The document discusses various household poisons including aluminium phosphide (ALP), bleach, and pyrethrins. It provides details on the mechanism of action, signs and symptoms, diagnosis, and treatment of poisoning from these substances. ALP poisoning results from phosphine gas release in the stomach and causes metabolic acidosis, organ damage, and often death within 24 hours. Bleach contains hypochlorite and hydrogen peroxide and can cause irritation or burns depending on concentration. Pyrethrins are insecticides that prolong sodium channel activation and may cause allergic reactions, respiratory issues, or seizures from ingestion.

1. ALPHOS
(ALUMINIUM PHOSPHIDE)

2. CONTENTS
 INTRODUCTION
 MECHANISM &ACTION
 FATAL DOSE & PERIOD
 SIGNS AND SYMPTOMS
 LABORATORY FINDINGS
 DIAGNOSIS
 TREATMENT
 POSTMORTEM FINDINGS
 MEDICO LEGAL ASPECT
 SUMMARY & CONCLUSION
 CASE REPORT

3. INTODUCTION
 Solid & fumigant pesticide, insecticide and rodenticide
 Used as Grain preservative in north India,
 Available as White tablets of Celphos, alphos, Quickphos, Phostoxin, Phosphotex
 Wt of each tablet 3gms – liberates 1 gm of PHOSPHINE (PH3)
 Leading cause for death due to poisoning.
 Phosphine is a colorless and odourless gas
 But on exposure to air it gives characteristic garlic/decaying fish like odor.
 It is spontaneously inflammable and violently combines with oxygen and halogen
 When phosphine burns – dense white cloud of ‘phosphorus pentoxide’

4. MECHANISM & ACTION
 ALP liberates phosphine when it comes in contact with air and moisture.
 It reacts with acidic media (HCL) of stomach and release phosphine gas, which is
rapidly absorbed from gastrointestinal tract by simple diffusion.
 Phosphine is a protoplasmic poison interfering with enzymes and protein
synthesis.
 It acts by inhibiting the electron transport resulting from inhibition of Cytochrome
Oxidase

5. Fatal Dose – 1 to 3 gm; 1 to 3 tablets
Fatal Period – 1 hr to 4 days – majority die within 24hrs

6. SIGNS & SYMPTOMS

8. LABORATORY FINDINGS
 Chemical analysis for ph3 in blood or urine is not recommended as ph3 is rapidly
oxidised
 Leucopnia
 Increased Serum glutamic oxaloacetic transaminase(SGOT) and serum glutamic
pyruvic transaminase (SGPT)
 Metabolic acidosis
 Decreased plasma magnesium and serum cortisol
 Raised plasma renin levels

9. DIAGNOSIS
 Altered liver function tests with raised transaminase levels
 ABG shows metabolic acidosis
 ECG — sinus tachycardia
 Silver nitrate test –
 the patient is asked to breathe through a piece of filter paper impregnated with 0.1 N
silver nitrate solution for 5 to 10 minutes.
 If filter paper becomes black, it suggests presence of phosphine.
 The blackening is imparted because phosphine reduces silver nitrate to silver.

10. TREATMENT

12. POSTMORTEM FINDINGS
 Typical garlicky odor
 Congested organs
 Bright fluid blood
 Pleural effusion
 Pulmonary edema
 Bleeding
 Gastric mucosa shows shedding
 Kidney shows acute tubular necrosis
 Liver shows fatty change, congestion, edema, inflam-matory infiltrate in portal
tract and centrizonal necrosis

13. MEDICO LEGAL ASPECT

14. SUMMARY AND CONCLUSION
 Toxic effect of alphos is due to liberation of phosphine gas when it comes in contact with hcl
of stomach
 Phosphine acts by inhibhiting cytochrome oxidase and oxidative phosphorylation
 Phosphine gives characteristic garlic /decayin fish like odour
 Signs & symptoms:abdominal pain,arrthymia,altered mental state,metabolic acidosis,lung
failure,seizures
 Cause of death in alphos poisoning –metabolis acidosis and acute renal failure
 Fatal dose 150-500mg (1tablet is fatal)
 Test for alphos poising : silver nitrate test
 No antidote
 Treatment is conservative – for shock ,ARDS,metabolic acidosis,arrhythmia
 It is considered as ideal suicidal poison

15. CASE REPORT
 A 34-year-old woman was brought to the emergency department with alleged history of taking ALP tablets.
Her relatives revealed the aluminium canister of ALP tablets and alleged she had taken 2 tablets 30 min before.
On arrival, she was drowsy and was not responding to verbal commands. Her body was cold and hypotonic,
and her skin was pale with mottling. Her vital signs were as follows: Pulse rate 110/min regular, blood pressure
70/52 mm Hg, respiratory rate 20/min, shallow and body temperature, 36.1°C. On emergency investigations,
the electrocardiogram showed sinus tachycardia, pulse oximetry showed O2 saturation of 91% on room air and
arterial blood gas analysis demonstrated metabolic acidosis with pH of 7.1. Presentation of ALP tablets by the
family and symptoms of patient favoured diagnosis of ALP poisoning. The patient was instantly attended to;
intubation was carried out, and a nasogastric tube was inserted. Normal saline was administered by infusion
intravenously. After gastric washing with sodium bicarbonate, gastric lavage was performed using potassium
permanganate (1:10,000) and then activated charcoal (100 g) was administered. Shortly afterwards, she
vomited hot charcoal filled with small bubbles covered with white smoke that led to thermal burning of the left
side of the her face. A simultaneous cough splashed some vomit on the personnel's clothes. She was
immediately transferred to an isolated room and underwent infusion of calcium gluconate and magnesium
sulphate. The patient's situation progressively deteriorated. Sensorium decreased and apnoea occured
necessitating resuscitation and mechanical ventilation. At 3 h after emergency department admission, the
patient had cardiac arrest and died.

16. HOUSEHOLD POISONS

17. CONTENTS
 DEFINITION
 ROUTE OF POISONING
 COMMON HOUSEHOLD POISONS WITH
EXAMPLES /CLASSIFICATION
 HOUSEHOLD BLEACHES
a) Chlorine based
b) Non chlorine based
-CLINICAL EFFECTS
- TREATMENT
 SOME EXAMPLES
 DESSICANTS
 PYRETHRIN
a) Mechanism
b) Clinical features
c) Management
d) Autopsy findings
e) ML importance
- PREVENTIVE MEASURES

18. DEFINITION
 Household poisons are poisoning that occurby exposure to home
products, especially happened by children(because they don't know it
is,or mimickers to adults), and by adult (accidental, mistakes)
 Over 90% of toxic exposure to household product occurs in children
under 5 year &usually at time when product is in use rather than storage.

19. ROUTE OF ADMINISTRATION
 Injestion
 Inhalation
 Skin contact

20. Common Household poisonings
1.Medicines
sleeping tablets – Barbiturates
Headache tablets – aspirin
2. Cosmetics and personal care
Suntan lotions –denatured alcohol
Nail polish remover – acetone
Soaps and shampoo
3.Detergents (bleaching agents,floor
cleaner,etc)
4.Pesticides
Rat poison –aluminium phosphide,zinc
sulphide
Insecticide spray-DDT,gammaxene
5 Hydrocarbon Solvents(kerosene,
Thinner,petrol)
6.Plants
7.Kitchen
Baking powder – tartaric acid50%
Dish washing compounds-sodium poly
phosphates,sodium carbonate

21.  8. Miscellaneous:
 (1) Insecticide spray:
 (2) Moth balls:
 (3) Marking ink:
 (4) Ink remover:
 (5) Anti-rust products:
 (6) Cleaning solvents:
 (7) Fluorescent lamps:
 (8) Furniture polish:
 (9) Paint remover:
 (10) Shoe polish:
 (11) Hair bleach:
 (14) Crayons (chalk):
 (15) Crayons (wax):
D.D.T., Gammexane, etc.
Naphthalene.
Aniline.
Sodium hypochlorite 5%.
Ammonium sulphide, hydrofluoric acid
Petroleum hydrocarbons; carbon tetrachloride;
Beryllium.
Turpentine; petroleum hydrocarbons.
Sodium hydroxide; lead acetate.
Aniline; nitrobenzene.
Potassium permanganate: hydrogen peroxide.
Salts of arsenic, copper, lead.
Paranitroaniline.

22. Household
bleaches
1.Chlorine based bleaches
- contain chlorine or hypochlorite
- general disinfectant and bleaching agent.
- The toxicity of bleach is related primarily to
the oxidizing capacity of the hypochlorite ion
and the pH of the solution

23. 2.Non-chlorine bleaches
- used in numerous household products,
including disinfectants, chlorine free
bleaches, fabric stain removers, contact
lens disinfectants, hair dyes and tooth
whitening products
- May contain hydrogen peroxide, sodium
perborate, sodium percarbonate

24. 1.Chlorine based
(main content Hypochlorite)
 1. Most household bleach solutions contain 3% - 5%hypochlorite.
*swimming pool disinfectants &industrial bleach : up to 20% hypochlorite
 2. Bleaches with a hypochlorite concentration greater than 10% are corrosive
 while those with a concentration of less than 10% are irritants.
 3.Householdd bleach is a mild to moderate irritant which does not cause tissue
 damage unless ingested in large amounts. Systemic toxicity may occur after a
large ingestion.
 4.Ingestion of more than 100 mL in a child or 300 mL in an adult of a household
 bleach (<10% sodium hypochlorite) may cause significant toxicity.

25. Clinical effects of Hypochlorite
MILD TO MODERATE
*dilute hypochlorite
solutions (3%-5%)
 immediate burning in the
 mouth & throat.
 GI upset
 no further injury
SEVERE
*concentrated solution
 significant esophageal &
gastric burns
 dysphagia, drooling, severe
throat, chest & abdominal pain.
 hematemesis & GI
perforation

27. 2.Nonchlorine based
(main content hydrogen peroxide)
 Colourless, odourless, acidic oxidizing agent available in a
variety of concentrations from 3 to 90%
 General purpose disinfectants 3%
 Hair bleach and hair dyes 6%
 Contact lens disinfectants 3%
 Chlorine free bleach 6%
 Fabric stain removers 5-15%
 Industrial strength up to 90%

28. Treatment

30. Some examples

31. PYRETHRUM, PYRETHRINS & PYRETHROIDS
 Pyrethrum is extract of the chrysanthemum flower.
 Pyrethrum contains six active components labeled pyrethrins.
 Pyrethroids are synthetic derivatives of pyrethrins.
 Commonly used as insect and mosquito repellants

33. Mechanism of action
 Pyrethroids prolong the inactivation of the sodium chan-nel by binding to it in
the open state.
 However, in most of the cases, toxicity with these agents occurs because of
the allergic reactions to these compounds.

34. CLINICAL FEATURES
 Fatal dose - Pyrethrum 1 gm/kg
 Dermal exposure - erythema, dermatitis, blister formation
 Ocular exposure causes irritation, lacrimation
 Inhalation causes rhinorrhea, sore throat, wheezing, cough, dyspnea
 Ingestion - causes nausea, vomiting, paresthesia, vertigo, fasciculation,
hyperthermia, altered mental status, convulsions, pulmonary edema and
coma

35. MANAGEMENT
Decontamination
Systemic Poisoning –
 Ingestion - gastric lavage and administration of activated charcoal
 Fatty substance should be avoided as they promotes the absorption through GIT
 Allergic reaction should be treated with epinephrine and antihistamines
 Bronchospasm should be treated with appropriate bronchodilators
 Convulsions –diazepam

36. AUTOPSY FINDINGS
 Insect repellant like smell
 Froth at mouth and nostrils
 Cyanosis
 Congestion of organs
 Pulmonary edema
 Cerebral edema.
ML IMPORTANCE
 Accidental poisoning may occur.
 Suicidal poisoning is rare.
 Homicidal is also rare

37. Preventive Measures

40. Akash A Kattimani
3rd year Gamc