1. Inorganic irritants like phosphorus, iodine, chlorine, and powdered glass act locally to damage tissues through various mechanisms like extracting water, coagulating proteins, and directly corroding surfaces. 2. Phosphorus poisoning can cause serious and potentially fatal effects within 12-48 hours from just 1 gram ingested. Chronic exposure leads to "phossy jaw" bone necrosis. 3. Aluminum phosphide used as a fumigant is highly toxic and a common cause of suicide, with mortality rates over 50% even from a single tablet. It liberates phosphine gas which is cytotoxic.

1. INORGANIC IRRITANTS
by
Dr. K. Anudeep Kumar

2. Intro…
• Corrosive – Substance which erodes and destroys any surface in
contact with.
• *Almost acts exclusively locally.
• True mainly in case of inorganic acids and alkalis.
• MOA:
• Extraction of water from tissues.
• Coagulation of cellular proteins.
• Conversion of Hb to Hematin.

3. Corrosive v/s Irritants
• Diluted corrosives behaves like irritants and vice versa.
• Compared to corrosives, irritants are less severe*.
• MOA: Mainly gastroenteritis with variable systemic.

4. Classification
• Inorganic
• Non-metallic: Phosphorus, Chlorine, Iodine and Bromides.
• Metallic: Arsenic, Lead, Mercury, Iron, Copper,Thallium, Antimony etc.,
• Organic
• Plant Origin: Castor, Croton, Capsicum, Calotropis, Abrus, Ergot,
Semecarpus etc.,
• Animal Origin: Snake and Insect venom.
• Mechanical Irritants: Powdered glass, Pins, Needles, Nails, Hair
etc.,

5. Phosphorus
• Uncommon now-a-days
Since safety matches* replaced yellow phosphorus matches.
• Safety matches: Potassium chlorate + Antimony sulphide

6. Derivatives…
• Aluminium and Zinc phosphide
• Phosphine gas

7. Uses…
• Ammunition – Incendiary bombs, tracer bullets, smoke screen etc.,
• Rescue flares
• Fire works
• Rodenticide and Insecticide.

12. Physical appearance
Red
• Amorphous & Non-toxic relatively.
Yellow
• Crystalline & toxic
• Translucent, waxy & luminous
• Garlicky odor & highly volatile.
• Ignites at room temperature, So stored under
water

13. Clinical features
• Fulminant poisoning:
>1gm intake, peripheral vascular collapse and death in 12-48hrs.

14. Acute poisoning
• 0.1-1gm intake
• Nausea, vomiting and diarrhea. The vomitus and stools are luminous and may
emit fumes (SMOKY STOOL SYNDROME).
• Garlicky or sulphurous odor in the breath.
• Intense thirst.
• Abdominal pain
• Delayed symptoms due to latency
• Same as above
• Hepatomegaly and jaundice
• Abnormal bleeding (hypoprothrombinaemia)
• Yellow atrophy of liver
• Ranal failure
• Convulsions and delirium
• Death

15. Chronic Poisoning
• Occupational Hazards
• Not common now due to safety matches
• Inhalation of fumes of phosphorus over time.
• Tooth ache, ulcerative stomatitis, loosening of teeth
• Phossy jaw: Necrosis of jawbone with osteomyelitis resulting in multiple sinus
formation , discharging foul smelling pus. By Bristowe
• Fatal dose: 1mg/kg body weight.

16. Rx
Fulminant & Acute Poisoning:
• Stomach wash : Pot. permanganate + Hydrogen peroxide / Copper
sulphate
• No oily demulcents / oily foods.
• Calcium gluconate: 5-10ml of 10% Solution
• Vitamin B-complex, K and C
• Soda bicarb – acidosis
• Low fat and high carb – liver stress
• Supportive measures
• Skin – copious washing with 2% sod.bicarb / 1% copper sulphate

17. Rx…
Chronic Poisoning
• Decontamination
• Dental treatment

18. P.M Appearances
• Garlicky odor
• Jaundice
• Purpuric spots
• Luminous contents
• Congestion of GI tract
• Enlarged liver
• Viscera congestion.

19. MLI
• Accidental: in children and Unqualified medical practitioners.
• Suicide: old by using match heads, now by rodenticides.
• Homicidal: by adulteration.(Ricketts Case)
• Arson

20. Aluminium Phosphide
• Marketed in India under trade names – Alphos, Celphos, Chemfume, Delicia,
Fumigran, Phosphotek, Phostoxin, Quickfos, Synfume etc.,
• Available as greyish green tablets of 3gm each, mixed with urea and
ammonium carbonate.
• Each tablet liberates 1gm of phosphine.

21. Uses
Most ideal grain preservative – cheap and very effective in repelling pests.
AIP + 3H2O Al(OH)3 + PH3
*Traces of phosphite and hypophosphite of Aluminium may be present, but they are non-toxic.
Fatal dose – 1-3tablets

22. C/f
Same as acute poisoning in Pure form.
• CVS – hypotension, tachy/bradycardia and ECG
abnormalities
• R.S – distress
• CNS – coma
• Cyanosis, cold and clammy skin.
Systemic effects
High mortality if taken >3 tablets.

23. Dx
• Garlicky odor
• Urinalysis – Occult blood, bilirubin, glucose, and albumin.
• Abnormal LFT & RFT
• ECG Changes

24. Phosphine detection tests
• Breath test: 8AgNO3 + PH3 + 4H2O H3PO4 + 8Ag + 8HNO3

25. Biological
Test
5-10ml gastric aspirate / 5-10gm liver - sample
Taken in a steam distiller and equal amount of water is added
and then acidified with HCl /H2SO4 and then heating up to 50 C
for 15 min.
The distillate is received through ice cold receiver
containing silver nitrate
If Phosphine present – the solution turns black
For confirmation – add Nitric acid to black precipitate and boil,
after sol. Is clear add ammonium molybdate and heat for a
minute – yellow colour confirms phosphine

27. Autopsy
findings
Hypoxic organ damage – congestion &
petechiae
Stomach- hemorrhagic with mucosal
shredding and garlicky odor
Microscopic necrosis in liver and kidney
Heart – toxic myocarditis + fibrillar
necrosis
Lungs – ARDS with pul.edema

28. Significance
• AlP is a fumigant for stored cereal grains, used to kill insects and
rodents.
• Cases of AlP poisoning is under-reported. AlP is cheap, readily
available, highly toxic.
• AlP is the most common cause of suicidal death in North India.
• Mortality rates from AlP poisoning vary from 40-80%, usually >50%.
• The toxicity of aluminium phosphide is attributed to the liberation of
phosphine gas.
• Phosphine (PH3) is a colorless gas with a disagreeable odor of fish or
garlic. It is a cytotoxic compound that causes free radical mediated
injury, inhibits vital cellular enzymes and is directly corrosive to
tissues. CDC has classified phosphine as immediately dangerous to
life at 50 parts per million.

29. Hepatotoxic
Poisons
• Alcohol
• Aminoglycosides
• Anabolic steroids
• Arsenic
• Carbon tetrachloride
• Iron
• Paracetamol
• Paraquat
• Phosphorus
• Naphthalene
• Oral contraceptives
• Sulphonamides
A SOAP IN A CAPP

30. Iodine
• Bluish-black, soft and scaly crystals and has a metallic luster and an
unpleasant taste.

31. MOA
• Protoplasmic poison fixing protein and causing necrosis.

32. C/f
• Inhalation – glottic & pul.edema
• Ingestion – acid corrosive poison
• Burning pain from mouth and stomach
• Intense thirst, salivation, vomiting, purging, giddiness, cramps or convulsive
movements of the limbs and fainting.
• Lips and angles of mouth are brown.
• Vomit or feces – dark-yellow / blue in colour – contain blood – with iodine
odour.
• Urine – scanty- red-brown colour – albumin.
• Metabolic acidosis
• Nephritis
• Renal failure
• Pulse – slow & weak
• Skin – cold / clammy and rashes present

33. Fatal Dose & Period
• 2-4g ( 30-60ml tincture)
• 24hrs

34. Rx
• Emetics or stomach wash with warm water containing soluble starch and
albumen
• Sodium thisulphate
• NaCl
• Supportive
• Skin lesion with 20% alcohol.

35. P.M Appearances
• Mucosa of bowel – inflamed, excoriated and brown.
• Fatty degeneration – heart, liver & kidney
• Edema of brain.

36. Chronic poisoning
• Pain over frontal sinus
• Running nose, conjunctivitis, bronchial catarrh
• salivation, nausea, vomiting, purging
• emaciation, lymphadenopathy, parotid swelling (iodide mumps)
• wasting of breasts, testes etc.,
• acne or erythematous patches on the skin, urticaria etc., (ioderma)

37. Chlorine
• greenish – yellow gas, unpleasant irritating odor
• Exposure – laboratories, factories and chemical works.
• Oxidizing agent – destruction of organic tissue.

38. C/f
• Inhaled – irritant and suffocative effect
• Acute – irritation of eyes, throat and mucous mem. Of respiratory tract with
violent coughing & extreme dyspnea
• Nausea, vomiting and glottis spasm
• Death – cardiac failure – edema of lungs and Pul. congestion.

39. Fatal dose & Period
• 1:1000 in 5min
• <2days

40. P.M appearances
• Asphyxial
• Respiratory tract inflammation, pul.edema, rupture of alveolar walls,
hemorrhages and thrombosis in lungs
• Increased viscosity of blood

41. Mechanical Irritants
• Act mechanically and have only local action – not absorbed

42. Powdered Glass
• C/f:
• Sharp burning pain in throat, stomach, intestine, usually constipation but rarely
diarrhea.
• Death – shock as a result of bowel perforation
• Fatal dose & period – uncertain
• P.M Appearances –
• erosions of bowel
• Sticky mucous over stomach along with glass particles
• Inflamed and congested gastric mucosa
• MLI
• rarely suicide or homicide
• Used as cattle poison.