This document discusses toxicology and poisoning. It defines key terms, classifies poisons, and outlines factors that modify the effects of poisons. It also covers the history of toxicology, diagnostic approaches, treatment methods including decontamination and administration of antidotes, and information resources on poisons. The objectives are to learn about toxicology, classifications of poisons, diagnosis and management of poisoning.
This lecture includes Introduction to Poisons, Different Types of Classification of Poisons, Analysis of Poisons (Volatile, Nonvolatile) (Acidic, Basic, Neutral).
Heavy metal poisoning is caused by the accumulation of certain metals in the body due to exposure through food, water, industrial chemicals, or other sources. While your body needs small amounts of some heavy metals to function normally — such as zinc, copper, chromium, iron, and manganese — toxic amounts are harmful.
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EXHUMATION.ppt ("Revealing untold stories that time had to burry"))Shruti Pawar
Introduction
The word Exhumation comes from Latin words ex meaning "out of", and humus, meaning "ground". Thus the word literally means "out of ground".
Exhumation means the lawful disinterment or digging out a body from a grave, which has already been buried.Section 176(3) of CrPC.
Objectives:
For the purposes of identification (For unidentified dead bodies as well)
Re-Autopsy in the case of foul play.
(To identify what was the exact cause of death)
To determine the cause of death especially when the foul play is suspected for e.g. homicide, disputed case of death or poisoning.
Procedure:
District Magistrate /Sub-Divisional Magistrate /Executive Magistrate are empowered to order for the exhumation.
Carried out during early morning hours.
In India ,no time limit is fixed.
Body is exhumed under the supervision of a magistrate in the presence of a doctor. The presence of a police officer is required for providing witness to the identity the grave and the dead body as well as maintaining law and order.Autopsy may have to be done at the spot for which a tarpaulin screen may be erected around the grave or the body/skeleton may be shifted to a close-by mortuary.
It is advisable to be conversant with the nature of the geological layout of the cemetery and direction of any water drainage. If the grave is water-logged, samples of water should be collected.
Identification of Grave:
The identified grave should then be dug carefully to avoid damage to the coffin and its contents. Notes should be made about the condition of the soil, water content and nature of vegetation.
In suspected case of mineral poisoning about 500 gram of sample of earth in actual contact with coffin should be collected preserved in a dry clean glass bottle for chemical analysis.
Control samples at some distance from the coffin should be taken.
If interment has been recent then post mortem is carried in usual manner.
After the dirt has been removed from above and around the corpse, it needs to be photographed. A drawing of the grave and body or skeleton should be made noting all the details.
In case of bodies which has been underground for a sufficiently long time undergone putrefaction, an attempt should be made to determine:
1) Sex
2) Stature
3)Marks of Identification
Disinfectants should not be sprinkled on the body.
If decomposition is not advanced, a plank or a plastic sheet should be made to spread under the body and the body be gently shifted onto plank or sheet and then removed from the grave.
If skeletonization is advanced, then it may become necessary to dig down beside and beneath the body and the skeleton (including some soil from beneath and sides) be lifted on some plank or sheet and transported to a mortuary.The soil must be carefully screened for smaller objects like teeth, bullet(s), hyoid bone, thyroid cartilage, etc. If necessary, X-ray examination of the body with surroundings should be undertaken before transporting the body.
This lecture includes Introduction to Poisons, Different Types of Classification of Poisons, Analysis of Poisons (Volatile, Nonvolatile) (Acidic, Basic, Neutral).
Heavy metal poisoning is caused by the accumulation of certain metals in the body due to exposure through food, water, industrial chemicals, or other sources. While your body needs small amounts of some heavy metals to function normally — such as zinc, copper, chromium, iron, and manganese — toxic amounts are harmful.
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EXHUMATION.ppt ("Revealing untold stories that time had to burry"))Shruti Pawar
Introduction
The word Exhumation comes from Latin words ex meaning "out of", and humus, meaning "ground". Thus the word literally means "out of ground".
Exhumation means the lawful disinterment or digging out a body from a grave, which has already been buried.Section 176(3) of CrPC.
Objectives:
For the purposes of identification (For unidentified dead bodies as well)
Re-Autopsy in the case of foul play.
(To identify what was the exact cause of death)
To determine the cause of death especially when the foul play is suspected for e.g. homicide, disputed case of death or poisoning.
Procedure:
District Magistrate /Sub-Divisional Magistrate /Executive Magistrate are empowered to order for the exhumation.
Carried out during early morning hours.
In India ,no time limit is fixed.
Body is exhumed under the supervision of a magistrate in the presence of a doctor. The presence of a police officer is required for providing witness to the identity the grave and the dead body as well as maintaining law and order.Autopsy may have to be done at the spot for which a tarpaulin screen may be erected around the grave or the body/skeleton may be shifted to a close-by mortuary.
It is advisable to be conversant with the nature of the geological layout of the cemetery and direction of any water drainage. If the grave is water-logged, samples of water should be collected.
Identification of Grave:
The identified grave should then be dug carefully to avoid damage to the coffin and its contents. Notes should be made about the condition of the soil, water content and nature of vegetation.
In suspected case of mineral poisoning about 500 gram of sample of earth in actual contact with coffin should be collected preserved in a dry clean glass bottle for chemical analysis.
Control samples at some distance from the coffin should be taken.
If interment has been recent then post mortem is carried in usual manner.
After the dirt has been removed from above and around the corpse, it needs to be photographed. A drawing of the grave and body or skeleton should be made noting all the details.
In case of bodies which has been underground for a sufficiently long time undergone putrefaction, an attempt should be made to determine:
1) Sex
2) Stature
3)Marks of Identification
Disinfectants should not be sprinkled on the body.
If decomposition is not advanced, a plank or a plastic sheet should be made to spread under the body and the body be gently shifted onto plank or sheet and then removed from the grave.
If skeletonization is advanced, then it may become necessary to dig down beside and beneath the body and the skeleton (including some soil from beneath and sides) be lifted on some plank or sheet and transported to a mortuary.The soil must be carefully screened for smaller objects like teeth, bullet(s), hyoid bone, thyroid cartilage, etc. If necessary, X-ray examination of the body with surroundings should be undertaken before transporting the body.
War gases - types, action & clinical features in briefASHUTOSH POTDAR
War gases mainly include chemicals widely used in warfare against enemy. this presentation is about classification of war gases, mechansm of action & treatment to some extent.
Forensic science PowerPoint presentation on Injury and it's medico-legal importance.
The slide is made for medical students. Mainly for BAMS students. It covers maximum points.
The slide is full of example with pictures which make it easy to understand the concept. It contains post-mortem findings as well as medico-legal importance of the each type of injury.
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
War gases - types, action & clinical features in briefASHUTOSH POTDAR
War gases mainly include chemicals widely used in warfare against enemy. this presentation is about classification of war gases, mechansm of action & treatment to some extent.
Forensic science PowerPoint presentation on Injury and it's medico-legal importance.
The slide is made for medical students. Mainly for BAMS students. It covers maximum points.
The slide is full of example with pictures which make it easy to understand the concept. It contains post-mortem findings as well as medico-legal importance of the each type of injury.
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Sulphuric acid as a corrosive poison. the characteristics, fatal dose, fatal time, sign and symptoms, post-mortem appearance and medicolegal importance are discussed
Poisoning: first aid, types of poison, medications most commonly linked to poisoning, snakes, insects.
Food poisoning: signs that you may have a more serious case of food poisoning that requires medical attention.
Symptoms, treatment and prevention of poisoning.
Excellence of Rasaaushadhi In Ayurveda Practice
Dr.KSR Prasad as Resource Person in Rasashastra ROTP at Nori Ramashastry Govt. Ayurveda College, Vijayawada delivered Guest lecture on Excellence of Rasaaushadhi In Ayurveda Practice – Part-1 :: Part-2 and Avaji on December 14 and 15th 2009.
Excellence of Rasaaushadhi In Ayurveda Practice
Dr.KSR Prasad as Resource Person in Rasashastra ROTP at Nori Ramashastry Govt. Ayurveda College, Vijayawada delivered Guest lecture on Excellence of Rasaaushadhi In Ayurveda Practice – Part-1 :: Part-2 and Avaji on December 14 and 15th 2009.
1. Toxicology, Scope of Pharmacology in Cosmetic Tech .pptxJagruti Marathe
Cosmetology is the study and application of beauty treatment. Branches of specialty include hairstyling, skin care, cosmetics, manicures/pedicures, non-permanent hair removal such as waxing and sugaring, and permanent hair removal processes such as electrology and intense pulsed light.
Chap 1 General principles involved in the management of poisoningChanukya Vanam . Dr
1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
poisoning, its types and emergent management.bhartisharma175
it explain about definition, causes, types of poison, severity , diagnostic evaluation, complication of poisoning, emergent management, supportive management and nursing management.
Poisoning in Children by Dr Shamavu Gabriel .pptxGabriel Shamavu
PAEDIATRICS EMERGENCY, BASIC AND ADVANCED LIFE SUPPORT
Approach and management of Poisoning in Children
Prepared by Dr GABRIEL KAKURU SHAMAVU, Resident (Medical Senior House Officer) in Paediatric Department / Kampala International University Teaching Hospital.
Mentorship: Professor Yamile Arias Ortiz
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. “In the name of Allah the most
beneficent and merciful”.
3. References:
• Micheal Kosnett, Heavy metal intoxication and chelators;
Bertram G. Katzung, Basic and clinical
pharmacology:11:999-1011;2009
• Cutis D. Klassan,Heavy metals and heavy metal antagonists;
Goodman and Gilmans, Pharmacological basis of
therapeutics; 11;1753-66; 2005.
• Rang and Dale, Chelators, Pharmacology;6;668-75;2009
• Tripathi K.D.,Chelating agents; Essentials to medical
pharmacology; 6;865-68;2009
• R.S. Satoskar, Metal and their antagonists , Pharmacology
and Pharmacotherapeutics;21;1040-48;2009
5. Toxicology
All substances are poisons. There is none
which is not a poison. The right dose
differentiates a poison & a remedy.
- Paracelsus 1532
the father of modern toxicology”
6. History
Socrates was forced to drink Hemlock (Conium
genus of one of the highly poisonous plant, F:
apiacae) for corrupting the youth of Athens
Cleopatra committed suicide through the bite of an
asp; a poisonous snake
In 15th Century in Italy, Cesar and Lucrezia Borgia
assassinated many of their political rivals by
poisoning with arsenic, copper and phosphorus
Lead caused poisoning in hundreds of thousands
from the time of Roman era till 17th and 18th century
as it was used in pottery, cosmetics, paints and in
automobile fuels
7. History
Mustard Gas and other poisonous gases were used
in many wars started from WW-I in 1914 by
Germans
Newer versions are Neurotoxins, Sarin (
organophosphorous compound)
Chemical toxicities has caused disasters too, like in
Bhopal, India in 1984 where release of methyl
isocyanate killed many thousands
8. Definitions
• Toxicology – is the science dealing with properties,
actions, toxicity, fatal dose, detection of,
interpretation of the result of toxicological analysis
and treatment of poisons
• Toxin – naturally derived, naturally exposed toxic
chemical
• Toxicant – manmade toxic chemical or of natural
origin but manipulated, concentrated, or dispersed
by humans
• Antidote – medicine given to counteract the
influence of poison or an attack of disease
9. Forensic Toxicology is the study of the chemical
and physical properties of toxic substances and their
physiological effect on living organisms
Forensic toxicology deals with the medico-legal
aspects of the harmful effects of chemicals on
human beings
Clinical toxicology deals with diagnosis and
treatment of human poisoning
Poison is a substance (solid, liquid or gas), which if
introduced in the living body, or brought into contact
with any part thereof, will produce ill health or
death, by its constitutional or local effects or both
10. Ideal Suicidal Poison:
Should be cheap and easily available
Should be tasteless or be of pleasant taste
Capable of being administered with food materials
Should be highly toxic and capable of sure shot
death
Should be capable of producing painless death
e.g. Opium and Barbiturates, but commonly used
are Organophosphorus compounds and Endrin
11. CLASSIFICATION OF POISONS
CORROSIVES:
Strong Acids:
Mineral / Organic Acids:
Sulphuric acid, Hydrochloric acid & Nitric acid
Organic Acids:
Carbolic acid, Oxalic acid, Acetic acid, etc.
Strong Alkalis:
Hydrates and Carbonates of Na, K, NH4
Metallic Salts:
ZnCl2, FeCl2, CuSO4, AgNO3, KCN, etc.
12. SYSTEMIC POISONS:
Cerebral:
CNS Depressants:
Alcohol, GA, Opioid
analgesics, Hypnotics and
Sedatives.
CNS Stimulants:
Cyclic Antidepressants,
Amphetamine, Caffeine.
Deliriant poisons:
Dhatura, Belladonna,
Hyoscyamus, Cannabis,
Cocaine, etc.
Spinal Poisons:
Nux vomica and Gelsemium
Peripheral poisons:
Conium and Curare.
Cardiovascular:
Aconite, Quinine, Oleander,
Tobacco, HCN.
Asphyxiants:
An asphyxiant gas is a nontoxic or minimally
toxic gas which reduces or displaces the
normal oxygen concentration in breathing
air.
CO, CO2, H2S
13. Routes of Poison Administration:
Inhalation:
Benzene, Xylene, Acetone, Methyl Chloroform, CCl4, CO,
H2S, Methane, Lead, Mercury, Asbestos, etc.
Injection into blood vessels
Intradermal, Subcutaneous, Intramuscular Inj.
Introduction into Stomach
Introduction into natural orifices
Rubbing into skin:
Organic phosphates, Nicotine, Phenol, Mercury, and Hydro
cyanic acid
14. Factors Modifying Poison Actions:
Quantity:
• Higher the quantity, more severe action
Form of the Poisonous substance:
• Poison acts most rapidly in gaseous form
and least in liquid form
• When the combination of chemicals is
more soluble, then more is the action
• Alteration of action or efficacy when
mixed with inert substances
Mode of Administration
15. Factors Modifying Poison Actions:
Conditions of the body:
Age factor: Poisons have
greater effects at two
extremes of age
Idiosyncrasy: Which is
inherent personal
hypersensitivity
Habit: Effect of certain
poisons decreases with
habituation. It results from
a decreased reaction
between the chemical and
the biological effectors
State of Health: A healthy
person tolerates better than a
diseased one
Sleep and Intoxication: Action
of some poisons get delayed if
a person goes to sleep
Cumulative Action: Those
poisons which are slowly
eliminated from the body, may
gradually accumulate and then
may produce poisonous
symptoms
16. The following group of symptoms are suggestive of
poisoning:
Sudden onset of abdominal pain, nausea, vomiting, diarrhea
and collapse (Arsenic)
Sudden onset of coma with constriction of pupils (Organo-
phosphates)
Sudden onset of convulsions
Sudden onset of delirium with dilated pupils. (Dhatura)
Paralysis of LMN (Lower Motor Neurons) type (Strychnine)
Jaundice and hepato-cellular failure (CCl4)
Oliguria with proteinuria and hematuria
Diagnosis of Poisoning
In these cases, collect:
Stomach washings (entire)
Urine (as much as possible)
10ml of Blood
17. Diagnosis of Poisoning
First, collect all the relevant information from Inquest report and also from the
relative
Postmortem examination may show: External findings:
STAINS on clothes, marks of vomit or poison
COLOR CHANGES on affected skin and mucous membrane. (black
color in H2SO4 & HCl, brown in Nitric acid.
STAINING may be Dark brown/yellow in Phosphorus, Cherry red in
CO, Chocolate color in Nitrates, Nitrobenzene etc.
ODOUR from nose and mouth may be GARLIC like (P, Arsine gas,
Arsenic), SWEETISH (Ethanol, Chloroform), ACRID (Paraldehyde,
Chloral hydrate), ROTTEN EGG (H2S, Mercaptans)
INJECTION MARKS may be detected which may suggest route of
administration.
SKIN may show HYPERKERATOSIS (Chr. Arsenic poisoning),
JAUNDICE (P, KClO4).
VIOLENCE MARKS such as bruise or other injuries if seen, suggests
mode of death from cause other than poisoning.
18. In the Dead [Cont…]
Internal Findings:
SMELL: Peculiar smell seen in
Cyanide, Alcohol, Phenol,
Chloroform and Camphor
poisoning
MOUTH & THROAT: To be
examined thoroughly for
evidence of corrosion and
inflammation or staining
ESOPHAGUS: Marked softening
seen in Corrosive alkalis.
UPPER RESPIRATORY
TRACT: May show evidence of
volatile poisons
STOMACH: May show
hyperemia, color changes,
softening, ulcers, perforation, etc.
All the contents should be
emptied in a jar with NaCl and
the stomach preserved for
chemical analysis
DUODENUM/INTESTINE: Ulceration
beyond pylorus points to natural disease.
Characteristic changes are seen in Hg
poisoning. Normal GI tract rules out
poisoning by Corrosives, Phenols, Hg and
Arsenic compounds
LIVER: Phosphorus, Chloroform, TNT,
CCl4, etc leads to Necrosis of liver. Fatty
liver is seen in case of As, CCl4,
Mushroom poisoning, P4, etc.
RESPIRATORY SYSTEM: Corrosive
poisons leads to glottic edema and
congestion
KIDNEYS: Metallic poisons, Cantharidin
poison leads to degenerative changes. PCT
necrosis is seen with HgCl2, Phenols,
Lysol, CCl4 poisoning
HEART: Subendocardial hemorrhages in
Left Ventricle are seen in Acute Arsenic
poisoning
BLADDER / VAGINA / UTERUS: Should
be specially examined in cases of Criminal
abortion
19. General Lines of Treatment [ABCD…]
Airway/Antidote
Breathing
Circulation
Decontamination/Dextrose/Drugs
Removal of unabsorbed poisons:
Inhaled poisons: Fresh air
Injected poisons: Ligature application
Contact poisons: Immediate removal of clothing and washing
thoroughly
Ingested poisons: Gastric Lavage
20. Information resources
• Computerized database: Poisindex is a
computerized CD-ROM database that is
updated quaterly and is a primary source for
poison control centers
• Printed Publications: textbooks, manuals etc
• Internet
• Poison control center (A national poison and drug
information center with a toll-free telephone number (0800-77767)
set up at the Jinnah Postgraduate Medical Centre)
21. Gastrointestinal decontamination
Emesis:
It is useful within 3 hrs of ingestion
Done with ipecac syrup(30 ml)
Activated charcoal:
It is useful within 1 hr of ingestion
Works by adsorbing poisons
Dose 50gm(adults), 1 gm/kg (children)
Gastric lavage:
It is useful within 3 hrs of ingestion
Tube used is Boas tube or Nasogastric tube
22. Gastric lavage is continued till the pumped out
washings are colorless. At this point a small amount
of the agent is left out inside the stomach
Contra-indications:
Absolute CI is Corrosive poisoning due to danger of
perforation of stomach. (Exception: Carbolic Acid
poisoning)
Can be used but by taking precautions in:
Convulsant poisons
Comatose patients
Volatile poisons
Hypothermia
Gastrointestinal decontamination
23. Catharsis
It is known to reduce the
transit time in GIT
Two types are
Ionic/saline and
Saccharide cathartics
Ionic/saline cathartics:
Magnesium citrate 4
ml/kg
Sodium sulphate 30 gm.
Saccharide cathartics:
Sorbitol (D - glucitol) 50
ml 0f 70% solution
Whole Bowel Irrigation
Involves the administration
of non-absorbable
polyethyleneglycol which is
instilled at the rate of 2L/hr.
in adults
Indications:
Large ingestion of iron,
lithium, sustained release or
enteric coated drugs
Gastrointestinal decontamination
24. ADMINISTRATION OF
ANTIDOTES
Physical antidotes: They
neutralize poisons by
mechanical action or prevent
their absorption.
Activated Charcoal:
This is a fine, black, odorless
powder
Produced by destructive
distillation of various organic
materials, usually from organic
pulp and then treating at high
temperatures. This process
increases the absorptive capacity
Particles are small but with high
absorptive capacity and it acts
mechanically by adsorbing and
retaining within its pores organic
and some mineral poisons
Usually given mixed with
water
Helpful in Barbiturates,
Atropine, Benzodiazipine,
Opiates, Quinine,
Strychnine,
Phenothiazines,
Pyrethrins, Aluminium
Phosphide, etc.
Less useful in Corrosives,
Heavy metals, Cyanide,
Hydrocarbon and Alcohol
poisons
Dose: 50 – 100 mg
(Adults) and 15 – 30 mg
(Children)
25. Demulcents:
These are substances which form a protective coating on the
gastric mucous membrane and thus do not permit the poison to
cause any damage
Examples include Milk, Starch, Egg white, Mineral oil, Milk of
Magnesia, etc.
Fats and oils should not be used for fat soluble poisons like,
Kerosene, Phosphorus, OP compounds, Phenol, Acetone, etc.
Bulky Foods:
They act as mechanical antidote to glass powder by
imprisoning the particles within its meshes and thus prevents
damage by the sharp glass particles
26. Physiological Antidotes:
These are substances which produce exactly the
opposite actions to that of poison
e.g. atropine in organophosphorus poisoning and
naloxone in morphine poisoning
Chelating agents:
These agents act by forming stable and soluble
complexes by the inner ring structure which can
combine with the metallic poisons
e.g. British Anti Lewisite (BAL) and Ethylene diamine
tetra-acetic acid (EDTA)
27. Methods for enhancing elimination of toxins
Urinary alkalization:
This is also known as alkaline diuresis
IV bicarbonate 1 lit. of 1.26% over 3 hrs is given
Potassium levels can fall, so add 20-40 mmol.
potassium to each lit. of IV fluids given
Aim for a Urinary pH of 7.5-8.5
Indications: poisoning with chlorpropamide,
phenobarbitone, salicylates, phenoxy acetate
herbicides
28. Extracorporeal
techniques:
Hemodialysis: can be
considered for poisoning with
salicylates,
ethylene glycol, methanol,
ethanol, theophylline &
lithium
Haemoperfusion: can be
considered for poisoning with
theophylline, phenobarbitone
& carbamazepine
Multiple-dose activated
charcoal: This can increase
elimination of some drugs by
interrupting their enteroenteric
& enterohepatic circulation
The dose given is 50 gm (1
gm/kg in children) of activated
charcoal every 4 hrs.
Indications: poisoning with
carbamazepine, dapsone,
quinine, phenobarbitone,
theophylline
Methods for enhancing elimination of toxins
A medical procedure to
remove fluid and waste
products from the blood and
to correct electrolyte
imbalances
The passage of blood through columns
of adsorptive material, such as
activated charcoal, to remove toxic
substances from the blood.
29. Toxicity screening
• Acute toxicity
– administration of progressively larger single doses up to
the lethal dose
– “No-Effect” dose – largest dose at which a specific toxic
effect is NOT seen
– Minimum Lethal Dose – smallest amount of the drug
that can kill a study animal
– LD50 – dose that kills half of the experimental animal
population
• Subacute / chronic toxicity
– administration of multiple doses to detect any adverse
effects
30. Toxicity screening
• Mutagenicity –
– detection of possible ability to induce genetic
alteration (mutation)
• Carcinogenicity –
– detection of possible ability to induce abnormal
clonal uncontrolled proliferation of genetically
altered cells
• Teratogenicity –
– detection of possible deleterious effects on the
developing fetus
31. 1. Available dosage forms
include oral
immediate-release and
sustained-release preparations
as well as parenteral agents.
1. Toxicokinetics
Some agents have
prolonged elimination half-
lives (e.g., heroin,
methadone).
32. Clinical presentation
includes
Respiratory depression and
a Decrease level of
consciousness.
Rare effects include
Hypotension, Bradycardia,
and Pulmonary edema.
Seizures have been reported
in patients with renal
dysfunction in individuals
who are receiving
meperidine owing to the
accumulation of the
metabolite normeperidine.
33. 4. Laboratory data
includes baseline ABGs
and toxicology screens.
5. Treatment
a) Naloxone is given 0.4-2 mg every 5 min up to 10 mg and 0.03-
0.1 mg/kg in pediatric patients.
b) Naloxone has a very short half-life and resedation is a concern in
patients overdosing on long-acting opioids or sustained-release
dosage forms.
c) Nalmefene (Revex) has a half-life of 4-8 hr. Initial dosage s are
0.5 mg/70 kg. A follow-up dose 2-5 min later is 1 mg/70 kg.
34. Cocaine
Available forms:Includes alkaloid obtained from
Erythroxylyn coca.
Toxicokinetics: Cocaine is well absorbed after oral,
inhalational, intranasal, and IV administration. Cocaine is
metabolized in liver and excreted in the urine.
Clinical Presentation :Includes CNS and sympathetic
stimulation e.g hypertension, nausea, vomiting, seizure,
tachycardia). Death may result from respiratory failure,
myocardial infarction, or cardiac arrest.
Laboratory Data: Include cocaine and cocaine
metabolite urine screens.
Treatment: Benzodiazepine for sedation seizure
treatment, Labetalol for hypertension.
35. 1.There are variety of available forms
they are usually pesticides or
chemical warfare agents.
1.Toxicokinetics
Organophosphate are absorbed
through the lungs, skin, GIT, and
conjunctiva.
36. 1.Clinical presentation
includes excessive cholinergic
stimulation.
1.Laboratory data
include red blood cell acetyl
cholinesterase activity.
1.Treatment
a) Decontamination
b) Atropine is given 0.5-2 mg IV to reverse the
pheripheral muscarinic effects.
c) Pralidoxime (2-PAM; Protopam) is given 1g IV over 2
min and repeated in 20 min as needed.
37. 1. Available dosage forms
include liquid, sustained release tablets
and capsules as well as parenteral forms.
2. Toxicokinetics
Well absorbed orally with a Vd of
approx. 0.5 L/kg. Theophylline is hepatically
metabolized and has a half life of 4-8 hr.
Theophylline clearance depends highly on age,
concomitant disease states, and interacting
drugs.
3. Clinical presentation
includes nausea, vomiting, seizures,
and cardiac dysrhythmias. Chronic toxicity
carries a poor prognosis than acute toxicity.
38. Laboratory data
Therapeutic Theophylline
leaves are 5-20 µg/ml. Hyperglycemia
and Hypokalemia are seen with acute
ingestions. Other useful laboratory tests
include serum electrolytes, BUN,
creatinine, hepatic function, and ECG
monitoring.
39. 5.Treatment
includes maintaining an airway and treating seizures
and dysrhythmias as they occur.
Syrup of ipecac not recommended.
repetitive doses to enhance elimination. Whole-
bowel irrigation for massive ingestions (especially with sustained-
release products). Charcoal hemoperfusion is used in unstable
patients who are in status epilepticus. Hemodialysis is used when
hemoperfusion is unavailable.
(e.g., esmolol, brevibloc) are used to treat the
hypotension, tachycardia, and dysrhythmias caused by elevated
cyclic adenosine monophosphate levels.
40. 1.Available dosage forms
include a variety of OTC products:
oral, rectal, and topical.
2. Toxicokinetics
Salicylates are well absorbed after
oral administration. The half-life is 6-12 hr at lower
doses. In overdose situations, the half-life may be
prolonged to more than a 20 hr.
41. Clinical presentation
includes nausea, vomiting,
tinnitus, and malaise (mild toxicity). Lethargy,
convulsions, coma, and metabolic acidosis
appear in more severe overdoses. Potential
complications from therapeutic and toxic
doses include GI bleeding, increased PT,
hepatic toxicity, pancreatitis, and proteinuria.
42. 4.Laboratory data for the following 6-hr post ingestion
levels are;
a) 40-60 mg/dl : tinnitus.
b) 60-95 mg/dl : moderate toxicity.
c) More than p5 mg/dl : severe toxicity.
d) With the presence of acidemia and aciduria, evaluate
ABGs.
e) In addition, laboratory evaluation may show leukocytosis,
thrombocytopenia, increased or decreased serum glucose
and sodium, Hypokalemia, and increased serum BUN,
creatinine, and ketones.
43. 5. Treatment
Repetitive doses of activated charcoal every 6 hr,
with 1 dose of cathartic for patients who ingested > 150
mg/kg. Whole-bowel irrigation for large ingestions.
is given as noted in decontamination section to
enhance Salicylates excretion. This is indicated for levels >
40 mg/dl.
is used for severe intoxications when serum levels
are > 100 mg/dl. This method of decontamination is much
better than repetitive doses of activated charcoal.
replacement is administered as needed.
are used to correct any coagulopathy.
45. Acute poisoning
• Results in
• Marked respiratory
depression
• Tachycardia
• Decrease body temperature
• Oliguria (decrease urine
production)
• Circulatory collapse
• Renal faliure
• Coma (leads to death )
• Chronic poisoning
• Same signs as in acute
poisoning .
• But effects are more
pronounced when given
to empty stomach.
46. Treatment of barbiturate poisoning
• Maintenance of respiration and
circulation
• Alkalinization of urine
• Eg administration of osmotic diuretic
• In conscious patient – induce emesis
• Gastric lavage with activated charcoal
• Antidote – tacrine
47. Strychnine
• It is very bitter therefore produces increased salivary secretions
when taken orally
• It has been used in mixture meant to increase appetite
• It decreases inhibitory tone of spinal cord (inhibiting glycine)
• It decreases inhibitory effect of various fibers at synapses in spinal
cord
Strychnine poisoning :
Due to strychnine patient goes into convulsions
Convulsions are tetanic type and uncoordinated
Threshold of various stimuli is greatly reduced, therefore all external
stimuli will lead to convulsions such as excessive light, noise and by
touching patient
47
48. Strychnine poisoning :
• Due to simultaneous contraction of
both groups of muscles the body gets
a typical posture and this is called
OPISTHOTONUS
In lower limbs extensors are powerful
therefore
• Legs are stretched
• The muscles at the back of the neck
are also powerful therefore
• Necks goes backwards
• The muscles of trunk and limb region
are contracted and this part gets the
shape of an arch
In upper limbs flexors are more
powerful therefore
• they are flexed on chest
• Jaws are totally closed
49. Strychnine poisoning :
• These convulsions are repeated every 3-4 mins in
between convulsions are decreased
• Person may die due to stoppage of respiration
• These convulsions are very painful and unfortunately
person remains conscious during convulsions
Treatment :
• I/V thiopental Na
• I/V diazepam are used to control convulsions
• Muscle relaxants are also helpful
• The patient must be kept in very dark places, better in
sound proof room
50. Available forms Include gas line antifreeze, windshield washer
Toxicokinetics
Alcohol dehydrogenase converts methanol to formaldehyde, which is then
converted to formic acid
Clinical
Presentation
Stage 1: Euphoria, gregariousness, and muscle weakness for 6-36hr,
depending on the rate of formation of formic acid.
Stage 2: Vomiting, abdominal pain, diarrhoea, dizziness, headache, dyspnoea,
blurred vision, coma, cereberal edema, resp. And cardiac depression & death.
Laboratory
Data
Include severe metabolic acidosis, hyperglycaemia, and hyperamylasemia
Treatment
1. Gastric lavage
2. Folic acid administred at 1mg/kg IV every 4hr for 6 doses increase the
metabolism of formate.
3. Fomepizole
4. Na bicarbonate
5. Hemodialysis
Methanol
51. Available
forms
Include chlordiazepoxide. Diazepam, flurazepam, midazolam, lorazepam,
alprazolam, and triazolam.
Toxicokinetics These drugs are hepatically metabolized
Clinical
Presentation
Include drowsiness, ataxia, and confusion. Fatalities are rare.
Laboratory
Data
Drug level monitoring is not indicated
Treatment
1. Suppportive treatment includes gastric emptying , activated charcoal,
and a cthartic.
2. Flumazenil is given 0.2mg IV over 30 sec. Repeat doses of 0.5mg over
30sec. At 1min interval max. cumulative dose of 5mg.
Benzodiazepines
52. Available forms Include oral and parentral
Toxicokinetics
Digoxin is well absorbed, primarily renally eliminated, and has a half life of 36-
48hr. Its volume of distribution is 7-10L/kg. Equilibration b/w serum level and
myocardial binding requires 6-8hr.
Clinical
Presentation
Includes confusion, anorexia, nausea, and vomiting in mild cases, cardiac
dysrythmias are seen.
Laboratory
Data
Include serum digoxin levels, electrolytes, particularly serum potassium levels
and an ECG.
Treatment
1. Decontamination with activated charcoal is recommended.
2. Suportive therapy includes managing hyperkalemia, or hypokalemia, and
inotropic support is needed.
3. Digoxin specific FAB antibodies (Digibind)
Digoxin
56. Acute Effects
• Classic stimulant effects of arousal (e.g. increased
heart rate and blood pressure, alertness, appetite
suppression)
• Carbon monoxide (in smoked form) reduces oxygen
transport to heart and other organs
• Vasoconstriction
• Can have calming (anxiolytic) effects in some
individuals
• Mild euphoria
• Cognitive enhancements
• Antidepressant effects
57. Chronic Effects: CANCER
• Tobacco use accounts for one-third of all
cancers
– Cancers relating to tobacco include:
• Mouth
• Pharynx
• Larynx
• Esophagus
• Stomach
• Lung
• Cigarette smoking has been linked to about 90
percent of all lung cancer cases
• 430,000 annual deaths are attributed to
cigarette smoking
• Cervix
• Kidney
• Bladder
• Throat
• Pancreas
58. More Chronic Effects
• Emphysema
• Chronic bronchitis
• Stroke
• Vascular disease
• Esophageal reflux
• Heart Disease
– It is estimated that nearly one-fifth
of deaths from heart disease are
attributable to smoking
* Many of these are actually caused by
other chemicals in cigarette smoke or in
smokeless tobacco products
• Secondary smoke also increases
the risk for many diseases
– Secondhand smoke is
estimated to cause
approximately 3,000 lung
cancer deaths per year among
nonsmokers and contributes
to as many as 40,000 deaths
related to cardiovascular
disease
– Exposure to tobacco smoke in
the home increases the
severity of asthma for children
and is a risk factor for new
cases of childhood asthma
– Environmental tobacco smoke
(ETS) exposure has been linked
also with sudden infant death
syndrome
59. Addiction
• Nicotine meets both the psychological and
physiological measures of addiction
– Psychological - People who are addicted to something
will use it compulsively, without regard for its negative
effects on their health or their life
– Physiological - anything that turns on the reward
pathway in the brain is addictive. Because stimulating
this neural circuitry makes you feel so good, you will
continue to do it again and again to get those feelings
back
Recent studies suggest those excitatory
amino acid systems and, in particular, N-
methyl-D-aspartate (NMDA) receptors,
may have an important role in this
phenomenon.
60. Tolerance & Withdrawal
• Mild tolerance to behavioral and cardiovascular effects
• Prolonged Desensitization of nicotinic acetylcholine
receptors (nAChRs), has been proposed as the mechanism of
chronic tolerance to nicotine
• Withdrawal may start after as little as one hour, may last for
as long as several months, can include:
– Craving
– Irritability
– Anxiety
– Dysphoria
– Anger
– Difficulty concentrating
– Restlessness
– Impatience
– Increased appetite, weight gain
– Insomnia