Arsenic poisoning was described, noting that arsenic can be detected in hair and bone long after death. Symptoms can mimic cholera. Chronic arsenic poisoning may cause fatty liver infiltration and basal cell carcinoma. Lead poisoning was also discussed, mentioning features like basophilic stippling of red blood cells, Burtonian lines on gums, and constipation. Phenobarbital poisoning presents with fever, contracted pupils, hypotension, cyanosis, and progression to coma. Datura poisoning causes altered sensorium, hyperpyrexia, and dilated pupils from its anticholinergic effects.

1. -DR.AKIF A.B

2. 1) Q. The poison that can be detected in hair long after death is:
A) Lead
B )Mercury
C Arsenic
D Cannabis

3. Ans. C Arsenic
Arsenic is a poison that can be detected in body including hair &
bone long after death.

4. Aldrich mee lines
- Rain drop pigmentation/rash/Red velvety Mucosa
Sub endocardial hemorrhage
Excessive pigmentation
Neuritis
Iron Oxide + BAL : Treatment
Mimics Cholera

5. ARSENOPHAGISTS – Persons who can tolerate Arsenic in high doses
-Mimics Cholera/Measles/addison’s disease
- may cause basal cell carcinoma
- also causes fatty infiltration of liver/NCPF
- Ideal Test: Gutzeit Test > Reinsch Test
- In chronic poisoning arsenic may be found in Bones/nails/hairs
-Can be detected even in decomposed body/bones/ashes
- delays putrifaction

6. 2) Arsenic poisoning presents with symptoms mimicking:
A Cholera
B Dhatura poisoning
C Barbiturates poisoning
D Morphine poisoning

7. Ans. A Cholera.
Differences between Arsenic poisoning & Cholera-

8. 3) Caustic poison erodes mucosa because
A Hygroscopic in nature
B It has glue like action
C It is being programmed to stick
D It has affinity for mucosa

9. Ans. A HYGROSCOPIC IN NATURE
Alkalis are bases and hygroscopic in nature thus they dissolve in water.
They all contain a positive radical and a hydroxyl group.
Alkalis produce a liquefaction necrosis when they come in contact with
mucosa and penetrate deeply with full thickness burns common.
Acids cause coagulation necrosis; an eschar forms, limiting further damage.
Acids tend to affect the stomach more than the esophagus.
Alkalis ( more damage than acids) cause rapid liquefaction necrosis;
no eschar forms, and damage continues until the alkali is neutralized or diluted.

10. 4) Barbiturates excretion in urine may be increased by:
A Diuretics
B Alkalinization
C Acidification
D Dialysis

11. Ans. B Alkalinization
Barbiturates & salicylates excretion ↑ by alkalinisation of urine.
Acidification is not recommended.

12. - When Acid is mixed with alkali , it becomes neutral i.e non-ionised form and is
thus easily excreted.
-Done in case Of acidic substances : S = Salicylates
P = Phenobarbitone(Barbiturates)
M =Methotrexate

13. Done in case Of alkaline substances like : Strychnine
Morphine
Mnemonic : ‘ine’ containing
substances
Diuresis with 0.9%NaCl Amitabh =Alcohol
Bacchan = Bromide
Corporation = Calcium
Limited = Lithium

14. 5) Urine appears ‘Liquid Gold’ in which poisoning:
A) Heavy metals
B ) Barbiturates
C )Organophosphorus
D ) Lead poisoning

15. Ans. BARBITURATES
-It causes severe CNS depression.
- Constricted Pupils
-Happus Reaction : Alternate dilatation and constriction of Pupil.
-Liquid gold urine
-Hemodialysis can be done

16. 6. A patient presented with pain abdomen, ataxia and
constipation. Peripheral blood smear examination showed
basophilic stippling of RBCs. He is suffering from poisoning
due to:
A Iron
B Lead
C Cadmium
D Arsenic

17. Ans. Lead

18. -MC route of poisoning = Inhalation
-Sindhur = Lead Tetraoxide
-Antidote = E.D.T.A ( In children: DMSA (succimer)
-MC lead leading to toxicity= Lead acetate
-Lethal dose = 20gm
-Chronic poisoning is known as Plumbism/Saturnism

19. Anemia/Amenorrhoea
Basophilic stippling/Burtonian lines
Colic/Constipation
Drop(Wrist/foot)
Encephalopathy
Facial pallor

20. Basophilic stippling
Blue dots on RBCs

21. Burtonian lines
- Blue lines on Gums.

22. Drop(Wrist/foot)

23. LAB PARAMETER VALUES REMARK
1) Coproporphyrin in
Urine
>150mcg/l Exposure to lead
2) Amino Levulinic
Acid in Urine
>5mg/l Indicates lead
absorption
3) Lead in blood >70mcg/100ml Clinical symptoms
appears
4) Lead in urine >0.8mg/l Lead exposure and
absorption
5) Basophilic stippling
of RBCs
Punctate basophilia

24. 7) A patient was brought with history of pyrexia, contracted
pupils, hypotension, cyanosis, progressing to coma is suspected
to be suffering from poisoning due to:
A Cannabis
B Dhatura
C Phenobarbitone
D Diphenhydramine

25. Ans. C Phenobarbitone
Pyrexia + contracted pupils = Phenobarbitone poisoning;
Pyrexia + dilated pupils = Datura poisoning.

26. 8) All the following are features of chronic lead poisoning EXCEPT:
A Encephalopathy
B Burtonian line
C Cutaneous blisters
D Constipation

27. Ans. Cutaneous blisters

28. Anemia/Amenorrhoea
Basophilic stippling/Burtonian lines
Colic/Constipation
Drop(Wrist/foot)
Encephalopathy
Facial pallor

29. 9) A chronic alcoholic presented to the casualty with altered sensorium.
His blood sugar level was normal. Which of the following treatment
is to be given?
A IV dextrose 5%
B IV dextrose 50%
C Inj. Vitamin B 1
D IV Normal saline

30. Ans. C Inj. Vitamin B 1
Alcohol intoxication is associated Vit.B1 deficiency and Vitamin B1 is required for
enymes metabolising Carbohydrates
Chr. Alcohol poisoning Syndromes:
Korsakoff’s psychosis- ↓consciousness;
Delirium tremens- insanity, disorientation, visual hallucinations, tremors;
Alcoholic polyneuritis;
Wernicke’s disease- brain/spinal cord lesion;
Marchiafava’s syndrome- corpus callosum;
Mallory-Weiss syndrome- rupture oesophagus & mediastinitis;

31. -Females have less no. of metabolic enymes for alcohol. So even less
dose produces full effects.
Types of alcohol % of alcohol
1) Absolute Alcohol 99.95%
2) Rectified Spirit 90%
3) Denatured alcohol 95%
4) 100% proof ethanol 50%

32. Types % of alcohol
Rum 50-60%
Whisky/ Brandy 40-45%
Port/Sherry 20%
Wine 10-15%
Beer 4-8%

33. - If alcohol in blood = 1…..then in urine = 1.3
CSF =1.1-.27
Alveoli= 0.0021
-
-Follows zero order kinetics
-Maximum absorption in = Small Intestine
-Fatal dose = 150-250ml
-No Antidote for Ethanol

34. Blood Alcohol levels Features
<30mg% Driving Limit
70mg% Limit for punishment
>80mg% Nystagmus
> 150mg% Motor inco-ordination
>400mg% Coma & Death

35. WIDMARK FORMULA
A = P C R
Wt. of
alcohol Body wt.
Conc.of
alcohol
Constant, Males=0.6
Females= 0.5

36. -Best method for alcohol estimation= Gas chromatography
- Amitabh = Alcohol dehydrogenase
-K = Kozelka test
-B = Breath analysis test
-C = Cavett test
Based on Henry’s
Law

37. 10. An 8 year old boy, Kallu, is brought to the casualty with a history of
consuming something while playing outside in a play ground.
On examination, there was altered sensorium, hyperpyrexia, and dilated
pupils. Most probable cause is:
A Datura poisoning
B Organophosphorus poisoning
C Parthemium poisoning
D Barbiturate poisoning

38. Ans. A Datura poisoning
Pyrexia + contracted pupils = Phenobarbitone poisoning;
Pyrexia + dilated pupils = Datura poisoning.
Dhatura poisoning:
Delirium (Muttering (talking irrelevant), pill roling, carphologia),
Drowsiness,
Dilated pupils not responsive to light, Diplopia,
Drunken (staggering) gait,
Dilated cutaneous blood vessels (flushed face)
Dry mouth,
Dysarthria (slurred speech, difficulty in talking)
Dry and hot skin,
Dysphagia,
Tachycardia
Bronchodilation Constipation
Death

39. -Principle : Hyoscine/Atropine/Hyoscyamine/Scopola
-So all anti-cholinergic effects are seen
-Lethal Dose = 100-125seeds
-Seeds resembles chilly seeds
Antidote: Physostigmine/Pilocarpine

40. DATURA SEEDS
CHILLY SEEDS