Copper is an essential micronutrient in our body. Tamra is included under shudha loha as per rasashastra

1. REVIEW ON TOXICITY OF
COPPER
SUBMITTED BY
Dr Anitha M
2nd Year MD Scholar
Dept R & B

2. CONTENTS
✓ Introduction
✓ Absorption and excretion of copper
✓ Metabolism of copper
✓ Circumstances of poisoning
✓ Sources of poisoning
✓ Signs and symptoms
✓ Fatality
✓ Treatment
✓ Chronic poisoning
✓ General symptoms of chronic poisoning
✓ Postmortem appearances
✓ Hereditary diseases of copper
metabolism
✓ Tamra in Ayurvedic perspective

3. INTRODUCTION
✓ Copper is an essential micronutrient in our body
✓ Copper content of the body – 150 mg
✓ Safe daily intake of dietary copper – 2 to 3 mg
✓ Copper plays an important role in cellular energy, connective tissue formation, blood
formation, metabolism of neurotransmitters, formation of melanin pigment, as an
antioxidant etc
✓ Copper as a metal is not poisonous
✓ Copper compounds are powerful inhibitors of enzymes
✓ Poisonous compounds include Copper Sulphate (Blue Vitriol), Copper Subacetate
(Verdigris), Copper Arsenite, Copper Acetoarsenite, Copper chloride etc

4. ABSORPTION & EXCRETION
ABSORPTION
✓ Lungs
✓ Mucous membrane
✓ Raw surfaces
✓ Duodenum
✓ Upper section of small intestine
EXCRETION
✓ Bowels
✓ Kidneys
✓ Saliva
✓ Bile
✓ Milk

5. METABOLISM

6. CIRCUMSTANCES OF POISONING
✓ Accidental poisoning – Food contaminated with Verdigris formed from the action of
vegetable acids on copper cooking vessels which are not properly tinned inside
✓ Ingestion of food to which copper has been added
✓ Swallowing of copper sulphate by the children
✓ Salts are taken internally for abortion
Rarity :
✓ Rarely for homicide because of the colour and taste
✓ Suicidal cases are rare
✓ As cattle poison

7. SOURCES OF COPPER TOXICITY
✓ Copper exposure in industry is primarily from inhaled particulates in mining or metal
fumes in smelting operations, welding etc
✓ Sanitary fittings
✓ Insecticides and fungicides
✓ Copper wires
✓ Vitamin and mineral supplements
✓ Cookwares
✓ Beverage containers
✓ Birth control pills

8. SIGNS AND SYMPTOMS
INGESTION :
✓ Symptoms appear in 15- 30 minutes
✓ Metallic taste
✓ Increased salivation
✓ Burning pain in the stomach with colicky
abdominal pain
✓ Thirst
✓ Nausea
✓ Eructations
✓ Repeated vomiting – blue/green vomitus
✓ Diarrhoea – with much straining,
motions – liquid, brown but not bloody
✓ Oliguria
✓ Haematuria
✓ Albuminuria sometimes
✓ Acidosis
✓ Uraemia

9. ✓ Haemolysis
✓ Haemoglobinuria
✓ Mathaemoglobinaemia
✓ Jaundice Severe
✓ Pancreatitis cases
✓ Cramps of legs or spasms
✓ Convulsions
✓ Breathing difficulty
✓ Cold perspiration
✓ Severe headache
✓ Limb paralysis followed by
drowsiness, insensibility, coma,
death due to shock
✓ Later deaths - hepatic / renal
failure or both

10. INHALATION
Acute inhalation of large dose of copper
dusts or fumes -
✓ Upper respiratory tract irritation
✓ Sore throat
✓ Cough
✓ Conjunctivitis
✓ Palpebral oedema
✓ Sinus irritation
✓ Nasal membrane atrophy with
perforation
EXPOSURE TO SKIN
✓ Irritant contact dermatitis
On severe exposure :
✓ Greenish blue discolouration of the skin

11. FATALITY
FATAL DOSE :
✓ Copper sulphate – 30gm
✓ Copper subacetate – 15gm
FATAL PERIOD :
1 to 3 days

12. CHRONIC POISONING
✓ Workers with the metal due to inhalation of dust
✓ Food contaminated with Verdigris
✓ Chronic inhalation of copper sulphate spray – Vineyard sprayer’s lung disease

13. GENERAL SYMPTOMS OF CHRONIC
POISONING
✓ Gradual anaemia
✓ Green line on gums
✓ Nausea
✓ Vomiting
✓ Colic
✓ Diarrhoea
✓ Malaise
✓ Peripheral neuritis
✓ Degeneration
✓ Muscle atrophy

14. CHALCOSIS
✓ The presence of copper deposits in the tissue is called chalcosis
✓ Copper may be deposited in the cornea resulting in a pigmented ring in the deeper layers
✓ Chronic contact with swimming pool water containing algicidal copper chemicals cause
green hair discolouration

15. DIAGNOSIS
✓ Hair copper level is a very unreliable indicator for copper toxicity
✓ Serum copper and serum ceruloplasmin
✓ Liver biopsy
✓ Hb level examination
✓ LFT
✓ Serum or whole blood copper level

16. TREATMENT
✓ Stomach wash – 1 % Pottassium ferrocyanide solution
✓ Demulcent drinks
✓ Haemodialysis (Early stage of poisoning)
✓ Castor oil – to remove poison from the intestines
✓ Chelation – EDTA/BAL/Pencillamine
Contraindication:
✓ Emetics

17. POSTMORTEM APPEARANCES
✓ Skin – Yellow
✓ Mouth & nostrils – greenish blue froth
✓ Gastric mucosa and stomach contents – greenish or bluish
✓ Gastric mucosa – congested, swollen, inflamed, occasionally eroded
✓ Liver – soft & fatty
✓ Spontaneous haemolysis of blood and degenerative changes in proximal tubules of kidney
occur
✓ Poisoning by inhalation of vapours – signs of chronic pneumonitis
✓ Blood picture is altered with presence of premature cells in peripheral blood

18. HEREDITARY DISEASES OF COPPER
METABOLISM
✓ Menkes disease
✓ Wilson disease
✓ Indian childhood cirrhosis (ICC)
✓ Idiopathic copper toxicosis

19. MENKES DISEASE
✓ X-linked recessive disorder caused by mutations in genes coding for the copper transport
protein ATP7A leading to copper deficiency in male infants
✓ It is characterised by peculiar kinky hair, failure to thrive, severe mental retardation,
neurologic impairment
✓ Additional signs and symptoms : hypotonia, sagging facial features, seizures,
developmental delay, intellectual disability
✓ Death usually by 5 years of age

20. WILSON’S DISEASE
✓ It is an autosomal recessive genetic disorder of copper metabolism characterized by the
excessive accumulation of copper in liver, brain, kidneys and cornea
✓ Signs and symptoms of liver disease - Jaundice, fatigue, loss of appetite and abdominal
swelling
✓ Nervous symptoms – clumsiness, tremors, difficulty in walking, speech problems, impaired
thinking ability, depression, anxiety and mood swings
✓ Ocular symptoms – Green to brownish ring around the cornea (Kayser-Fleischer ring),
difficulty in eye movements

21. INDIAN CHILDHOOD CIRRHOSIS
✓ Disorder occurring in young children characterized by jaundice due to an insidious and
progressive liver disease
✓ Etiology – not known, copper contaminated milk feeds
IDIOPATHIC COPPER TOXICOSIS (ICT)
✓ Non Indian childhood cirrhosis
✓ Largest series of cases are reported from Austria
✓ Population was using copper vessels to store milk
✓ Incidence of the disorder has declined since replacement of the copper vessels

22. TAMRA IN AYURVEDIC
PERSPECTIVE

23. ✓ Tamra is included under shudha loha as per rasasastra
✓ 2 varieties – Mlecha nad nepalaka
✓ Copper possessing qualities like snigda, mridu, ghana, svacha, japakusumaprabha and loha
nagadi rahitha is considered to be grahya
✓ Copper which is sadala, pandura, katina, laghu, bangura, samala is considered to be
agrahya

24. PROPERTIES
✓ Rasa – Tikta Kashaya Madhura Amla
✓ Guna – Sara, Snigda
✓ Virya – Ushna
✓ Vipaka – Katu
✓ Doshakarma – Pitha kapha samana
✓ Rogaghna karma – Jatararuk kushta amaghna, krimihara, urddhva adha sodhana,
sthaulyapaha, durnama kshaya pandu samana, netrya, lekhana, vishahara

25. NECESSITY OF SODHANA &
MARANA
✓ न विषं विषमित्याहुस्ताम्रं तु विषिुच्यते I
एको दोष: विषे, ताम्रे तु अष्टदोषा: प्रकीर्तिता: II (AP)
✓ Ashta doshas: Bhrama, murcha, vidaha, sveda, kleda, vami, aruchi, chithsantapa (AP)
✓ Asudha tamra is ayurghna, kanti veerya balapaha, kushta sula mada moha janana
✓ शुल्बं वििर्ियर्त सििजगात्रतापं
क्षिप्रं नयत्यावप च शोषिशेषर्ातून I
कािं विरेचयर्त िै जनयेच्च िूर्ाि
संशुद्र्हीनमिह चेर्त खलु िाररतं स्यात्II (RT)

26. SODHANA
✓ Samanya sodhana : Nirvapa in taila, takra, gomutra, aranala, kulatha kashaya for 7 times in each
liquid
✓ Visesha sodhana :
1. Nirvapa in nirgundi swarasa for 8 times
2. Nirvapa in souviraka for 8 times
3. Swedana in gomutra for 1 yama
4. Nirvapa in mahisha takra for 7 times

27. MARANA
✓ Nimbu swarasa bhavitha kajjali is smeared over tamra patras followed by 3 gajaputas
✓ Jambeera swarasa bhavitha kajjali is smeared over tamra patras followed by 3 gajaputas
✓ Charngeri swarasa bhavitha kajjali is smeared over tamra patras followed by 3 gajaputas
✓ Kumari swarasa bhavitha sudha tamra patra + sudha parada + sudha gandhaka kept in
lavana yantra and subjected to intense heat for 12 hours to obtain tamra bhasma

28. TAMRA BHASMAAMRITHIKARANA
✓ 1 part tamra bhasma + ½ part sudha gandhaka in panchamritha
✓ 1 part tamra bhasma + ½ part sudha gandhaka in nimbu swarasa
✓ Tamra bhasma in kumari swarasa
(RT)

29. ANTIDOTE
✓ Juice of dhanyaka or decoction of seeds of dhanyaka for 3 days
✓ Mixture of munivreehi and sugar along with water (BRRS)

30. FORMULATIONS
✓ Arogyavardhini rasa
✓ Panchamrita parpati
✓ Vijaya parpati
✓ Lakshmivilasa rasa
✓ Hridayarnava rasa
✓ Trivikrama rasa
✓ Nityananda rasa
✓ Arogyavardhini rasa
✓ Mrityunjaya rasa

31. COPPER CONTAINING MINERALS
IN AYURVEDA
SASYAKA SODHANA SWARNAMAKSHIKA SODHANA
✓ Bhavana in nimbu swarasa
✓ Dolayantra swedana in gomutra
✓ Dolayantra swedana in mahisha mutra
✓ Dolayantra swedana in ajamutra
✓ Bhavana in raktavarga
✓ Swedana in snehavarga dravyas - 7
times
✓ Nirvapa in triphala kwatha for 7 times
✓ Swedana in kadali kanda toya for 2
ghatikas
✓ Swedana in eranda taila + matulunga
swarasa for 2 ghatikas
✓ Bharjana with saindhava lavana and
jambeera swarasa

32. TAMRA BHASMA IN GARAVISHA
✓ Garavisha is considered as the form of chemical/combinative/ resultant poison which gets formed
by the combination two or more poisonous (food additives like sweeteners, flavouring agents,
colouring agents, preservatives in junk food etc) or nonpoiosnous substances (over consumption of
milk products like cheese, butter etc) and finally damages the whole body by vitiating all the
dhathus in the body
✓ RX : Hrit visodhanartham – tamra rajas + kshoudra / tapya suvarna churna + sarkara + kshoudra
“ योगादपि पिषं तीक्ष्णं उत्तमं भेषजं भिेत् I
भेषजं च अपि दुयुुक्तं तीक्ष्णं संिद्यते पिषम् II ” (Ca Su)

33. REFERENCES
✓ Modi’s Medical Jurisprudence and Toxicology
✓ The Essential’s of Forensic Medicine & Toxicology
✓ Rasatarangini
✓ Rasaratna samuchaya
✓ Astanga Hridaya Uttarasthana
✓ Astanga Hridya Suthrasthana
✓ Caraka Samhitha Suthrasthana
✓ Brihat rasaraja sundara

34. THANK YOU