Clinical symptoms and management of- Barbiturates, Morphine, Organophosphorus compound and Lead, mercury, Arsenic poisoning.

1. Clinical Symptoms and
management of
Barbiturates, Morphine,
Organophosphorus compound and
Lead, Mercury and Arsenic poisoning.
Presented by- Nikita Bankoti.
KUDOPSss

2. 1. Barbiturates
 Barbiturates are used in medical practice as sedative, hypnotics,
anaesthetic and antiepileptics or in strychnine poisoning cases.
 Barbiturates are thus classified into four types,depending on
their time of onset and duration of action.
 1.Ultra short acting(<15-20min) - Thiopentane Na ,Hexabarbital
Na.
 2.Short acting(<30min) - pentabarbitone,amobarbitone.
 3.Intermediate acting(3-6hrs) - amylobarbitone,butobarbitone.
 4.Long acting(6-12 hrs) - barbitone,phenobarbital.
 MOA - Barbiturates binds to specific site of GABA sensitive ion
channel found in CNS.
 It act as a depressant at all level of CNS.
 However,depending upon the dose of degree of depression can
be altered from transquility to deep coma.
 Eg- increase the action of alcohol(synergistically).

3. Symptoms Of Barbiturate Poisoning:-
1. Prolonged coma with respiratory depression.
2. Hypotension.
3. Pulmonary oedema.(excess fluids in lungs)
4. Hypothermia.(decrease in body temperature)
5. Oliguria.(low urine output)
6. Mental confusion
7. Inco-ordination and Muscle weakness
8. Cardiac arrest.(suddenloss of heart function, breathing)
THE FATAL DOSE IS 50-60grains.

4. Treatment:-
1. Further absorption of barbiturates can be controlled by the
administering activated charcoal.
2. Artificial respiration must be given by a mixture of 95%
oxygen and 5% carbondioxide(CO2).
3. Haemoperfusion and haemodialysis are the available
options for the severe toxicity.
4. Amphetamine sulphate in the dose of 10mg every half an
hour must be given intravenously till improvement occurs.
5. Alkalisation of urine to pH8 with sodium bicarbonate helps
in the elimination of phenobarbitone.
6.Gastric lavage should be performed using potassium
permanganate.

5. 2. Heavy Metal Poisoning:-
Heavy metal block the body enzyme system as they form chelates with the
body enzymes.
A. Arsenic
Symptoms - (i) Acute poisoning:-
1. Nausea, cramps in legs, dilated pupil, vomiting, diarrhoea, faintness, pale
anxious face, malaria, tachycardia(increase in heart beat), burning pain in
stomach, dyspnoea(difficulty in breathing).
2. Vomiting initially consists of stomach content but later it becomes greenish or
black in colour due to the presence of bile.
3. Diarrhoea is complained and stools contain mucous tinged with blood.
4. When arsenic dust is inhaled it may cause pulmonary oedema, restlessness,
cyanosis( bluish discoloration of skin due to poor circulation or inadequate
oxygenation of the blood).
THE FATAL DOSE IS 130-300 mg.

6. Treatment:-
1. Stomach wash with sodium and magnesium sulphate is recommended .
2. Morphine and atropine is given to relieve colic pain.
3. EDTA acts as chelating agent.
Symptoms
(ii) Chronic Toxicity:-
1. Redness of Skin.
2. Loss of weight.
3. Horny growth of cornea.
4. Inflammation of mucous membrane.
5. Coughing.
6. Patchy brown pigmentation of skin.
7. White strips of fingernails.
8. Tenderness of muscles.

7. Treatment:-
1. Dimercaprol 3mg/1kg is administered intramuscularly at
4 hourly intervals.
2. Fluid replacement and use of pressor agents like
dopamine is used to control hypotension.

10. Treatment:-
(i) Acute poisoning:-
1. Gastric lavage with zinc sulphate followed by the large draughts of
milk and eggs with sodium and magnesium sulphate .
2. Morphine and atropine are used to relieve colic pain .
3. EDTA is used as chelating agent.
(ii) Chronic poisoning:-
1. Removal of patient from source of further exposure.
2. Chelation therapy with edetate calcium disodium is used .
3. B.A.L(Dimercaprol)—Birtish anti lewisite is used as complexing
agent.
4. Penicillamine(heavy metal antagonists) is also included in the
dosage regimen.

11. C.Mercury.
Symptoms:-
(i) Acute poisoning:-
1. Inflammation of airways.
2. Metallic taste in mouth.
3. Tremors(shaking or trembling movements).
4. Abdominal pain.
5. Vomiting and vomit consist of long stringy masses of white mucous mixed
with blood.
6. Gums may become swollen and loosening of teeth occur.
7. Pneumonitis(inflammation in your lungs tissues without an infection).

13. (ii) Chronic poisoning:-
1. Anorexia(eating disorder).
2. Excessive salivation.
3. Metallic taste in mouth.
4. Loosening of teeth with painful inflammed gums.
5. Nervous disturbance ,delirium.
6. Weight loss, loss of memory.
7. Insomnia(sleep disorder).
8. GIT disturbances.
FATAL DOSE - 3-5 grams.
Treatment:-
1. Patient must be removed from source of exposure.
2. Forced emesis or gastric lavage is done to remove mercury.
3. I.M. injection of dimercaprol is given.
4. Extract of belladonna can be given to relieve the excessive salivation.

14. 3. Organophosphorus compounds
Insecticides are generally discussed as organo-phosphorous
compounds, D.D.T and Endrin.
The compounds belonging to this category are-
i. Hexaethyl tetra- phosphate(HETP)
ii. Tertraethyl pyrophosphate (TEPP)
iii. Octamethyl pyrophospharamide(OMPA)
FATAL DOSE of HEPA - 160mg by (I.V., I.M.) and 350mg by oral
route.
OMPA- 80mg by (I.M.,I.V)and 175mg by oral route.

15. Symptoms:-
1.The poison affect the involuntory muscles and secretary glands
first.
2. Then it affect the voluntary muscles, and finally vital brain
centers.
3.The initial complaints are-
headache,Malaise(feeling of overall weakness),Constriction in
the chest,accompanied by photo-phobia due to pin-point pupil.
4. In next 2-8 hrs , the symptoms may occur in following order –
nausea, Abdominal cramps, vomiting, Diarrhoea, Profuse
sweating and Salivation, Muscular twitching.
5. If poisoning is severe, symptoms are-
Pulmonary oedema, Convulsions, Possibly death may occur.ss

16. Treatment:-
1. Decontamination - the patient must be removed from the source of
poison. The skin and mucous membrane should be decontaminated
by washing with tap water and soap.
2. Vomiting should be induced if the poison is ingested be the patient.
3. Clearing of air ways- artificial respiration may be necessary to clear
the airway.,
4. Antidote- Atropine 2mg every 15-30 min i.m. or I.V. till it's effects
appear i.e. dry mouth, dilated pupils, false pulse, warm skin etc.
It antagonise the peripheral action of organophosphorus, but cannot
block the effect on CNS and neuromuscular effect.

17. 4. Morphine
It is natural phenanthrene derivative of opium.
Opium is used extensively as a sedative and painkiller.
The various derivatives are also habbit- forming narcotics.
Seeds inside are non-poisonous and called KHASKHAS which
constitutes a condiment in Indian cooking.
Symptoms:-
1.If consumed in large dose, respiration become shallow.
2. Constriction of pupil takes place and Heart rate decreases.
3. Body temperature drops, cyanosis and ultimately death occurs
due to respiratory depression and cardiac arrest.

18. Treatment:-
1. Nalorphine is a specific antidote of morphine. The dose of 5-10mg
is given by I.V. route immediately till respirations become normal.
2. Gastric lavage is done to remove any unabsorbed drug.
3. Patients must be kept awake, as in awake condition ventilation
and basic metabolic rate is more which is responsible for
detoxification of opium.

19. Thank you