This document discusses various types of drugs that act on the central nervous system. It describes two main stages of poisoning from these drugs - excitement and narcosis. It then categorizes different types of drugs and their effects, including inebriants like alcohol, ether, and chloroform. The rest of the document focuses specifically on alcohol, describing its absorption, metabolism, stages of poisoning, signs and symptoms, treatment for alcohol poisoning, and long term effects of chronic alcohol use including diseases of the liver, brain, and other organs.

1.  Drugs acting on cns
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2.  Group of poisons characterized by two
sets of symptoms:
 A. Excitement
 B. Narcosis
 Note: The stage of excitement is well
marked in some and that of narcosis in
others.
2

3.  Crossives
 Irritants
 Neurotics
 Cardiac
 Asphyxiants
 Miscellanous
3

4.  Cereberal
 Ineberient
 Deleriant
 Somniferous
 Spinal
 peripheral
4

5. Inebrient poisons
5

6.  ALCOHAL
 ETHER
 CHLOROFORM
6

7.  It is present in all hard drinks in different
conc. these drinks also have
ketones,ether and essential oil.
 Transparent ,colorless, volatile liquid
 Spirit like odor
 Burning taste
 Active ingredient in many social
 “beverages”
7

8. Beverages Alcohol % by volume
Wine 8-13.5
Beer 2-10
Whiskey 42.8
Brandies 42.8
Country liquor 11.4 – 45.7
8

9.  95% by volume
 Absolute alcohol
 Water content not > 0.2%
9

10.  Rapid absorption from GIT
 Factors affecting absorption
1- conc. Of alcohol in the fluid
2- presence or absence of food
3- rate of drinking
 Fate
90% is oxidized in the liver
10% is excreted in the urine and
breath
 After absorption alcohol level
reaches its max. in 45 to 90 min
10

11.  Normal capacity of the body to
metabolize alcohol = ½ fluid ounce
which is equal to one drink
 The rate of fall of plasma level is 15-18
mg /dl/hr.
11

12.  Alcohol acts as CNS depressant
 It depresses the CNS irregularly in
descending order from cortex to medulla
 Poisoning occurs in three stages
› 1-stage of excitement
› 2- stage of in coordination
› 3- stage of narcosis
12

13.  It is due to the depression of
the higher centers which
control judgment and behavior
 SYMPTOMS
feeling of pleasure and well
being
increased sexual desire
person becomes talkative
he laughs or becomes angry
easily
he may disclose secrets
13

14.  Thought ( confusion impaired
judgment)
 Speech ( slurred speech )
 Action ( staggering gate )
Most of the offences are committed
in this stage.
Impaired judgment may lead to.
accidents
violence
sexual offences
other crimes 14

15.  Deep sleep
 Responds to only strong stimuli
 On examination
pulse rapid
temp subnormal
pupils contracted
 MACEWAN’S SIGN
 Death may occur if this stage
lasts for >12 hrs, due paralysis
of cardiac or respiratory
centre.
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16. MACEWAN’S SIGN
On pinching the neck or face, the pupils
dilate initially and slowly return to their
original size.
Hand-over effects
Headache due to cerebral oedema.
It’s a temporary state
16

17. Depends upon
Age
Drinking habits
Strength of liquor
Conc. Of 350 mg% or above
in the blood is usually
sufficient to cause death
17

18. CAUSE OF DEATH
depression of resp. centre
alcohol is lethal in low conc. If
taken with other CNS
depressants like barbiturates,
morphine, and CO.
FATAL PERIOD
is usually 12-24 hrs and may be
delayed up to 5-6 days
18

19.  Hospitalization
 Stomach wash with 5% NaHco3
in warm water
 Keep the pt. warm
 Treat hypoglycemia
 Treat increased ICP→
 O2 inhalation
 Artificial respiration
 Hemodialysis / peritoneal
dialysis
19

20.  EXTERNAL FINDINGS
Clothes disorderly / torn
Stains vomit or blood
Bruises or other injuries
Rigor mortis lasts longer
20

21.  Alcoholic odor on opening the body
 Fatty liver
 Stamach shows ch. Gastritis
 Brain is edematous
 Subdural / epidural hemorrhage showing
head injury
 Vitreous analysis
21

22.  Routine viscrae
 Vitreous fluid
 CSF
 Blood from a peripheral vein
22

23.  Prohibited in our religion
 Death due to acute poisoning is rare
 Complications are common
Head injury
23

24. Drowning
Accidents
Crimes
Suicidal tendency
Café coronary syndrome
A close relationship exit between
alcohole,crime and violence
24

25.  Prohibits driving under the influence of
alcohole,absence of physical ability etc
 Examination of the driver
 Consent for examination
25

26.  Is due to continued use of
alcohol
 Results in
Physical
Moral deterioration
Mental
26

27.  Lack of personal hygiene
 Loss of appetite
 Ch. Gastritis
 Impotence and sterility
 Fatty changes in liver and
heart
 Cirrhosis of liver
27

28.  Manifests as crimes
(1) He commits crime to get
drink
(2) He becomes suspicious of
his wife’s fidelity and may
assault her or the suspected
paramour
28

29.  Manifested as Dementia
29

30.  Delirium tremens
 Korsakoff’s psychosis
 Acute hallucinosis
30

31.  State of excitement with hallucinosis. It lasts for 3-4
days.
 Results from
an unsual bout of drinking
sudden withdrawal of alcohol
acute infection like Pneumonia
Shock from injury eg fracture of bone
Exposure to cold
 Manifested as
excitement
tremors 31

32. Marked tremors
Hallucinations chiefly visual &
occasionally auditory
Violent behavior --- may
commit
suicide
32

33. Treatment
(1)Give sedatives such as
chlorpromazine 100mg 6 hrly
(2)Hypertonic glucose sol I/V to
relieve cerebral oedema.
(3)Treat infection energetically.
33

34. It is syndrome
 Characterized by
Hallucinations
Disorientation
Multiple neuritis
Amnesia – Recent memory is lost
This condition may last from one
month to 12 months.
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35.  A psychiatric emergency
 Hallucinosis chiefly auditory , with
delusions of prosecution lasting from
weeks to months
 Pts. may become suicidal or
homicidal
 Pts. Must be hospitalised. sedated
and treated accordingly.
35

36.  Degenerative changes in
liver
kidney
brain
 Atrophic gastritis
 Cirrhosis of the liver
 cardiomyopathy
36

37. (1) The drug antabuse (disulfiram) is the
most suitable treatment for all cases. 500
mg daily and can be continued for
long time.
(2) Tab Temposil (calcium carbamide
citrated) 50mg daily.
(3) They sensitise the individual to even
small doses of alcohol.
37

38. According to law, the accused can be
examined by medical officer at the
request of police.
Such examination may include taking of
samples / fluids in case of suspected
intoxication.
38

39. In absence of head injury & other
pathological conditions, a person is
definitely under the effect of alcohol if
there is smell of alcohol in his breath &
vomitus, provided most of the following
symptoms & signs are present:-
39

40. (1) General Behaviour→ Excited, talkative,
abusive.
(2) Clothes→ Disarranged & Dirty
(3) Eyes. Eyes congested. Fine lateral
nystagmus
a. Pupils. May vary from extreme
dilatation to extreme contraction
40

41. (4) Tongue. Dry or Excessive salivation
(5) Coordination→ Impaired Ask the patient
about
(i)Thread a needle
(ii) Button his clothes
(iii) Finger nose test
(iv) Stand with heel together & eyes
closed
(v) gate is staggered.
41

42. (7) Memory. Loss or confusion of recent
events disorientation about time &
space
Sample for Alcohol detection
(1) Blood
(2) Urine
(3) Breath
(4) CSF, vitreous fluid, bile (in case of
Autopsy)
(5) Blood
5ml of blood
42

43. Preservative = 5mg of sodium fluoride &
15mg of pot oxalate for 5ml of blood.
43

44. Urine. Ask the pt to empty the
bladder & a second sample
collected within 30-60 minutes.
Preservative. 30mg of phenyl
mercuric nitrate for 10ml of
urine.
44

45. Breath. The person is asked to
blow into a breath analyser
(drinkometer, intoximeter,
alcometer). The test based on
the principle that alcohol react
with an oxidising agent &
produces change in colour,
proportional to the amount of
alcohol.
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46. The amount of alcohol in 2100ml of
alveolar air is approximately equal to as
that in 1ml of blood. Electric Breath
Analyser gives quantitative results with
device giving print out results of analysis
which is accepted in the court.
46

47. 1. KOZELKA and
HINE/CAVETTmethod.
2. Gas chromatography
3. Alcohol Dehydrogenase (ADH)
Method
4. Breathalysers
47

48. 1. Kozelka & HINE/CAVETT method
It involves diffusion/distillation under low
pressure,
Principal. Alcohol is easily oxidised to
accetic acid by oxidising agent like
potassium dichromate and H2 SO4.
Each ml of N/20 dichromate solution
that is reduced in the process is
equivalent to 0.525mg of alcohol
48

49. 2. Gas Chromatography.
A measured (microlitre) quantity of
sample is placed in previously heated
chamber. The vaporised alcohol is
carried by an inert carrier gas like
Nitrogen through a column containing
suitable adsorbent material. The various
constituents of the sample are
separated due to differences in
adsorption and then
49

50. detected by sensitive
detector. A record on a
moving chart
(chromatogram) provides
the qualitative & quantitative
analysis.
50

51. Principle. It is based on the
principle that ADH (alcohol
dehydrogenase) converts
alcohol into acetaldehyde
with coenzyme NAD
(nicotinaomide adenine
dinucleotide). The reaction is
completed at high PH and
removing acetaldehyde with
semicarbazide
Breathalyser (as already
discussed) 51

52. (Wood alcohol, wood spirit
methanol)
It is used in arts and used as paint
remover, varnish and manufactured
as denatured spirit.
It is more toxic than ethyl alcohol
because
(1)It is slowly excreted from body, so
acts as cumulative poison.
52

53. (2) It converted in the body into
formaldehyde & formic acid. These
are more toxic:
(3) Eyes. It causes either primary
blindness or permanent blindness
due to atrophy of optic nerve.
(4) Abdominal Pain. It causes intestinal
contraction which may affects the
small or large intestines or both
resembling a thick pipe of very
narrow lumen. It is diagnostic of
methanol poisoning.
53

54. FATAL DOSE: 60 – 240ml – cause death.
15ml → cause blindness
For children: 1ml/kg body wt
Fatal period→ 1-4 days
Treatment→(1) Preventing absorption by
gastric lavage.
(2) Bicarbonate to combat
acidosis.
(3) Administration of ethanol
as a
competitive antagonist
(4) Bowel irrigation
54

55. 1. Stomach wash with 5% sol
of sodium bicarbonate in
warm water (oral).
2. For acidosis→Give Sodium
bicarbonate 2gm (1/2 TSF)
in 250ml of water every 2
hrs.
I/V 50gm of sodium
bicarbonate dissolve in 1
litre of 5% dextrose water.
55

56. 3. Oral administration of 50% ethyl alcohol
(0.75-1ml per kg body wt) for 3-4 days.
4. Haemodialysis.
Antidote
1. 4-methylpyrazole
2. Folinic acid
56

57. Note:
Eyes should be kept
covered to protect from
strong light.
ML aspects.
Accidental poisoning due
to consumption of liquor
containing methyl
alcohol by drinkers which is
cheap easily available.
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