For the undergraduate Students of 2nd professional MBBS and MD pgt

1. ARSENIC

2.  Greeks (500 B.C) and Hippocrates used as external remedy
for ulcers.
Jabir ibn hayyen (8 A.D) Arabian alchemist obtained
arsenic from AS2 S2 (Realgar) by boiling.

3.  Existence:- AS2 S3 (orpiment)
by heating AS2 S2 (realgar)
AS2 O3
By product from smelting of copper, lead, zinc.
 Natural Source:- Daily intake 0.5 – 1mg (adult)
 Availability:- i. Rocks and Soils.
ii. Hot spring mineral water.
iii. Drinking water supply.
iv. Sea water.
v. Vegetables, Fruits, Grains.
vi. Fish, Shelfish, Crabs, Meat.

4. 1. Production of glass.
2. Wood preservative.
3. Hardening of metals
4. Weed killers, rodenticides.
5. Chemical warfare
6. Production of pigments and enamels.
7. Preparation of wallpapers and artificial flowers.
8. Calico – printing, taxidermy.
9. Preservation of timbers
10. Management of rheumatism, syphilis, impotence and tropical
eosinophillia

5. Is arsenic an ideal
homicidal poison?

6. 1. Combines with SH. Groups of mitochondrial enzymes system.
2. Blockage of Krebs cycle and interruption of transformation of
oxidative phosphorylation.
3. Inhibitions of transformation of thiamine into acetyl COA and
succinyl COA.
4. Dialatation of capillaries.
5. Peripheral NV. – Disintegration of axis cylinder (Axonal
neuropathy).
 Fatal Dose:- 180 mg.-200mg
 Fatal Period:- 12 – 48 Hrs.

7. A. Fulminant Poisoning :- Lump of Arsenic Ingestion
Features of peripheral failure.
B. Acute poisoning :-
a) G.I Symptoms:- Pain in throat
Vomiting- projectile.
Loose motion
Pain abdomen.
. Dysphagia.
Increased salivation and thirst.
Rice watery stool.
tenesmus and irritation around Anus
b) Widespread vasodialation Peripheral failure.

8. Olliguria, Haematuria, Proteinuria
Cardiovascular symptoms:- Ac. Cardiomyopathy,
Subendocardial Haemorrhage. ECG – Inverted T. Wave
prolonged QT interval

9. c) Narcotic type- Ingestion of massive dose
symptoms start by 5-10 mins.
Usually complains of-
Headech, tightness of chest
Giddiness, Tenderness of ms, Delirium,
Convulsion, Lock jaws.
Loss of speech and Memory.

10. D) Subacute type: Repeated small doses ingestion
dyspepsia
coated tongue
throat irritation, tingling sensation
foul smelling breath
cough
g.i symptoms

11. Laboratory Findings:-
i. Urine – Estimation 0.2mg / liter
(0.01 – 0.06 mg / liter)
Proteinuria, Casts, Urobilinogen
ii. Blood – As Estimation – 100mg / liter
Leucopenia, anaemia
(2000 – 5000 / cumm)
iii. Bl. Biochemistry – Serum alk phosphatase
serum bilirubin Raised

12. iv. Nails and Hairs – 1 mg / 100 gm (Indicate Poisoning)
v. Chemical Analysis – 20ml. Stomach contents + 4ml HCL
+ Cu strip boiled
REINSCH Strip black (As, SB, Bi)
TEST
Cu strip + 2ml / 10% KCN.
Deposit dissolve As

13. Treatment:-i) ABCD
ii) Stomach wash
iii) Freshly prep hydrated Fe2O3.
2FeCL3 + 3MgO Fe2O3 + 3MgCl2
(45ml) (15gm) + ½ glass H2O
One tablespoonful ferric arsenide
ii. Dialysed Iron.
iii. B.A.L-2.5 to 5 mg /kg in 20% benzyle benzoit, 4 hrly first 2days,
twice for 3rd day, and then once daily for 7 days.
iv. Antibiotics
v. MgSO4 / Castor oil Reduce intestinal absorption of As

14. Chronic As poisoning (Signs and Symptoms)
First Stage:- Loss of weight
(gastric) Loss of Appetite
Salivation
Colicky Pain and Constipation
Gum – Red and Soft
Oedema – Eyelids, Ankles
Second Stage:- Laryngitis
(cutaneous) Bronchitis
Husky Voice
Running of Nose, Perforation Nasal Septum
Haemoptysis
Erythema

15. Rain drop pigmentation-Flexors, Nipples, Abdomen, Eyelids, Temples
Aldrich – Mee’s Line
(White transverse lines at nail plates)
Alopecia
Third Stage – Tingling / Numbness – Skin
(sensory) Muscle Cramps
Facial Oedema
Knee Jerk – Lost
Impotence
Aplastic Anaemia, Thrombo Cytopenia

16. Fourth Stage – Peripheral Neuritis
Sensorimotor Neuropathy
Wrist drop and Foot drop
Tremor
Management – Removal of Patient
B.A.L
Inj B1, B6, B12
Arseno Phagists – Tolerance upto 0.3 gm.

17. ARSENIC CHOLERA
Pain in throat Burning
Vomiting Vomiting
Burning Pain in throat
Voice not changed Husky voice
Vomitus – Mucus bile Blood Blood Bile
Rice water stool + Blood Rice watery stool without Blood
Tenesmus (+) Tenesmus (x)
Convulsion(+) Convulsion (x)
Stool – As present Microbiological study

19. LEAD
Physical appearance & Use –
(i) Lead Acetate ( Sugar of Lead)- Therapeutic use
(ii) Lead carbonate (white lead)- used as a white pigment in Lead
paint
(iii) Lead oxide - is used as a colouring element in ceramic glazes
(iv) Tetraethyl lead ( antishock) - to prevent detonation
(v) Lead tetraoxide (Sindur) – cosmetic use
(vi) Lead sulphide ( surma)

25. Environmental Domestic Occupational
Automobile exhaust
(0.56gm/Lt),
Drug abuse,
Soil
Water
Ceramic wire,
Coloured picture books,
Contaminated flour,
Cosmetics,
Health foods,
House paints,
Indigenous medicines,
Pencil,
Toys
Auto repair works, Battery
making,
Glass and plastic
manufacture,
Mining,
Plumbing,
Pottery,
Printing,
Rubber industry,
Ship building and breaking,
Soldering (electronic), Steel
welding and cutting

26. Fatal Dose:
Lead acetate – 20 gm.
Lead tetraethyl – 100mg/kg; usually uncertain.
Lead carbonate – 40 gm.
Absorption of more than 0.5 mg/day.
Fatal period: Uncertain, usually 2-3 days.

28. Mechanism of Action
1. Inhibits sulphydryl enzyme
2. Decrease haeme synthesis by inactivating
a. ALA dehydrase
b. ALA synthatase
c. coproporphyrinogen oxidase
d. ferrochelatase