1. Copper and copper compounds like copper sulfate and copper subacetate are toxic heavy metals that can cause acute and chronic poisoning through ingestion, inhalation, or skin exposure. 2. Acute copper poisoning causes gastrointestinal symptoms like vomiting and diarrhea as well as liver and kidney damage. Chronic poisoning can result in conditions like anemia, bronchitis, and corneal ulcers. 3. Iron and thallium are also toxic heavy metals that can cause multiple organ damage and even death in acute overdoses. Their absorption is followed by stages of toxicity affecting the gastrointestinal tract, liver, kidneys, and other organs. 4. Potassium permanganate is a toxic compound of manganese that

1. COPPER / TAMBA

2. COPPER
• It is a brown colour metal
• As a metal it is non poisonous
• Important integral of enzymes
Action:
– high affinity for sulphhydryl and amino groups.
– May also target nucleic acids

3. Toxic compounds and its uses:
• Copper sulphate (CuSO4, blue vitriol, neela tutia):
– Large blue crystals, soluble in water and styptic taste
– Used in algaecides, fungicides, electroplating, leather
tanning, hide preservation to impart rich green colour and
for preservation of fruits and vegetables and also usedas
emetic except in arsenic.
– It is used as an antidote in phosphorus poisoning where it
forms cupric phosphide (non toxic substance).

4. Copper sulphate

5. • Copper subacetate (verdigris / zangal) :
– Bluish green powder formed by the action of
vegetable acids on improperly tined copper
cooking vessels.
– Used in arts and external medicine
• Copper carbonate
– fungicide

6. Exposure, Absorption and Excretion:
• Principal route of exposure is through
– Ingestion,
– Inhalation of fumes and dust and also
– Exposure of skin
• Maximum absorption occurs in stomach and GIT and
then transported to liver to bond with ceruloplasmin
• Excreted in feces, bile and urine

7. • F.D.: copper subacetate: 15 gm
copper sulphate: 20 gm
• F.P. : 1- 2 days.

8. Signs and symptoms: Acute
• GIT: Metallic taste, ptyalism, thirst, colicky
abdominal pain, nausea, eructation, repeated vomiting
(blue/green). Diarrhea (brown) with much straining
• Hemolytic tendencies due to increased concentration
of copper in the erythrocytes, resulting in
haemetemesis and Melaena.
• Hepatic: jaundice

9. – Renal: oliguria, haematuria, uraemia
– MS: cramps/spasm of legs, paralysis
– Inhalation of fumes: sore throat, cough;
conjunctivitis; perforation of nasal mucosa
– Skin exposure: contact dermatitis

10. Treatment :
– No need to use emetic as vomiting occurs in 5-10 min
– Gastric lavage 1% potassium ferrocyanide as it form
insoluble cupric ferrocyanide
– Demulcents: egg white or milk
– Castor oil
– Chelating agents: D-pencillamine (2 gm / day in four
divided doses orally), EDTA or BAL
– Morphine and diuretics
– Symptomatic
– For severe cases: cortisone 50- 100 mg thrice daily

11. Post mortem findings:
– Skin yellow d/t jaundice
– Greenish blue froth from mouth
– Greenish blue tinge in the mucus membrane of GIT.
– Liver : soft and fatty; shows centri-lobular necrosis
and biliary stasis
– Kidneys : degenerative changes in proximal tubules,
Hb casts

12. Chronic poisoning :
• Seen in factory workers
• It result from, preservation and cooking of food in
unclean copper utensils may result in poisoning as it
is contaminated with verdigris.
• Chronic consumption of fruits and vegetables
preserved and coloured with copper sulphate.

13. – Greenish or purple line on gums at its junction
with the teeth called Clapton’s line.
– Giddiness and headache
– laryngitis and bronchitis
– Metal fume fever
– Progressive emaciation with anemia malaise and
debility
– Conjunctivitis and corneal ulcers
– Bronze diabetes m/b present
• Treatment: Symptomatic management
Signs and symptoms:

15. PM findings
• Liver: fatty degeneration
• Kidneys: degeneration of epithelial cells

16. Medico Legal Aspects
– Suicide: common
– Accidental: eating food coked in copper utensils,
children
– Copper used in IUCDs and haemodailysis
equipment.
– Copper is used as antidote in phosphorus
poisoning and wound debridement
– Cattle poison
– Homicide is rare

17. IRON
– Incidence usually d/t overdose and in children less
than 6 yrs of age
– M O A: taken up by parenchymal cells of liver,
causes mitochondrial damage and cellular
dysfunction l/t
• Metabolic acidosis and Necrosis,
• Liver failure,
• Hypoglycemia,
• Coagulopathy and death.

18. Signs and symptoms ( 4 stages)
• Phase 1: (30 min to few hrs)
– vomiting, gastroenteritis, with grey or black vomitus and stool with
metallic odour l/t collapse and coma
• Phase 2: (6 - 24 hrs)
– s/s alleviate finally progressing to next stage
• Phase 3: (12 to 48 hrs)- hepatic stage
– severe lethargy, convulsions, shock, gastrointestinal hg, cv collapse,
metabolic acidosis, hepatic failure with hepatocellular necrosis, jaundice,
hypoglycemia, Coagulopathy, pulmonary edema and renal failure.
• Phase 4: (2- 5 wks)
– Formation of gastric strictures and pyloric stenosis, Hepatic cirrhosis

19. Diagnosis and Treatment
– X-ray abdomen show iron tablets
– Serum iron level more than 350 μg/dl
– Blood glucose : > 150 µg/dl
– Prothrombin time increased
– Fatal dose: 20-40 gm of ferrous sulphate/ 150 mg of iron
A 325-mg tablet of
ferrous sulfate has 65 mg of elemental iron
ferrous gluconate has 39 mg of elemental iron
ferrous fumarate has 107.25 mg of elemental iron

20. Treatment:
– GL with sodium bicarbonate
– Demulscents
– Antidote: desferoxamine: iv at the rate of 15- 80
mg /kg BW/hr

21. THALLIUM
– Heavy metal with lustrous colour on exposure to air form
thallous oxide
– It is a cumulative poison
– All salts as well as metal are poisonous.
• Toxic compounds and uses:
Thallium acetate: depillatory creams, fire works,
rodenticides and insecticides
Thallium sulphate: rodenticides and insecticides

22. Absorption and Excretion
• Abs through all routes
• Deposited in epididymis, liver, kidneys,
muscles and bones.
• Excreted through kidneys and in breast milk

23. Signs and symptoms
• Acute:
– Metallic taste, nausea vomiting, colic, diarrhoea,
– Conjunctivitis, scotoma, blindness,
– Polyneuritis, peripheral neuropathy- (burning feet
syndrome), ataxia coma, encephalopathy
– Loss of hair, mees lines and deafness,
– Maculo-papular skin eruptions on face with butterfly
distribution,
• F.D.: 1 gm
• F.P.: 2-3 days

24. Chronic Poisoning
• Alopecia
• Skin rashes
• Painful peripheral neuropathy
• Mental confusion with lethargy

25. Diagnosis and Treatment
• Eosinophilia
• Urine m/b green
• thallium > 40 μgm % in blood and > 150 μgm/l in urine
• Opacity in liver on X-ray
• Signs of gastric irritability and loss of hair.

26. Treatment:
– Stomach wash with 1% sodium or potassium
iodide
– Prussian blue (potassium ferric hexacyanoferrate)
orally 250 mg/kg/day in 2-4 divided doses
– BAL and EDTA are contraindicated
– Pilocarpine is physiological antidote
– Hemodialysis/ peritoneal dialysis
– Symptomatic

27. MLI:
• Ideal homicidal poison: more prevalent in European
countries.
• Chronic poisoning in industries.
• Accidental poisoning d/t therapeutic over usage.

28. MANGANESE
• Important compounds are Potassium
permanganate and manganese dioxide.
• Potassium permanganate :
• Dark purple slender crystals with astringent
taste. powerful antioxidant and disinfectant.
• MOA: causes coagulation necrosis and brown
discolouration of mucus mb., paralysis of heart

29. Signs And Symptoms:
– Burning pain from mouth to stomach, thirst,
colicky abdominal pain, nausea, eructation,
repeated vomiting, difficulty in swallowing,
dyspnoea , stridor, cough.
– Discolouration initially purple brown but later
changes to brown then coal black d/t formation of
manganese dioxide
– F.D.: 10- 20 gm
– F.P.: few hrs

30. Treatment:
• GL
• Demulscents
• Charcoal
• Symptomatic
PM appearance:
• necrosis , Hg and corrosion
• Liver and kidneys show degensrative changes

31. MLI:
– Usually suicidal poisoning
– M/b accidental in case of children
– Abortificient: inserted into vagina- causes
ulceration ( acute, localised, punched out with
raised edges and granular black base)
– Fictious injury: when applied to skin for 10 -20
min causes ulcer resembling syphilis.