motor neuritis:

C/P :
Convulsion
1)Brain Encephalopathy
Mental
Paralysis
Motor Muscle atrophy

Wrist & foot drop = Peroneal ms+ Median n (extensors)

2) Buccal Stomatitis
Blue line

38
3) Bowel Colics D.D Intestinal Obstruction
Constipation

4) Reproductive System ♀ Abortion by 2 ways Ecbolic ‘ Uterine cont.’

♂ Impotence Ovum Death
Sterility
5) Bone Arthralgia
Lead Lines by X-Rays
6) Blood&
Vascular Pallor V.C
Anaemia

Fragility

Microcytic hypochromic anaemia Haemolysis

Punctate basophilia
Mature RBC
Ribosomal RNA

Immature RBCs Enzyme

Lead

Treatment:

‫ ﺟﻮﻩ اﻟﻌﻈﻢ ﺑﺪل ﻣﻦ اﻟﺪم‬Pb ‫ﻳﺪﺧﻞ‬

+
1) Prophylactic Ca+2
Check up
Clothes
Containers

2) Prevention of further exposure

3) Physiological antidote Chelators

Most imp EDTA

39
4) Symptomatic:
Brain Encephalopathy + Anticonvulsion
Paralysis Physiotherapy & Splint
Bowel relaxant Colics
?????? Purgative
Blood Iron or Blood Transfusion

Chronic poisoning (Mercury)

‫ﻣﺘﺴﻮل‬ Mercuralism

C/P:

1) Mercurialentis

2) GIT Mercurial dysentery

Mucous + blood

+ Vomiting + Diarrhea

3) Renal failure Olig + ABC : anuria

4) Oral Salivation
Gingivitis
Grey line (Mercury)
Cancrum Oris Gangrenous

5) Skin weeping dermatitis (oozing dermatitis)

6) Cerebellum kinetic tremors

7) Psychic shyness
loss of confidence
erytheism
TTT:
cloth
0) Prophylactic container
check up

40
 1)Prevention
2)Physiological antidote
3)Symptomatic ttt:-
*psychological *BAL skin ointment
*Nervous *BAL eye drops

Metallic poisoning
Anti muscle of heat
Anti mansoni &
Ampoules

Napolion ponapart + ‫ارز‬

Arsenic Antimony
Diagnosis: Reinch test

‫اﺷﻜﺎل هﻨﺪﺳﻴﻪ‬ Amerphous

powder
Kinetics: Ascending & descending colon Stomach

F.D: 100 mg 100mg

F.P: 1day dehydration & shock 1day

1 week liver failure dehydration & shock
Heart failure

Source: 1-‫اﻟﻄﻴﺐ‬ As2 S3 (yellow) 1-Antimony sulphide (‫)آﺤﻞ‬

2-‫اﻟﺸﺮﻳﺮ‬ As2 O3 (White) 2-Antimony oxide (‫)اآﻞ‬

3-Organic Syphilis 3-Antimony chloride

Corrosive
4-Inorganic salts
lead arsenate 4-Tartar emetic
Insecticide
Cu arsenite

41
 5)Arseine gas 5-Stibine gas haemolysis
ttt haemolysis RF
blood CNS
transf. renal failure irritation
+ dialysis
USES:
1-‫اﻟﺒﻴﻮت‬ glass 1-Insecticide

ceramic 2-War gases

Paint paper

2-Insecticide

3-war gases

C. of Therapeutic
Poisoning: overdosage
• Accidental Household • ACC.
Occupational Accumulation
in organs
• Suicidal Rare
hypersensitivity
• Homicidal Common
Industrial exposure
Advantages:
1) Colics (gastroenteritis)
2) Color • Hom.
3) Can escape (4hrs) Rare
4) No Characteristic • Suic
smell/odour

Disadvantage:
Detected after putrefaction
In ‘B, N, H’

42
Actions:
1)Local: GIT GIT
2)Remote: SH group enz SH group enz

Liver Heart

Heart Liver
Kidney Kidney

C/P: 1)Local: 1) Local

m n V

s C D Rice watery
stool The Same
D&S due to
toxic
capillarities

stress of intestinal 2) Remote: Heart Failure

mucousa

2)Remote: Liver Failure

D.D: Arsenic Cholera
1)Toxic √ X
2)Bacteria X √
3)Colics √ X
4)Vomiting V......D D......V
& Diarrhea
5)Temp ↓ ↑
P.M.P: SUS Ulcer SUS 1) Ulcers
+ + 2)
SES SeS
+
B 3) Heart
+

43
 P
+
P.M putrefaction
+
C/P congested liver C/P: Sometimes complications
Kidney 8% toxic jaundice
Heart

TTT:
1) S & S • Care of shock • Shock
• Care of liver • Heart
2) ECG √√√ √√ Except antimony
Chloride

Corrosive
3) Local 1)Charcoal (Adsorp) 1)Tannic acid
antidote 2)Fe(OH)3 (percipt) 2)Charcoal

4) D & D √√ √√

5) Physiological BAL
antidote DMSA
EDTA

44
 Chronic Arsenic

A R S E N I C

Coryza + perforated
-Alopecia nasal septum

- Aplastic anaemia Skin Nails

Sensory neuritis falls

‫زﻳﺎدﻩ‬

Melani ‫ﻓﻲ اﻟﻠﻮن‬

Warts ‫ﻓﻲ اﻟﺤﺠﻢ‬

+ GIT manifestation

+ Organ Liver

Heart

Kidney

TTT:- clothes

1)Prophylactic containers

2)Prevention

3)Physiological antidote (BAL, etc…)

4)Symptomatic ttt BAL eye drops & ointments

45
 Chronic Antimony

‫اﻟﻔﻼﺣﻴﻦ‬

(Pustules)

Heart

GIT + Organ Liver

Kidney

Arsenic Cholera
1)Toxic √ x
2)Bacteria x √
3)Colics √ x
4)Vomiting & diarrhea Vomiting diarrhea Diarrhea vomiting
5)Temperature ↓ ↑

46
 Phases

Phosphorescent garlic Phosphorus

Fatty liver + kidney

----------------

Ca

Source:- 1)‫( اﻻﺻﻔﺮ‬Yellow) Rat posion + Fertilizers

2)‫( اﻷﺳﻮد‬Black) Zinc phoshide Rat poison

3) ‫( اﻷﺣﻤﺮ‬Red) Matches

4)‫( اﻟﺸﻔﺎف‬phosphene gas) Melting

Kinetics:- Fat soluble

Smell

Diagnosis:- (As before) (No Reinsch)

F.P 1d D&S

F.D 1w 200mg/kg liver & kidney

C.of poisoning:-

Children

• Acc workers

• Suic √
• Homicidal x smell

47
Action:-

1)Local GIT

Protoplasmic (Disturb metabolism)

2)Remote + Fat deposit Necrobiosis Fatty

- Glycogen & Liver

Acute fatty liver

Kidney

3) ↓Ca in blood + Ca in bone Bone sequestration & necrosis

- Ca in blood

C/P:- n c

1)Local:- (GIT) v D

(1ry phase) Garlic

( Smoking stool

Apparent Syndrome) phosphorescent (luminous)

Recovery

2)Remote (liver) →

(2ry phase) (Kidney) → 

3)↓Ca Cramps & convulsions

48
P.M.P:

SuS 1)Smell

+ 2)Ulcer + luminous

SeS 3)Resist putrefaction

+ 4)Fatty liver & kidney

P.M

C/P

TTT :- Shock & Dehydration

1)S & S Liver

Kidney

↑↑ 2)ECG √√
1)Charcoal
↓↓3)L.A 2)CuSo4 (precipitate)
3)H2O2 (Oxidation) (O2 ‫)ﻋﺪو‬

KMNO4 phosphate
↑↑ 4)D&D

1) Physiological Antidote X NO Chelators ‘ Not True Metal’

Ca Gluconate ‘Due to Ca Deficiency’

49
 ‫ ﺑﺎﻟﺘﺮﺗﻴﺐ‬Stages
IRON
C/P:
Intestinal (GIT) plasma loss
I ↑Capillary permeability ↓O2, ↓BP
CNS CVS
R Recovery (unkown reason Cellular hypovolemic
Hypoxia shock

Convulsions Tachycardia
Tachypnea
O ↓O2, ↓BP C.V.S

Severe↓↓ cyanosis+metabolic acidosis(anaerobic metabolism)

N Necrosis of liver

S Stenosis of GIT (fibrosis pyloric)

(due to deposition of Fe)

Diagnosis:-
+ X-ray

F.D: 200mg/kg

F.P: 1d
1w liver failure

Actions:
1)Local
2)Remote
3) Capillary permeability

50
C.of poisoning:- Mainly children
Acc Therapeutic (predisposed)
Suic √√
Homicidal XX

P.M.P:-
SUS 1)Ulcers
+ 2)Tablets
SES
+
B 3)Brain
+
P
+
P.M.P 4)Resist putrefaction
+
C/P 5)Liver (necrosis)

TTT:- Shock
1)S & S Liver

2)ECG

3)LA NaHCo3 charcoal

4)D & D √√

5) Physiological Antidote Desferol

(until wine rose color of urine disappear)

51
 Chronic Iron Toxicity

Haemosiderosis Lung siderosis

Liver
+Brown
(Site of injection)

(As carbolic a.
But without IODINE
Gastic lavage)

Corrosive (as carbolic a)

R.F R.F
(I2) Allergy (renal & resp.f)

F.d 2gm

Sources & uses Antiseptic

Diagnosis ‫ﺧﻮارج وﺗﻘﺎﻃﻴﻊ‬

F.P 1day Respiratory failure

+ Allergy
1w Renal
Failure

52
Action:-
1)Local:- Corrosive (Coagulative necrosis)

Stomach Skin
2)Remote Renal failure

3)Allergy Respiratory failure

C/P:-
N V Brownish
+ corrosions
1)Local:- GIT C D
D&S

2)Remote:- Brown urine

3)Allergy Angioneurotic edema

(pulmonary edema)

P.M.P:-
Sus 1)Ulcers
+ 2)Eschars
Ses 3)Renal failure
+ 4)Respiratory Failure
B
+
P
+
P.M.P
+
C/p

53
TTT:-
Shock
1)S& S RF
RF
Allergy (Cortisone + Anti histaminics )

2)ECG XÆ NEVER as it is A Corrosive

3)L.A Demulcent

4)D & D √√

5)Physiological Antidote

54
Cytochrome oxidase - Na-nitro prusside
5Cs Coma Volatile ttt of HTN

Cyanide (Hydrocyaanic acid)

(prussic acid)
Source: A) ‫زراﻋﺔ‬ Cyanogenic plants
‫اآﻞ و ﻗﺘﻞ‬ Cidal

B) ‫ﺻﻨﺎﻋﺔ‬ Cameras
Graphic arts
Metallurgy

Kinetics:
Smell: (bitter almond oil)

D.D: CN
Red Asphyxia CO
Cold

C. of Poisoning:
child
Acc. workers

Suic. Spies
Lab. workers
Homic. X (smell)
Execution USA

F.D.:
- Acid & drop.
- Salt 300 mg.

F.P.: 1 min

55
 Action:
1) Cytochrome oxidaze enz.

Anoxia (Hisotoxic)

Asphyxia (Red)

Acidosis (Anaerobic)

2) Corrosives ( GIT)

C/P:
1) Large dose death

2) Small dose

Cytochrome oxidase O2 Corrosive

CNS CVS Corrosive

Headache Coma Convulsions Tachycardia

Tachypenia
BP, Pulse
Arrest

56
P.M.P:
1) Smell.
2) Ulcers (slats).
3) Brain oedema &congestion.
4) Int. & Ext. signs of Asphyxia ( Except blue Æ Red)

TTT: ***0) Physiological antidote.

1) S&S Care of resp.
2) ECG √
3) LA H2O2 or KMnO4 ( Oxidation)*
4) D&D&H √
5) Phys. A √√ 1/2 dose

Physiological Antidote

NT Kelo CT
Nitrite thiosulfate cyanor cobalamine
thiosulphate
1) NT Nitrite thiosulfate

c c Na Nitrite
a- Oxy Hb Met Hb
Amyl (inhalation)

+ Cyanide
b- Met Hb Cyanomet Hb
Cytochrome-oxidase

c- Cyanomet Hb + Na Thiosulfate Æ Na-thiocyanate ( non-

toxic) + Met Hb.

d- Met Hb + Vit C Æ Oxy Hb.

57
2) Dicobalt EDTA Kelacyanor

Directly chelate cyanide

Dose: 300-600 mg

3) C T thiosulfate
oH
(cobalamine)
a- Vit B12a + Cyanide cytochrome Æ Vit B12 + Free Enzyme
Oxidaze (Cyanocobalamine)

Na thiosulfate
b- Vit B12 Vit B12a (Reduced)

58
 Methanol MICC
(Wood alcohol)
Because it’s derived from wood

Source: ‫ﻣﺼﺎﻧﻊ‬ solvents

‫ﺑﺎرات‬ adulterated (‫)ﻣﻐﺸﻮش‬

denaturated

Uses:
• In factories.
• Unfit for drinking

Kinetics:

• Absorb. GIT 5%
Lung 5%
Skin
• Distribution: organs with H2O content + Optic nerve

• Metab. & Excretion Æ90% liver, slow excretion Æcummulation effect

Alcohol Alcohol
Methanol formaldehyde formic acid
dehydrogenase dehydrogenase folic
more dengerous acid
than methanol

CO2 + H2O

• 10% excretion as it is 5% mouth

5% urine

C. of poisoning Acc. Child

workers (fumes)
Mainly because its Addicts
not fit for drinking

59
F.D. 100 ml Æ death
15 ml Æ blindness

F.P. Less than 10 hrs ( few hrs)

Action:
Methanol formaldehyde formic acid

1)CNS 2)Optic n, atrophy 3)Acidosis

C/P:

M Mydriasis
Metabolic acidosis (kaussmal respiration ) ‫ﺟﻌﺎﻧﺔ ﻟﻠﻬﻮا‬

‫ﻗﺪام‬
I Intestinal n c ‫ورا‬ hge pancreatitis
Vd

C Convulsions

C Coma, Death, Central asphyxia

P.M.P:

1) Smell
2) Brain
3) Asphyxia
4) Optic n. Atrophy
5) Pancreatitis
pipe stem atrphy

TTT:
Phys. Antidote Æ Ethanol Æ compete with methanol
Dose ½ ml/kg 2hr 2days
Better : folic acid ( leucovorin Ca)

60
 Ethanol EICC
EICC

D.D: Atropine
Diagnosis: Breath Analyzer or Drunkometer
C. of poisoning:
Children
▪ Accidental Workers
Addicts
Therapeutic

▪ Suicidal Indirect cause

Depression excess intake Head inj.
Drowning
Car accid.

▪ Homicidal Expensive
Characteristic smell
Famous Rape
Robbery

Sources: Produced fermentation of sugar by yeast

concentrated by distillation.

Uses: Hospitals & industry Antiseptic

House Cologne
Bars Beverages

F.D: 800 ml

F.P: 10 hrs.

61
Action:
Local Systemic
Skin cooling ‫ﻳﻨﻴﻢ‬ CNS
M.M irritation ‫ﻳﻔﺘﺢ اﻟﺸﻬﻴﺔ‬ secretion of
** Toxic dose** GIT
1- CNS depression ‫ﻳﺪر اﻟﺒﻮل‬ ADH
2- Acidosis ‫ﻳﺪﻓﻰ‬ cut. blood flow
3- NO Eye Manifestations ↓temp ↑sweat
V.D evaporation

C/P:

1- Excitation 0.5-1.5 mg/ml frontal lobe

parietal
2- Incoordination 1.5-3 mg/ml occipital
cerebellum
3- Convulsion & narcosis 3-5 mg/dl √√
4- Coma > 5 mg/dl medulla

S&S
1- ◊ Feel happy (Euphoria).
◊ Fool behaviour (sexual crimes).
◊ Feeble reaction time.

2- ◊ Can't stand (ataxia) staggering.

◊ Can't see (diplopia).
◊ Can't speak hiccough
vomiting
tremors
slurred speech

3- ◊ Convulsion ◊ Hypoglycemia
◊ Conjugate eye deviation ◊ Hypothermia

4- Coma & death (central asphyxia)

- Smell
** - Sign (Mcewen's)

62
PMP:
1- Smell.
2- Stomach congestion & irritation.
3- Brain oedema & congestion.
4- Int. & ext. signs of asphyxia.
5- Hypostasis blue
Flushed

TTT:
•Care of respiration
•ECG
•NaHCO3 (acidosis)
•D&D
•Vit. B6 (pyridoxine)
+ Alcohol metabolism
I.V NaHCO3 for Acidosis.

**** BICARBONATE

Brain edema
Bl.Glucose Glucose or Mannitol “Osmotic Agent”

63
 Kerosene

Kitchen Cough + Colics + Cyanosis

Cuffed tube + Charcoal +
Culture antibiotic
Source: Petrolleum.

Uses: Fuel, solvent (factors).

Diagnosis: X-ray chest.

Condition of poisoning:
Accidental Children
Workers
Suicidal – ♀
Homicidal

F.D: 20 ml

F.P: 1 day central asphyxia

> 1 day chemical pneumonia

Action Clinical picture

1- Resp. tract chem. Pneumonia(asp) Cough & dyspnea

bact. pneumonia
2- GIT irritation. Nausea, vomiting, colic &
diarrhea.
3- CNS depression Coma, Cyanosis (CA)

64
PMP:
• Smell
• Stomach congestion
• Brain edema
• Int. & ext. signs of asphyxia
• Lung consolidated patches

TTT:
• Care of respiration S&S
• Antibiotic after culture & sensitivity ECG
• No emesis LA
• Cuffed endotracheal D&D
• Charcoal Phys.Antidote
• D&D
• No physiological antidote

65
 Toxic gases
Carbon monoxide

• Source : C + O → CO

1)Charcoal

2)Car fumes

3)Coal mines

4)Cigarettes

5)Fire

• Kinetics : silent killer ( odourless / colorless / smokeless )

• D.D. : Red asphyxia

CO CN Cold

• Diag. : Spectroscope + Gas chromatography

-Dilution test

-kunkels test

-Infra red analysis

• C.of poisoning :
Ocupp.
-ACC. Children
adult

-Suic.

-Homi. Rare

66
• F.D. : 0.1 % in air → 50 % CoHb

• F.P. : 2 hrs.

• Action :

1)Co + Hb (300)

2) - association - dissociation (shift to the lift )

Red Asphyxia

Anaemic Anoxia

• C.P. :

Conc. Key word S&S

0-10 %
20 % Two systems • CNSÆ headache
• CVS Æ Dyspnea(severe excercise )
30 % Three Systems • CNS Æ throbbing headache
• CVS Æ Dyspnea (more)
• Muscles >>> weakness
40 % Four systems • CNSÆ more &more
Fail to escape • CVSÆ dyspnea
• Muscles Æ incoordination
• GITÆ vomiting
50 % Flaring of • Shock
symptoms +
70 % Starting death • Convultions/coma/cheynestokes
resp.
>70 % Immediate death

67
 • Complications :

Brain

Heart Affected

Kidney Necrosis

Liver Degeneration

Muscles

• Pm. Pic. :

1) brain oedema & congestion

2) int. & ext. signs of asphyxia ( blue red )

3) lung , brain & heart complication

• TTT. NO SCHEME (GAS)

0) Prophylaxis ( ventil.) (MA.C) or (‫)ﻋﺼﺎﻓﻴﺮ اﻟﻜﻨﺎرﻳﺎ‬

1) Bed Rest
↓ O2 to ms.
2) Blanket

Phys. 1-fresh air

antidote.* 3) Hyper baric O2 2-100% O2

3- hyper baric O2

4) BL. Transfusion

5) Mannitol (brain oedema )

6) Helthion

688
Carbon Dioxide Æ small dose Æ ↑ RC

***Cyanosis ( CNS ↓↓↓ )

Source : factories (soft drinks ) & fire

Action : Simple asphyxia

69
 
 

Chapter 1: O.P. ( Organo-phosphorus)

Insecticide O.A ( Opposite Atropine)

1- Source & uses:

Parathion
Insecticides

2- Kinetics:
-Parathion Æ Paroxone ( Toxic).
-Smell Æ Garlic ‫رﻳﺤﺔ اﻟﺜﻮم‬

3- D.D.
3 C

Coma Cyanosis Constricted pupil

1. O.P
2. Morphine.
3. Carbolic Acid.
4. Pontine Hge.

4- C. of poisons: Children
Acc Workers
Feed
Suicidal √
Homicidal X (Garlic smell)

5- F.P.: Parathion
Pair hours

6- F.D.: Pair x 10= 20 mg

70
 
 
 

7- Action:

Choline Choline

esterase esterase (Irreversible binding)

Ach O.P

Circulation

Acetylated Enz. Phosphorylated Enz.

8- C/P:
1. Central: :

2. Nicotinic: N-M Junction

Secretion of bronchi
Salivation
: Sweat
=Skeletal ms. Lacrimation Urination
3. Muscarinic: Multiple glands S L U D Defecation
syndrome
P.P.P Muscles ( smooth ms.)

Broncho spasm

Bowel

Bladder

71 
 
 
 

9- Cause of death: Asphyxia

1. Central asphyxia.
2. Peripheral asphyxia.
3. Bronchospasm & Secretion of bronchi
( Mascarinic).

10- Diagnosis:
1. ‫ﺑﻮل‬ P.N.P. ( Para nitro phenol)
2. ‫دم‬ Choline estrase < 30%

11- Post-mortem picture:

1. Garlic smell √SUS
+
2. Brain Edema & congestion √SeS
+
3. Internal & External √B
Signs of asphyxia +
+ √P
Pulmonary +
Edema √P
4. Resist Putrefaction +
C/P

72 
 
 
 

12- TTT:
0. Prophylactic Clean
Clothes
Containers
Cholinesterase (Period examination of level in blood)

1. Care of respiration √
2. ECG√√√

3. L.A. H2O2 /Charcoal

Oxidizing
agent
4. D.D√√
5. Physiological Antidote:
a. Atropine 1-2mg/15 min
Except nicotine
Central + Mascarinic action only
b. Oximes 1gm /I.V.
Action: reactivate the enzyme
Should be taken
Early before ageing
Of enzyme

Cholinesterase Oximes Oximes

O.P O.P

Types: PAM Peripheral& Nicotinic

DAM
Obidoxime More effective & Better

73
 
  
 

Carbamates Baygon (typically similar to O.P except)

1. Phosphorylation ? Æ No
2. Prolonged action? Æ No (Because it’s reversible)

3. Potent? Æ No 1) Reversible effect on Enz. Cholinesterase.

2)Oxime & Cerbamate forms a bad compound

4. PAM & DAM? Æ No

5. Pass B.B.B ! Æ No !!

1. CNS +CVS
2. Cholemia + Uremia Chlorinated hydrocarbons
3. Cancer + Cutaneous inflammation
O.C (organo-choline)

Action C/P
1. CNS: then √

2. CVS ( arrhythmia) V.F.

3. Cholemia ( liver failure) √

4. Uremia (Renal failure) √

5. Cancer √ (Particularly Hepatoma)

74
 
 
 

P.M.P
1) Asphyxia S U S
(External & internal signs) +

2) Brain edema S E S
+
3) Liver √B
+

4) Kidney √P

√P

√ C/P

TTT:

Resp

CNS

1) Case of CVS

Liver

Kidney

2) ECG

3) L.A

4) D & D

5) Physiological antidote X NO!!

75
 
 Synthetic Drugs
Aspirin

- Source: Salicylic acid

- Uses:
1) Analgesic

2) Anti- rheumatic P.G

3) Anti-inflammatory Cortisone

- Diagnosis
X-ray (Aspirin cake)

- F.D. 1 day
Conditions of poisoning

Child
Mainly ACC Therapeutic
Hypersensitivity

Action & C/P

Abdominal pain (ulcer)
Arterial bleeding
Allergy
A.T.N (Acute Tubular Necrosis)
Aspirin (R.F) cause of death
Aural (ear)
Acid-base balance
Agitations (CNS : )
Respiratory failure

76
 Action C/P
1) GIT N C Ulcers
V D Bleeding
2) (-) Platelet aggregation - Bleeding
(-) Prothrombin synthesis
3) Allergy - Rash & urticaria
4) R.F - √√
5) Ear - Tinnitus / vertigo
6) CNS : - √√
7) Acid-base balance 1) Resp. hyperventilation
Respiratory alkalosis
(central action)
2) PH Neutral
(Kidney)
3) Metabolic acidosis Kidney
Kid of
Salicylic
Acid
X Kreb's
cycle

* For MCQ actions & C/P are classified into:

Mild Moderate Severe

“Salicylism”
-Ear -Dehydration -All the remaining
-Abdomen 1) hyperventilation points
2) Vomiting
3) Secreting

77
P.M.P:

SUS
1) Ulcers +
SES
2)Tablets +
3) Brain edema B
+
4)Internal & External P
Signs of asphyxia
+ +
Pulmonary edema P

5) Renal tubular necrosis R

Ttt:

1) Case of Kidney
Respiratory
Acidosis NaHco3
Allergy Antihistaminic
Bleeding Vit. K &
Blood
Transfusion
2) ECG
3) L.A NaHco3
4) D & D Forced alkaline diuresis
(Done to anything that causes acidosis)
5) Physiological antidote No!!

78
 PARACETAMOL
N-Acetyl Cysteine
Physiologic antidote

N A C
II Ache III
I- Nausea in urine
ARF

Central
lobular
Necrosis
1) Source synthetic (Aniline)

2) F.d 10/10gm

3) F.p Few days

Therapeutic
4) C.of poisoning Acc Child
Suic Rare

SH sulphate glucouronide

5) Kinetic: - Paracetamol Non-Toxic

Toxic (NAPQI)
When there’s absence of SH
SH
Glutathione Centri-Lobular Necrosis

Mercapturic Acid (Non-toxic)

79
 Action C/P
1)GIT I- n c
V d

2)Liver Failure II- Pain in lt.hypochondrium

↓ Urine output

3)R.F III- Hepatic failure (as before)

ARF (as before)

P.M.P
SUS
1)Congestion (intestinal ulcer) +

2)Tablets SeS

+
3)Brain edema √B
+
4)liver (centri-lobular necrosis) X P
+
5)Kidney failure XP
+
√ C/p

80
 Treatment:
liver
1)S&S care for Kidney
CNS
2)E.C.G √√√

3)L.A Charcoal

4)D& D √

5)Physiological antidote N.acetyl cysteine (mucolytic)

3 letters 3days

NAC
1) Dose 140mg/kg loading dose 7hrs
For 3 days 70mg/kg/4hrs 14hrs

For 72 hrs (after that death from

. centrilobular necrosis)

2)Action ↑ SH (for sulphate & glutathione)

81
 BARBITURATES
G A B A
ARF

Grading of coma Arrest Bronchopneumonia

Bowel
Bullous

1)Source:- Barbiturates

2) C.of poisoning:- Child

1) Acc Therapeutic
Addicts
2)Suicidal √√
3)Homicidal Rape & Robbery

3)Types:
Long sleep
1)Long-acting (6-12hrs) Luminal (Phenobarbiton)
Lower elect.impulses (epileptic)

2)Intermediate 5-6hrs (mid of long acting) Amytal ‫ﻣﻬﺪئ‬

3)Short 2-3hr (second) Seconal + Suppression of pain (analgesia)

4)Potent short (ultrashort) PairX10=20min Pentothal Presurgery (anaesthetic)

Sodium Psychoanalysis

F.D & F.P Long 4gm 4day

Short 2gm 2hours

82
 Action C/P
1)CNS ↓↓ Coma, Cyanosis, Central asphyxia

*Shock
*Muscle hypotonia
*Dilated reactive
pupil

- VMC
2)CVS ↓ - Myocardium ↓BP, ↓Pulse :- Arrest
-Vascular ms tone
3)Lung Hypostatic pneumonia

4)Skin Bullous

5)Bowel Constipation & urine retention

6)ARF √√ √

Cause of death:

G A B A

Coma Arest Bronchopneumonia ARF

83
P.M.P:
SUS

1-Tablets +

2-Brain SeS
Oedema +
&congestion B
3-Asphyxia +

(Int& Ext signs) P

4-Pnumonia +

5-Kideny P.M
+
6-Blisters C/P

Treatment:-
Respiratory
1) S & S CVS
Bronchopneumonia (Antibiotics)
Renal

2)ECG √√ √

3)L.A Charcoal
NaHCo3

4)D & D Forced Alkaline Diuresis (Any acidic drug)

5)Physiological antidote X

82
 Adrenaline

AMPHETAMINE
Alkaline
Forced acidic dieresis

1)Source Synthetic (ephedrine)

2)Uses
a)Anorexia Anorexient

b)Dexidrine Depression

c)Retaline Rise up (Analeptics)

d)Benzidine Bl.vessels constrictor

e)Hyperkinesis (ADHD)
C. of poisoning: Therapeutic
1)Accid Child
Addicts
2)Suic
Actions :

↑ CNS ↓ MAO I.

↑ release & ↓ uptake

C/P :

1)CNS ↑↑↑

2)CVS ↑↑↑

3)Resp. ↑↑↑

4)Muscles (Movement) Hyperthermia

85
Cause of death :

1)Resp. failure

2)C.V.F (cardiac arrest )

P.M.P :

1) Tablets SUS

2) Maxtone Forte SES

(site of inj) +

3) brain edema & congestion √ B

4) Asphyxia (int.&ext. signs) √ P

P.M + C/P

TTT:

1)S&S Resp.

Shock

2)ECG √√

3)L.A Charcoal

4)D &D forced acidic diuriesis

5)Physiological Antidote Phentolamine

Diazepam & chlorpromazine

86
C. of Poisoning :

1)TCA * ACC. Theraputic

2)Glutathamide Child

3)meprobamate

4)Benzodiazepine * SUCC. Rare

5)Phenothiazine

TTT.:

1)TCA 1)S&S

2)Glutathamide 2)ECG

3)meprobamate 3)L.A

4)Benzodiazepine 4)D &D

5)Phenothiazine 5)Physiological Antidote

-Flumazenil (2mg) Benzodiazepine

-Benzotropine (2mg) Phenothiazine

-Physostigmine Anti-cholienergic

TCA Glutathamide

87
CNS ↓↓ CVS ↓↓ Allergic Anticholinergic Extra pyramidal
(A & B) (A & G)
All cause ↓ All cause Rash e.g atropine Neck rigidity &
except TCA Arrythmia & Articaria (dry mouth, dry skin, tremors
cause CV↓↓ DF pupil, urine Parkinsonism
stimulation except TCA constipation.
then meprobimate Benzodiazepine Phenothiazine
depression have no TCA
arrhythmia Glutathamide
but cause
pulmonary
edmema

88
 Addiction

Opium

1- Condition of addiction: - Medical

- Non –Medical
- Congenital Morphinism

2- Route of Administration: -Morphine Æ Injection

-Opium Æ Ingestion
Smoking + Goza
-Heroin Æ Snuff
Inhalation
Injection
3- Diagnosis of Opium Addict:
Nalorphine Æ Withdrawal Symptoms ( Within 15 min)

4- Mechanism of Action: -Endogenous Æ Endorphine & Encephaline

-Exogenous Æ Morphine
If No Endogenous nor Exogenous Æ Withdrawal Symptoms

5- C / P :

A- Physical B- Moral (Mental)

• Satiety (Anorexia) • Murder

• Skin manifestions • Liar

(Needle Picks abcesses)
• Dishonest
• Sexual (Impotence)
• Indifference
• Miosis Morphine
• Constipation ONLY • Crimes

89
6- TTT:
1) ‫اﻷهﻞ‬ Æ Admit Addiction + Hospitalization (High secrecy)

2) ‫ اﻟﻤﻤﺮﺿــﺔ‬Æ Nutrition Drugs

3) ‫ اﻟﻨﻔﺴـــﻴﺔ‬Æ Rehabilitation

4) ‫ اﻟﺴﻤـــﻮم‬Æ Gradual Withdrawal ‫ ﻣﺮات ﻓﻲ اﻟﻴﻮم‬4 / ‫ أﻳﺎم‬3

A-Codiene B-Methadone
SC Mouth
M 30 mg 1 mg = 2 mg Heroin
= 4 mg Morphine
m 10 mg Tranquillizer
in Case
Dose : 1/3 : 1/10 :
m + C 10 mg + of
1/20

Convulsions
C 10 mg Then STOP

90
 Alcohol
C / P:
1-Physical ‫ أﺻﻔﺮ‬+ ‫أﺣﻤﺮ‬ 2-Mental 3-Withdrawal 4-Nervous (3P)

-Conjunctivitis -Dipsomnia -Delerium - Preipheral

-Drunken nose ‫ﺷﺮﻩ آﺤﻮﻟﻰ‬ tremens Neuritis
-Bronchitis ‫أﺣﻤﺮ‬ (Mixed lat. More
-Gastritis -Dementia -Tremors motor )
‫ﻋﺘﻪ آﺤﻮﻟﻰ ﻣﺒﻜﺮ‬
-
( intellectual of
Hallucinations -tremors
mental power)
-Fatty Liver ‫أﺻﻔﺮ‬ -Convulsions -impotence

‐Delusions of jealousy 
-Pachymeningitis
( sexual desire +
N.B: Hagica
sexual potency )
Feotal Alcohol
Syndrome Chronic
-Delerium tremens
‫هﻼوس ﺑﺼﺮﻳﺔ‬ Subdural He
(terrifying)
Tremors -Pain in Muscles

-Auditory hallucinations Myopathy

‫هﻼوس ﺳﻤﻌﻴﺔ‬
Korsakoff psychosis ‫اﻟﻤﺆﻟﻒ‬
‫ﺑﻴﺄﻟﻒ ﺣﻜﺎﻳﺎت‬

-Wernicks
Encephalopathy ‫اﻟﻤﻬﺰوز‬

-Ataxia
-Nystagmus
-Tremors

91
TTT:
1- ‫اﻻهــــــﻞ‬
2- ‫اﻟﻤﻤﺮﺿــﺔ‬
3- ‫اﻟﻨﻔﺴﻴـــﺔ‬
4- ‫ اﻟﺴﻤـــﻮم‬Æ A + P
1) Antabuse (Disulfiram) 3) Promazine
+ Diazepam
2 gm ( If Convulsions)

1 ½ gm

1 gm

½ gm Æ Year

Alcohol Acetaldehyde

Action: Acetaldehyde Syndrome

(Acetaldehyde + Antabuse)

Vomiting Flushed Palpitation

Conj. Red

‫ اﻟﻤﺸﻜﻠﺔ‬Æ - Rotten Egg odour

- Drawsiness

2) Temposil

92
 Barbiturates
‫ﺑﻄﺊ وﻣﻬﺰوز‬

1-Condition of addiction: ‫ﻋﻼج ﻟﻜﻞ ﺣﺎﻻت اﻻدﻣﺎن‬

2-C / P:

A-Physical‫ﻣﻬﺰوز‬ B-Mental (Moral) ‫ﺑﻄﺊ‬ C-Withdrawal

-Poor thinking‫ﺑﻄﺊ ﻓﻲ اﻟﺘﻔﻜﻴﺮ‬ -Convulsions √√√√√

-Ataxia
-Poor memory -CHAIR
-Tremors
-Slurred Speech ‫ ﺑﻄﺊ ﻓﻲ اﻟﻜﻼم‬-Insomnia
-Nystagmus
-Hypersomnia

-Drowsiness

3- TTT:

1) ‫اﻷهـــﻞ‬

2) ‫اﻟﻤﻤﺮﺿــﺔ‬

3) ‫اﻟﻨﻔﺴﻴــﺔ‬

4) ‫ اﻟﺴﻤﻮم‬Æ Gradual (Convulsions ‫)ﻧﺒﺪأ ﺑﺠﺮﻋﺔ ﻣﺘﻌﻤﻠﺶ‬

0.5 gm (1 × 2)
‫ﻳﺨﻠﺺ ﻋﻼﺟﻪ‬
0.1 gm (1 × 2) after 3 weeks

93
 Cocaine

‫ ﺷﻜﻼ وﺧﻠﻘﺎ‬..‫ﺳﺖ وﺣﺸﺔ ﺟﺪا‬

1-C / P:

A-Physical B-Mental C-Withdrawal

-Cocaine bugs -Irritable

-Loss of weight (Tactile Hallucinations)
(Cachexia) - Secretions
-Aggressive
-perforated nasal ÆMentally
septum
-Toxic Psychosis

VC
Adulterations
‫ﻣﻐﺸﻮش‬
-Needle pricks

2-TTT:

1) ‫اﻷهـــﻞ‬

2) ‫اﻟﻤﻤﺮﺿــﺔ‬

3) ‫اﻟﻨﻔﺴﻴــﺔ‬

4) ‫ اﻟﺴﻤﻮم‬Æ No special TTT

Symptomatic ONLY

94
 Amphetamine

‫(ﻋﺎﻳﺰة ﺗﺨﺲ‬Paranoid) ‫ﺳﺖ ﺑﺎراﻧﻮﻳﺎ‬

1-C / P:

A-Physical B-Mental C-Withdrawal

-Insomnia + talkative -Hyperphagia

-Loss of weight +Euphoria
-Hypersomnia
- Bl.Pr, Palpitations -Parabnoid
Schizophrenia -Depression
-Erythema
-Persecution ‫اﺿﻄﻬﺎد‬
Psychosis

2-TTT:
Syptomatic
(Antipsychotic, Antidepressant ,,,)

95
 Animal Poisoning

Snake
Scorpion

Snake
Cobra (CNS) Horned

Curare Like Hyltic

- Haemolytic
- Cytolytic Æ Hgic
Resp.Failure - Coagulation

Death Shock & Renal Failure

TTT:
1) A + B

Assurance Bed rest

Anti-tetanus
Antibiotics

2) S. + S.

VC Suck
Solid ice
Anaesthesia ineffective

3) H2O + KM2O4

To detoxify the venom locally

96
4) Specific antidote + Supportive

Antivennins Cobra Hyltic

Mono Poly
-Resp. –Bl.Transfusion
-Renal

97
 Food poisoning

Atropa-belladonna

1)Toxic food stuff Aconite

Amygdalin (found in seeds of fruits before being full size )

2)Food Allergy

3)Contaminated Food

Bacteria Virus Protozoal Chemical

Staph. Rota Giardia Metallic

Salmonella Ent. histolytica Insecticide

Preservatives

BOTULISM

-Bulbar -Ocular -Tetraplegia

- Prevent ach.

BACTERIA Gram –ve (anaerobe)

Cl. Botulinium

Exotoxin A B C D E F G

Heat labile (destroyed by boiling at 100°c for 1 min. )

98
Actions:

- Ach.

C/P:

1)Bulbar 9 (glossoph.) → dysphagia

10 (vagus) → dysphonia

11 (access.) → pain in ???

12 (hypogloss.) → dysarthria

2)Prevent Ach. Constipation + Urine retention, Dry Mouth & Skin

Consious till the end

Dilated Fixed pupil

3) Ocular paralysis Diplopia

4)Tetraplegia descending &bilateral limbs resp.ms asphyxia

1 2 3 4

F.D.= 1μg vials trivalent 4hrs

F.P.=1DAY antitoxin

2 vials of trivalent antitoxin to be repeated after 4 hrs

99
TTT. :

1)S&S Care of Resp.

2)ECG Cuffed EndoTracheal tube (due to bulbar paralysis)

3)L.A. Charcoal

4)D & D √√√

5)Physiological antidote (2vials of trivalent antitoxin to be repeated after 4hrs.) .

100