Poison of animal origin

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poisonous animals/ snakes

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Poison of animal origin

  1. 1. Poisons Of Animal Origin Dr. Priyal Jain, Post Graduate Deptt. Forensic Medicine UCMS & GTBH Delhi
  2. 2.  Snakes  Scorpions  Bees & Wasps  Centipedes  Lizards  Spiders  Ants  Canthrides
  3. 3. Snake  Elapidae / Colubridae  Viperines / Viperidae  Hydrophidae
  4. 4.  A village person age about 44 yrs brought to casualty with alleged history of snake bite.  Attendant killed offending snake and brought to casualty.
  5. 5. Fangs
  6. 6. Snake Bite Dry bite ;- 20%, up to 75% Venom Apparatus Venom glands + maxillary Teeth(fangs) Venom Hemorrhagins Proteolytic Enzymes Myocardial Depressant Neurotoxins Severity Site, Time, Clothing, Season, Species.
  7. 7. Cobra / Naja Naja
  8. 8. King Cobra / Naja Bangarus
  9. 9. Common Krait / Bungarus caeruleus
  10. 10. Banded Krait / Bungarus Fasciatus
  11. 11. Symptoms  Mainly Neurotoxic  15 – 30 min  30 – 60 min.  1 – 2 hrs  Fatal dose 12-15 mg C , 5-6 mg Krait
  12. 12. Viper
  13. 13. Symptoms  Mainly Vesculotoxic  Fatal dose 15 – 20 mg  Fatal period 2 – 4 days.
  14. 14. Sea Snake
  15. 15. Symptoms  Mainly Myotoxic
  16. 16. Treatment  First Aid “Do it R.I.G.H.T.” R. Reassure the patient I Immobilise in the same way as a fractured limb. Use bandages or cloth to hold the splints, not to block the blood supply or apply pressure. Do not apply any compression in the form of tight ligatures, they don’t work and can be dangerous! G. H. Get to Hospital Immediately. Traditional remedies have NO PROVEN benefit in treating snakebite. T Tell the doctor of any systemic symptoms such as ptosis that manifest on the way to hospital.
  17. 17. Traditional Methods To Be Discard  Tourniquets  Cutting and Suction  Washing the Wound  Electrical Therapy and Cryotherapy  Pressure Immobilization Method (PIM)
  18. 18. Snake Bite Treatment Protocol  Patient Assessment Phase: On arrival. Pain Handling Tourniquets  Diagnosis Phase: Investigations  20 Minute Whole Blood Clotting Test
  19. 19. Other Useful Tests depending on availability 􀀻 Haemoglobin/ PCV/ Platelet Count/ PT/ APTT/ FDP/ D-Dimer Peripheral Smear Urine Tests for Proteinuria/ RBC/ Haemoglobinuria/ Myoglobinuria Biochemistry for Serum Creatinine/ Urea/ Potassium Oxygen Saturation/ PR/BP/ RR/ Postural Blood Pressure, ECG
  20. 20.  Cobra Krait R. Viper S.S.Viper H.N.Viper  Local Pain/ Tissue Damage YES NO YES YES YES  Ptosis/ Neurological Signs YES YES YES! NO NO  Haemostatic abnorma liies NO NO! YES YES YES  Renal Complications NO NO YES NO YES  Response to Neostigmine YES NO? NO? NO NO
  21. 21. ASV Administration Criteria  Systemic Envenoming  Evidence of coagulopathy: Primarily detected by 20WBCT or visible spontaneous systemic bleeding, gums etc.  Evidence of neurotoxicity: ptosis, external ophthalmoplegia, muscle paralysis inability to lift the head etc.
  22. 22.  Severe Current Local envenoming  Severe current, local swelling involving more than half of the bitten limb (in the absence of a tourniquet). In the case of severe swelling after bites on the digits(toes and especially fingers ) after a bite from a known necrotic species.  rapid extension of swelling ( for example beyond the wrist or ankle within a few hours of bites on the hands or feet). Swelling a number of hours old is nogrounds for giving ASV.
  23. 23. Dose And Route  Neurotoxic/ Anti Haemostatic 8-10 Vials  Children receive the same dose as adults B/c it is to neutralize venom which is same amount in both.  1. Intravenous Injection: reconstituted or liquid ASV is administered by slow intravenous injection. (2ml/ min) each vvial is 10ml of reconstituents.  2. Infusion: liquid or reconstituted ASV is diluted in 5-10ml/kg of isotonic saline or glucose.  All AVS over 1 hr in constant speed.
  24. 24. Neurotoxic Envenomation  In neurotoxic envenomation neostigmine test is done with 1.5 -2.0 mg of neostigmine IM, together with 0.6mg of atropine IV.  The paediatric neostigmine dose is 0.04mg/kg IM and the dose of atropine in 0.05mg /kg.  Observe victim for 1 hour.  If the victim responds to the neostigmine test then continue with 0.5mg of neostigmine IM ½ hourly plus 0.6 mg of atropin IV over 8 hrs in continuous infusion.  If there is no improvement in symptoms after one hour, the neostigmine should be stopped.
  25. 25. Autopsy findins  Fang mark 1.2 cm deep , 2.5 cm deep  Froth in mouth & nostrils  Changes in Nissle granules in brain matter, acute granular degeneration of medula  Evidence of hemorrhage in git, cerebrum, respiratory and urinary tract, serosal surfaces of organs, sub endocardial hemorrhage, regional lymphadenitis.  Venom Extraction From
  26. 26. Medico- Legal Importance  Accidental ; Most common  Suicidal ; Queen Cleopetra  Homicidal; Hannibal & Antiochus defeated Romans in a naval battle.  Cattle Poison.
  27. 27. Scorpion
  28. 28. Scorpion venom  clear and colourless toxalbumin that is more toxic than the snake venom The small quantity of venom is injected. The scorpion venom consists of a neurotoxin,haemolysins, proteinases, phospholipase A,leucocytolysin, coagulins,cholestrin and lecithin.
  29. 29. SIGNS AND SYMPTOMS  site of a wheal is having a red wheal with a hole in the centre and severe burning pain radiates from the site.  The area is swollen, reddened .  Increased temperature with chills and headache.  There is feeling of giddiness and fainting.  Excessive sweating and salivation  Muscular cramps and convulsions followed by unconsciousness.  Paresis and muscular weakness persists
  30. 30. TREATMENT  Application of tourniquet or pressure bandage above the site of bite and incising and washing the bitten area with weak solution of potassium permagnate, borax or ammonia.  The torniquet should be loosened for 1-2 minutes after every 10-15 minutes.  Local infiltration of 5%cocaine, or lignocaine solution in and around the bite relieves pain.  To treat shock, 5% of 500ml of dextrose saline should be given i.v along with glucocorticoids  i.m.calcium gluconate 10 ml of 10% solution should be given intravenously to combat muscular cramps.  To prevent pulmonary oedema, atropine sulphate should be administered
  31. 31. Autopsy Findings
  32. 32. Bee & Wasps
  33. 33.  Produce a painful local reaction, which recedes with time.  An allergic phenomenon produced by them may kill the patient because of prior sensitization. Number of stings may be so great or the patient is so young as to be killed with primary toxicity. Signs and symptoms:  Nausea and vomiting  Thoracic compression  Cardiac irregularities  Pulmonary oedema  Nephrosis  Cyanosis, convulsions and death. The fatalities may result a short while after the infliction of stings.
  34. 34. Anaphylaxis  Symptoms  Treatment  Autopsy Findings
  35. 35. Centepedes
  36. 36.  Local swelling,excruciatin pain and necrosis, paralysis and contracture of extremities, cardiac irregularities, arthritis and meningism may occur.symptoms subside in 2to 3 days
  37. 37. Lizards
  38. 38. Spiders
  39. 39. Brown Recluse Spider/ Loxasceles reclusa  Protease, esterrase, other enzymes  Sphyngomyelinase B bind to cell membrane causes neutrophilic chemotaxis  Vascular thrombosis 7 Arthus like reaction.  Fever, nausea, vomiting, arthralgia  Hemolytic anemia, ARF. Treatment;- supportive except YES to Dapsone & NO to Glucocorticoids
  40. 40. Widow Spider/ Letrodactus mactans  Buttocks / genitals  2 small red marks  Alpha latrotoxin leads to release of neurotrnsmitters  Antivenom available  Indication;- respiratory arrest, pregnancy, seizures  Rest treatment is symptomaic.
  41. 41. Marine Envenomation  Invertebrates hydroids, fire coral, jelly fish, portuguese man-of-war, sea anemones. Cnidocytes ;- stinging cells Cnidea ;- intacytoplasmic stinging organ
  42. 42. Symptoms  Burning, pruritis, parasthesia,  Redened, darkened, edematous.  Neurological, cardiovascular, G.I., Renal , Ocular.  Anaphylaxis.
  43. 43. Treatment  Application of Vinegar(5% a.a.)  Rubbing alcohol, baking soda, lime juice, papain.  Aneasthetic ointments/ antihistaminic cream/steroid lotions  Morphine
  44. 44.  Sea urchins;- Hollow, venom filled, calcified spines hemolysin, proteases, serotonins, cholinergic substances. Pain If spine is retained near vital structure than chances of granuloma formation which should get operated.
  45. 45. Cone shells  Predator carnivorous mollusks.  Neurotoxic venom delivered through harpoon like darts.  Wound, perioral, generalised parasthesia.  In severe condition Bulbar Dysfunction & Systemic Muscular Paralysis.
  46. 46. Australian Blue Ringed Octopus  Neurotoxin (maculotoxin) Na channel blockage leads to peripheral nerve transmisson inhibit.  Oral & facial numbness to total flaccid palsy.
  47. 47. Vertebrates  Stingray ;- envenomation + traumatic wound  Venom – serotonin, phosphodiesterase, 5`nucleoti dase.  Pain, Soft tissue swelling  Weakness, nausea, vomiting, diarrhea, hypotension, syncope, paralysis & death.  Scorpion Fish ;- same as of stingray. Stonefish, Scorpionfish, lionfish,  Cat fish ;- same as of stingray.
  48. 48. Treatment  Hot water immersion  No to cryotherapy  Pain killer,  Inj. T.T.  Antivenom for stonefish & serious scorpion fish .  Other supportive care.
  49. 49. Mammals
  50. 50. Ornithorhynchus anatinus • The venom apparatus is only present in malesa •Crural gland only secretes venom in breeding season • The use of the venom apparatus is probably related to combat with other males for territory or females.
  51. 51. Slow Loris Nycticebus coucang
  52. 52. Venomous and Poisonous Primate? Nycticebus coucang Nycticebus coucang inhabits the rainforests of southeast Asia, Assam, Burma, Thailand, Indo -China, certain Malayan states and East Indian Islands. • They have a brachial organ, a naked, gland-laden area of skin on surface of the arm that is licked during grooming. • When mixed with saliva, the toxin can repel some predators. • Anaphylaxis has been observed following loris bites. • N. coucang braAchial organ protein acts as an allergen.
  53. 53. Thank You

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