toxic forensic sashi sunanda

1. TOXICOLOGY
Dr Gopisankar M G

2. Duties of a doctor in suspected
poisoning is described under
 S.39 CrPC
 S.175 CrPC
 S.193 IPC
 S.176 IPC
 S.201 IPC
 S.202 IPC

3.  201 –(punishment IPC no. if not
done)preserve articles , food, excreta ,
stomach wash , bottles , capsules , paper
packets should be collected and preserved
 39 – if a private practitioner is convinced that it
is a homicidal poisoning he should inform
police officer or magistrate

4.  If 39 not done doctor is punishable under 176
 If he is sure that it is suicidal poisoning no
need to inform police since 309 is not included
in the section
 But under 175 if asked by police officer Dr
should give all information
 If conceals liable to get punished under 202

5.  False information – section 193
 He will be punished

7. Gastric lavage
 Within 3 hrs
 For salycylates,phenothiazenes,antihistaminics,TCA, -- lavage
can be done upto 12 – 18 hours
 Ewald’s / Baos tube
 First 250 ml then 500 ml
 CI – corrosive poisoning except for phenol
 Complications –
1. Laryngeal spasm
2. Aspiration pneumonitis
3. Perforation of the stomach
4. Sinus Bradycardia

8. Ipecan cuan ha-emetic

9. Antidotes
 Mechanical /Physical-
1. Activated charcoal,
2. Demulscents –milk,starch,egg white
3. Bulky food
 Chemical
 Physilogical / Pharmacological

10. Activated charcoal
 Sedatives,antihistamines,antidepressents,an
tiepileptics ,etc well absorbed
 NOT effective with
1. Corrosives
2. Heavy metals
3. Cyanide
4. Hydrocarbons
5. Alcohol

11. Dose of Activated charcoal
 Adults – 60 – 100 gm
 Children 15 – 30 gm
 Repeat 50 g every 4 hours
 Upto 2 days

12. Chemical antidotes
AgNo3 + Nacl Agcl

13. Albumin for Mercuric Perchloride

14. Fe for Arsenic

15. CuSO4 for Phosphorous

16. Potassium permanganate for cyanide
poisoning

17. Ticnture of iodine for most of alkaloids

18. Universal antidote = activated charcoal +
tannic acid + Magnesium Oxide

19. Physiological /pharmacological
antidotes
 Exactly opp. Symptoms
 Chelating agents –
1. BAL –Bi,Ar,Lead,Mercury,Cu
2. EDTA –Pb , Hg , Cu , Fe,cadmium ,Nickel
3. Pencillamine – chelating agent of maximum
eficacy in heavy metals
4. DMSA

21. some Abortificents
 Ergot
 Calotropis,
 Cantherides,
 Oleander,
 Aconite,
 Semicarpus

23. Stupifying agents
 Chloral hydrate
 Datura
 Cannabis

25. Delerium
 Belladana-
 Datura

27. Organophosphate poisoning

Mixed in a solvent called Aromax – kerosine
like smell in the body cavity,stomach contents ,
vomitus , froth, etc
 Inactivation of Che becomes irriversible after 24 –
36 hrs
 Sign & symptoms – when activity drops to 30% of
normal activity
 Death – paralysis of the respiratory muscles

28. Choline esterase test
 5 ml of heparinised blood
 average normal values
 77 – 142 in red cells
 41 – 140 in plasma
 Diagnosis can be confirmed by giving 2 mg of
atropine in normal signs of atropinisation and
in poisoned releives the symptoms

29. Choline esterase estimation

30. Dimethoate , methyl diazinon , Schraden , Phorate ..----
oximes not effective

31. Post Mortem appearance
 Signs of Asphyxia
 Congestion – face,all internal organs
 Cyanosis of lips,fingers , nose
 Blood stained froth--Respiratory path ,
mouth and nose
 Stomach content with smell of
kerosene
 Organophosphorous can be detected in
putrified bodies

32. Oxims
 DAM – Di Acetyl Monoxime
 Praldioxime Iodide
 Pralidoxime chloride

33. Endrin –Plant penicillin

34. Zinc Phosphide
 Fatal dose 5g
 Fatal period 24
hrs

35. Aluminium Phosphide
 Release
phosphine
 MOA – inhibition
of cytochrome
oxidase
 Fatal dose -1-3
tab
 Fatal period – 1
hour to 4 days

36. Sulphuric acid Poisoning

37. Treatment of Sulphuric acid
poisoning
 Avoid gastric lavage
 250 ml of water / milk / milk of magnesia /
lime water – within 30min
 Demulcents
 Prednisolone 60 mg / day - to prevent
esophageal stricture and shock
 If stricture develops – 4cm diameter Hg filled
bougie should be passed daily
 Give nothing by mouth
 Topica l paste of Magnesium oxide / sodium
bicarbonate

39. PM change
 Stomach – soft , spongy , black mass ,
when readily disintegrates when
touched

40. Treatment of vitriolage
 Wash with plenty of water
 Soap of Sodium or Potassium carbonate
 Thick paste of magnesium oxide / carbonate
is applied
 Eyes – irrigated with Dilute Sodium
bicarbonate solution
 Later a few drops of olive oil or castor oil is
applied to the eyes

41. Nitric acid

42. Sign and symptoms
 Greater abdominal distension due to gas
formation
 Tissues are stained yellow
 In esophagu and stomach …the corrosion of
the mucus membrane may not be associated
with yellow colour –Brown or Brown black due
to acid hemetin

43. HCl
 Corrosion is less severe
 Stomach contains brownish fluid
 The folds of the whole stomach mucosa are
brownish
 Perforation is rare
 Acute inflammation and edema of the
respiratory passage are common

44. Oxalic acid
 10%
 Rarely damage the skin
 Corrodes mucus membrane
 Vomitus – coffee ground appearance- altered
blood and mucus
 Hypocalcemia

45. Treatment of Oxalic Acid poisoning
 Stomach wash – Calcium lactate or gluconate
 Antidote – preparation of Calcium
 Lime water , Calcium gluconate ,Calcium
chloride
 Parathyroid extracts bowel may be evacuated
by enema or castor oil

46. Carbolic acid
 Carboluria – further oxidation of
hydroquinone and pyrocatechol in the
urine cause green colouration
 Chronic Poisoning – Phenolic
Marasmus-Anorexia , headache ,wt
loss ,headache ,darkurine , and
oochronosis
 Oochronosis – pigmentation of skin
and sclera

47.  Post Mortem findings in carbolic acid poisoning
 i) Esophagus - Mucosa is tough, corrugated,
arranged
in longitudinal folds.
 ii) Stomach - Mucosal folds are swollen covered
by opaque,
coagulated mucous membrane which is
thickened and leathery. Partial separation of
necrotic mucosa.
 iii) Duodenum, - Similar to stomach
 upper SI
 iv) Liver, Spleen - Whitish, hardened patch where
stomach has
been in contact.
 v) Kidneys - Haemorrhagic nephritis
 vi) Brain - Congested, edematous
 vii) Blood - Dark, semifluid, only partially coagulated.

48. Formic acid
 Action – corrosive actioo on GI mucosa
 Causes hemolysis leading to acute renal
failure
 ATP synthesis is diminished
 T/T –Milk –Folinic acid 1mg /Kg 4th
hourly

49. Arsenic Poisoning

51.  Metallic arsenic is not poisonous as it is
not absorbed from the alimentary canal
 Arsenic trioxide / white Arsenic
 MOA – binds and inhibits Pyruvate
oxidase which is a mitochondrial enz
 Affects vascular endothelium –
increased permiabilityesp in the
intestinal canal
 Irritation of the mucucs membrane
 Depression of the NS
 Interfers with glycolysis

52. Signs & symptoms
1. Fulminant type
2. Gatro enteric type
3. Narcotic

53. Fulminent tyoe
 Massive doses – 3 -5 gm Arsenic death in 1 –
3hrs – due to shock & peripheral vascular
failure

54. Gastro enteric type
 Common form of acute poisoning
 Mostly half an hour after ingestion
 Sweetish metallic taste
 Constriction of the throat and difficulty in
swallowing
 Burning and colicky pain in the esophagus,
stomach and bowel
 Purging
 Stools – frequently and involuntary first
Dark coloured stinking and bloody 
resembles rice water stools
 Garlicky odour in breath and feces may be
noted
 Death is usually due to circulatory failure

55. Narcotic Form
 Giddiness
 Formication and tenderness of the muscle
 Delerium coma and death
 Arseniurated hydrogen direct poison to Hb
 hemolysis ,hemoglobinuria , renal failure
 Death is almost instantaneous

56. Treatment of Arsenic Poisoning
 Emetics should not be used
 Alkalis should not be used
 Wash with large amount of warm water /
milk
 Ferric oxide
 BAL
 DMPS
 DMSA
 Penicillamine
 Demulscents
 Glucose saline with Sodium bicarbonate
 Hemodyalisis and exchange transfusion

57. PM appearance – acute

58. PM appearance- chronic

59. Mercury

Mercuric
 Egg white
 Ca – EDTA should not be used as it is
nephrotoxic with mercury
 PM – if the patient survives forfew days
..LI shows necrosis due to the reexcretion
of mercury into the large bowel

60.  Chronic poisoning – Hydrargyrism
 PRESENCE OF TISSUE DEPOSITS OF Cu
-CHALCOSIS

64. INORGANIC POISONING
 Phosphorus

65. Preservation for viscera in case of
suspected poisoning
 Stomach and its contents
 Upper part of small intestine and its contents
30 m
 Liver 200 300 g
 Kidney – half of each
 Blood 30 ml
 Urine 30 ml

66. Preservatives
 Saturated sodium chloride- all except
Corrosives
 Rectified spirit
 KF