Toxicology REVISION NOTES

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Toxicology
TONY SCARIA 2010
KMC
Father of toxicology  Paracelsus Father of modern toxicology  orifila
TONY SCARIA 2010 KMC

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Body packer  swallowing conainers like condoms
balloons with illegal drugs for smuggling
In body packer syndrome,
person dies of abused drug
overdose
Body stuffer
• Swallowing illegal drugs for concealement from authorities

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Laws
• Drugs and cosmetics act 1940
• Narcotic drugs and psychotropic substances act , 1985
Classification of toxins
Corrosives Irritants Neurotoxic
Acids Inorganic & organic inorganic Nonmetallic – phosphorous Cerebral Opium
Metallic – heavy metals ; Hg Pb
As
Inebriant • Alcohol
• Barbiturate
Alkalis Ammonia Organic Plants – calotropis castor Deliriant • Datura
• Cannabis
• Cocaine
Animals – snake scorpion psychotropic Antidepressants
Amphetamines
TCA
Antipsychotics
Hallucinogens LSD
Spinal Cardiac Asphyxiants Miscellaneous
Stimulant Strychnine Aconite • CO
• Cyanide
• Pesticide
Depressant Gelsemine
Periphery Curare

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General line of management
• Stabilisation  ABCD
• Decontamination
• Emesis
• Gastric lavage  ewald tube or ryles tube
• Activated charcoal
• Bowel irrigation
• Late presentation
EWALD TUBE
• Boa’s tube
• Gastric lavage tube
C/I of gastric lavage
• Kerosene
• Corrosive

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Hemodialysis Hemoperfusion
• Dialysable drugs
• Effeciveness is directly related to blood
concentration
• That are not removed by hemodialysis
• High proteinbound grugs that have large Vd & lipid
soluble
• Used in overdose of all therapeutic agents
• indication • Contraindication • Chlorapmphenicol
• Phenytoin
• Theophyllin
• Paracetamol
• Barbiturate
• Li
• Alcohol / arsenic
• Salicylates
• Theophylline
• Kerosene
• BZD
• Chloroquine
• Heroine

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Hemodialysis

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Activated charcoal
Useful in Not useful in
strychnine, morphine, atropine, nicotine, barbiturates,
alcohol, salicylic acid
Charged (ionized) chemicals, such as mineral acids,
alkalis and highly dissociated salts of cyanide, fluoride,
iron and lithium are not well adsorbed by charcoal.
Activated charcoal does not bind metals and thus
is of limited usefulness in cases of acute metal
ingestion
Activated charcoal acts by adsorption
C/I in activated charcoal
• After > 1hr of ingestion
• Substance not bound to charcoal
• Airway cannot be protected
• Oral antidote is given

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Forced diuresis
Saline diuresis Alakline diuresis acid diuresis
• Thallium
• Alcohol
• Fluride
• Excretion of acidic drugs (highly
ionised in alkaline urine  less
reabsorption)
• Chlorpropamide methotrexate,
phenobarbital and salicylate
• enhance the excretion of
amphetamines, cocaine, local
anesthetics, phencyclidine,
quinidine, quinine, strychnine,
sympathomimetics and tricyclic
antidepressants
• In weak acids In weak bases
Universal antidote
Powdered charcoal
(burnt toast)
2 parts charcoal Adsorbs alkaloids
Magnesium oxide (milk of
magnesia)
1 part Neutralizes acids
Tannic acid 1 part Precipitates alkaloids,
glycosides and metals

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Used in case of poisoningwith Comments
Succimer or DMSA (dimercaptosuccinicacid) • lead,
• mercury and
• Arsenic
• water soluble and orally effective
BAL (British anti-lewisite, dimercaprol) • arsenic, lead, bismuth, copper, mercury, gold and other heavy
metal poisoning
• Contraindicatedin liver damage, G-6-PD deficient individuals,
and cadmium and iron poisoning (since dimercaprol-cadmium
and dimercaprol-iron complex is itself toxic)
EDTA (Ethylene diamine tetra acetic acid, calcium
disodium versenate):
• Effective in lead, copper, cobalt, cadmium, iron and nickel
poisoning; superior to BAL for treatment of poisoning with arsenic
and mercury
• is highly ionized distributed only IV  distributed
• only extracellularly and rapidly excreted in urine (by glomerular
filtration carrying the toxic metal along)
• C/I in mercury poisoning
Penicillamine (cuprimine) • copper, lead and mercury poisoning
• Hepatolenticular degeneration (Wilson's disease which is due to
disorder of copper metabolism), cystinuria and scleroderma.
• C/I in arsenic poisoning
Desferrioxamine • in acute iron poisoning, hemochromatosis(characterizedby
excessive retention of iron in the tissues) and transfusional
chronic iron overload.
deferiprone and deferasirox • orally effective iron chelator
Viscera preserved in case of poisoning
• Stomach with contents
• Small intestine with contents ;
jejunum 30 cm
• Liver 500g  gall bladder area
• Kidney : half of each kidney
• Urine  30-50 ml
• Blood : 10-20ml
• In case of infants
• Entire liver
• Entire intestine
• Both kidneys

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PM staining in dyes
Carbon monoxide Cherry red
Hydrogen cyanide Bright red
Nitrate nitrite aniline Red brown / deep blue
Phosphorous Dark brown / yellow
H2S Blue green
Opium Black
Classification
• I. Corrosives:
• II. Irritants:

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• III. Neurotics:
• Cerebral
• somniferous, e.g. opioids
• inebriants, e.g. alcohol, anesthetics, ether
• deliriants, e.g. dhatura, cannabis, cocaine
• Spinal : Nux vomica, gelsemium
• (spinal cord is preserved in this suspected poisoning)
• Peripheral : Curare, conium
• IV. Cardiac
• Digitalis, oleander, aconite, nicotine, hydrocyanic acid
• Heart is preserved in suspected digitalis poisoning
• V. Asphyxiants
• VI. Miscellaneous
• i. Agrochemicals
• ii. Drugs of dependence: Tranquilizers, antidepressants, hallucinogens.
• iii. Petroleum products: Kerosene, petrol, naphtha.
• iv. Food poisoning: Bacterial, chemical (botulism).
• v. Others: Analgesics and antipyretics.TONY SCARIA 2010 KMC

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Cantharidin
• Drying ,crushing & powdered Spanish fly (blister beetle) mixed with
food  cantharidin poisoning
• Painful erection(priapism) (falsely believed as enlargement of penis)
• Blood in vomit urine stool
Cantharides

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Agrochemicals
• Pesticides
• Organophosphates,
• Organochlorines
• Fumigants
• Aluminum phosphide (alphos),
• ethylene dibromide
• Rodenticides
• Thallium sulfate, zinc phosphide
• Herbicides
• Paraquat, bromoxynil TONY SCARIA 2010 KMC
Ideal and common
• Ideal suicide poison = Cyanide
• Ideal homicide poison = Thallium, fluoride compounds.
• Commonly used homicidal poisons: Arsenic, aconite
• Commonly used suicidal poisons: Endrine, Opium, Barbiturates,
Organophosphorus compounds.

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• Cumulative poisons are:
• Barbiturates, and methyl alcohol
• Habit forming poisons are:
• Caffeine and Nicotine.
• Addiction drugs are:
• Alcohol, Barbiturates, Coccaine, Cannabis, Chloral hydrate, Opium, Pethidine.
Odours in poisoning
• Bitter almond
• Cyanide , prussic acid
• Garlicy
• Arsenic , AlP, malathion ,
parathion , phosphorous, Se,
Thallium (heavy metals)
• Rotten eg
• H2S, mercaptans,
• Fishy or musty
• ZnP
• Burnt rope
• Cannabis
• Phenolic
• Carbolic acid
• Fruity
• Ethanol, chloroform ,acetone
• Acrid
• Chloral hydrate ,paraldehyde

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Colour of post-mortem staining
• Dark brown or yellow
• Phosphorous or a/c copper poisoning
• Cherry red
• CO
• bright red
• Cyanides
• Bluish green
• H2S
• Chocolates / red brown coloured
• Nitrites/nitrate ,aniline,nitrobenzeneTONY SCARIA 2010 KMC
Colour of mucus membrane of stomach in
poisoning
• 1. Blue
• Copper sulfate, amytal capsule
• 2. Green
• Ferrous sulfate
• 3. Black/charred
• Sulphuric, hydrochloric or acetic acid
• 4. Yellow
• Nitric acid
• 5. Buﬀ/white
• Carbolic acid
• 6. White particles
• Arsenic
• 7. Slate
• Mercury
• 8. Brown leathery
• Cresols
• 9.orange
• Chromium
• 10 . Grey
• Oxalic acidTONY SCARIA 2010 KMC

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Miosis (constriction)
• Organophosphates
• Opiods
• Barbiturates
• Mushroom
• Early nicotine poisoning
• Pontine haemorrhage (pin point)
• Cholinergic drugs
• Chloral hydrate
• phenol
Mydriasis (dilation)
• Datura
• Cyanide
• Anoxia
• Anticholinergic drugs
(adrenergic)TONY SCARIA 2010 KMC
Hippus
• Alternate constriction & dilation of pupil
• Aconite & barbiturate poisoning
• Alcohol
• Barbiturate

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Blue lines on gums
• Pb poisoning (classically)
• Hg
• Cu
• Claptons line (d/t CuSO4)
• Bi
• Pb  burtonian lines
• Fe2+
Early appearance of rigor mortis
• Strychnine
• Hydrocyanic acid

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Poisons causing perforation
• Charring 
• H2SO4
• HCl
Poisons causing cerebral edema seizures
• OP
• Alcohol
• AlP

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Poisons resisting decomposition or
putrefaction
• Carbolic acid
• Arsenic
• Datura
• Alcohol
Nystagmus
• Ethanol
• Phenytoin
• Carbamazepines
• Barbiturates
• Benzodiazepines
• Phencyclidine

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Formication / tactile hallucination
• Arsenic
• Cocaine
• Ergot
Artificial bruise
• Seeds of semicarpus
• Calotropis

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• Poison resembling cholera = Arsenic
• Poison resembling tetanus = Strychnine
• Poison resembling natural death = Thallium
• Poison resembling fading measles = Arsenic
•
• Poison resembling malaria  Zn
• Poison resembling thyrotoxicosis = Bi-nitro compounds.TONY SCARIA 2010 KMC
Tests for detecting poisons:
• Arsenic = Marsh’s test, Reinsch’s test
• OPium = MaRQuis test (OPQR)
• Alcohol = Mc’evan’s test
• Datura = Mydriatic test
• Phenol = Green urine.

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Cyanide poisoning
• Hydrocyanic acid /Prussic acid/cyanogens/Scheele's acid (2% or 4%)
• bitter almond odor
• Sources:
almonds,apricot, apple,
peach, cherry, plum, etc
have Glucoside amygdalin
(cyanogenic glycosides )
HCN
Hydrolysis of these glycosides in the GI
tract (HCl)
emulsinin small intestineTONY SCARIA 2010 KMC
Rave drugs
• are the drugs used in various dance parties and clubs.
• Ecstasy – Hallucinogen/Stimulant. Ecstasy is a synthetic drug that is similar to methamphetamine and the hallucinogen
mescaline. Ecstasy can produce a significant increase in heart rate and blood pressure and a sense of alertness. The stimulant
effects, which enable users to dance for extended periods, may also lead to dehydration, hypertension, and heart or kidney
failure. It is one of the most widely used of the club drugs.
• Ephedrine – Stimulant. Ephedrine is in the Amphetamine family and can cause heart attacks, seizures, agitation,
palpitations, and other health problems. Ephedrine is a common weight-loss substance.
• Ketamine – Hallucinogen. Ketamine is usually snorted and is frequently used in combination with other drugs like ecstasy,
heroin and cocaine. The high lasts anywhere from 30-minutes to about 2-hours.
• Methcathinone – Stimulant. It produces an amphetamine like effect. The drug produces a burst of energy and feeling of
invincibility, accompanied by a state of well being and euphoria.
• LSD – Hallucinogen. LSD induces abnormalities in sensory perceptions. Effects are unpredictable depending on the amount
taken, on the surroundings in which the drug is used, and on the user’s personality, mood, and expectations. Effects come
can include physical effects of dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating,
loss of appetite, sleeplessness, dry mouth, and tremors.
• Magic Mushrooms – Hallucinogen. The effects of Mushrooms are similar to LSD. They include illusions and hallucinations,
distorted perception of time and distance. Trips or episodes can consist of psychosis, convulsions, flashbacks, and possible
death.
• Methamphetamine – Stimulant Methamphetamine affects many areas of the central nervous system. Methamphetamine
use is associated with serious health consequences, including memory loss, aggression, violence, psychotic behavior, and
potential cardiac and neurological damage.

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CN-
Cytochrome oxidase (Fe3+)
Inhibits (final step of oxidative
phosphorylation
and prevents the formation of ATP)
HISTOTOXIC
ANOXIA
anaerobic glycolysis
lactic acid production

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• Prolonged nitroprusside infusion  cyanide poisoning
• HCN
• Corrosive  corrosion and haemorrhages in walls of stomach
KCN is ineffective as a poison if kept
for long time,
patient takes excess of
carbohydrate or suffers from
achlorhydria.

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• Lee jones test
• For cyanide poisoning

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Fatal dose
• HCN  50 -100 mg
• KCN 200 mg
• Blood level >3micro g

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Treatment
Lillys antidote kit

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Other Rx option in cyanide poisoning
• Kelocyanor
• Dicobalt edetate chelates cyanide to form cyanocobal
• Hydroxy Cobalamin
• Hydroxycobalamine  combines with cyanide to form cyanocobalamin
CO poisoning anemic
hypoxia

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CO mistaken for drunkenness
Carbon monoxide
• Upper limit of CO in air 0.01%
• Cherry red discolouration
• Congested lung / froth + in mouth & nostril
• b/l symmetrical necrosis and cavitation of basal ganglia
• Tests for CO
• Kunkels test
• Presence of CO in blood
• Spectroscope
• Hoppo seyler
• Rx
• Hyperbaric oxygen

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Corrosives
• Corrosive acid coagulation necrosis
• Except hydrofluoric acid  liquefaction necrosis
• Corrosive alkali  liquefactive necrosis
• Nitric acid poisoning  yellowish discoloration (xanthoproteic
reaction)

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Boric acid
• Used as antiseptic & insecticide
• Boiled lobster appearance
• Beefy red skin rash mostly in palms & soles buttocks & scrotum
• Intense erythema  fb exfoliatinon
Oxalic acid poisoning
• Acid of sugar/salt of saurel
• In leaves of rhubarb
• Used for erasing writing and signature illegally
• Corrosive coffee ground vomitus

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Carbolic Acid poisoning  carbolism
• needle-shaped crystals
• Consticted pupils
• Corrosion of mouth lips and tongue
• Nerve endings  tingling
• stomach becomes brownish and leathery
• d/t anesthetic action in stomach  no vomiting
• Gastric lavage can be done only in carbolic acid poisoning
• Deposited in cornea cartilage ligaments  ochronosis
• Metabolites  hydroquinone & pyrecatechol  urine oxidation  green
colured urine  carboluria (in c/c phenol poisoning)
• Proximal tubular necrosis
• c/c poisoning  phenolic marasmusTONY SCARIA 2010 KMC

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Olive green colured urine or even black colour
Phenol in
urine
Hydroquinone and
pyrocatechol
On exposure to air
The same also causes oochronosis (deposition in cartilage and bone)
Urine with phenol + ferric chloride  blueTONY SCARIA 2010 KMC
Sulphuric acid/ oil of vitriol
• Vitriologae  throwing of sulphuric acid on another person
• Grievious injury 320 IPC
• Causing disfigurement 326 IPC
• Stomach  soft spongy disintegrates when touched (blotting paper
stomac)
• Perforation can occur

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Chalky white teeth in sulphuric acid poisoning
Nitric acid  xanthoproteic reaction

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Phosphorous white / Diwali poison
Protoplasmic poison
 affects cellular
oxidationanoxic
necrobiosis of liver
Used in fire works White phosphorous
Fertilisers
rodenticides
Red phosphorous is non toxic
White phosphorous oxidises and emits white fumes ,ignites at
34*c (phosphorescence so vomit and feces glow in dark 
smoky stool syndrme

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White phosphorous poisoning
Acute Chronic
cell necrosis
Fatty liver
Yellow atrophy
Lumonous vomit & fuming stool
Phossy jaw

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Phossy jaw / glass jaw
c/c phosphorus poisoning 
osteomyelitic changes  c/c
discharging sinus
• Garlicky odour for breath and excreta
• To preserve luminosity viscera are preserved in saturated saline
• c/c inhalation over years
• Necrosis of lower jaw PHOSSY jaw

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Treatment
• Gastric lavage with dil KMnO4 (1:5000) and CuSO4 (CuSO4
percipitates phosphorous)
Arsenic poisoning
• Most popular homicide poison
• Metallic arsenic is not poisonous as it is not absorbed from alimentary
canal
• Poisonous forms are
• As2O3 (arsenic oxide ) / sankhya/somalkar : most toxic
• Colouring agents in confectionary
• Scheeles green copper aresnite
• Paris green  copper aceto arsenite
• Acute or chronic TONY SCARIA 2010 KMC

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Acute arsenic poisoning
• Resembles cholera/ garlicy odour
• combining with the sulfhydryl groups of mitochondrial enzymes, especially
pyruvate dehydrogenase and certain phosphatases  uncoupling mitochondrial
oxidative phosphorylation interferes with cellular respiration
• Absorbed through GIT  liver >> kidneys > spleen
• Donot cross BBB (not found in brain)
• If patient survives
• it is found in the muscles (for months), bones, hair, nails and skin (sulfhydryl groups in
keratin) for years
• Constriction of throat /colicky pain/intense thirst /vomiting/uremia  circulatory
collapse
• Xray abdomen : As(radiopaque)
• ARSENIC POISONING  RED VELVETTY STOMACH

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a/c arsenic poisoning c/c arsenic poisoning
• Red velvetty mucosa
• Cholera like features
• Fatty liver
• Fatty changes in heart & kidney
• Rain drop pigmentation
• Hyperkeratosis of palms & soles
• Black foot disease
• Mees line

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Fulminant poison
• Death in 3 hors
• > 3 g
Chronic poisoning
• Skin and nail changes
• Hyperkeratosis of palms and soles
• Rain drop hyperpigmentation
• Sensory and motor polyneuritis
•  painful paraesthesia
• c/c consumption of arsenic
•  vasospasm black foot d/s
• Skin cancer
• MEES LINE
Rain drop hyperpigmentation

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Smell of garlic in breath
Mee’s lines after 6
weeks
• Mee’s lines
• Transverse white striae on nails

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• Tests
• Marsh test
• Reinsch test
• Detected in hair,nails and bones
• Delays rigor mortis & putrefaction
• In acute arsenic poisoning
• Sub endocardial haemorrhage
• Rted velvety appearance of stomach

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Treatment
• Freshly prepared hydrated ferric oxide or dialysed iron

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Iron poisoning
• Vin rose urine
• Rx
• Gastric lavage with 5 % NaHCO3 & desferioxamine
• Plenty of egg & milk  formation of iron protein complex
• Mg(OH)2 orally
Vin rose urine following Rx with
desferoxamine

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Mercury (quick silver)
• HgCl2 most poisonous
• ( calomel) reduced to metallic mercury by sodium formaldehyde sulfoxylate
• a/c poisoning  nephropathy (proximal tubular)
Mercury poisoning
• shaking palsy
• minimata ds occured by eating poisoned mercurial fishes,,
• an example of point epidemic
• concussio mercuralis-- condition when patient becomes unable to
dress,write or walk

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• Black MEAT
• Blue black lining of gums
• Mercuria lentis(Brown mercury deposits on lens)-- early feature
• Erethism( neuropsychiatric. Changes in form of
shyness,irritability,tremors,loss of memory
• Acrodynia(pink disease-- pink,puffy,paraesthesia,peeling of skin)
• Tremors danburry/ hatter's shakes/ glass blower's shakes
Chronic poisoning  hydragyrism
• Excessive salivation
• Blue line @ junction of gum with teeth
• Mercurial erethism
• Shyness,timidity ,irritability and shyness
• Mercuria lentis (brown malt reflex)
• Malt brownish deposit of mercury on the anterior capsule of lens
• b/l no effect on visual acuity
• Acrodynia /pink disease
• Exposure to mercury in children
• Ascending and transverse colitisdiphtheric colitis / bacillary dysentery
• Minimata d/s  organic mercury poisoning
• Cerebral palsy
• maternal intake of hg in pregnancy leads to cerebral palsy in neonates

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Treatment
• Anti dote
• BAL (british anti lewisite- dimercaprol)
• Ca-EDTA should not be used as it increases nephrotoxicity

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Lead poisoning
• Toxic in its native form
• Absorption of lead is mainly through lung
• Commonest industrial metal poisoning
• Toxic salts are
• Lead acetate
• Lead carbonate(paints)
• Lead tetraoxide (sindhoor)
• lead sulphide (surma on eyes) least toxic
Pb poisoning
• Inhibit heme synthesis
• Action as arsenic

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c/c plumbism or saturnism
• Pallor
• Mainly facial round the mouth (most consistent sign)
• Microcytic hypochromic anemia /basophilic stippling– early sign
• Burtonian line (stippled blue line on gums)- due to lead sulphide
• Pure motor paralysis wrist drop
• encephalopathy
• Nephropathy proximal
• Excretion of uric acid is impaired  saturnine gout
• Colicky abdominal pain & constipationTONY SCARIA 2010 KMC
facial pallor
Menstrual irregularity, Sterility

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Burtonian lines/lead lines
blue line gums' margin, PbS, 50-70% cases, near carious/dirty teethTONY SCARIA 2010 KMC
Basophilic stippling in mercury >200 punctate
basophilic sippling /mm3

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• Lead palsy, Pb encephalopathy, wrist drop, foot drop, Colic
(abdominal pain), Constipation, Menstrual irregularity, Sterility,
Nephropathy, X-ray- radio-opaque bands at metaphyses of long
bones, Pb >0.03mg% in blood is diagnostic
Lab investigations
• ALA in urine
• Coproporphyrin in urine (>0.25mg/L)
• Pb >0.03mg% in blood is diagnostic
• Increase in ¼ mg of Pb
• Zn protoporphyrin and free erythrocyte protoporphyrin
>50mg/100ml
• X-ray- radio-opaque bands at metaphyses of long bones

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Radio opaque bands at metaphysis

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Treatment in Pb poisoning
• Chelation with EDTA
Copper
• Copper sulphate (blue vitriol) and copper subacetate
• With in 1- 3 days
• a/c hemolysis
• Blue green vomiting
• Diarrhea
• Renal failure (PCT necrosis)
• Seizures
• Ptysalism
• Copious secretion of saliva
• Chalcosis calculi  cu in lens

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• c/c cu2+ poisoning
• Spray  vineyards lung ds
• Granulomatous lung
• Greenish hair
• PM  jaundice ,greenish stomach mucosa
• Monitored by serum ceruloplasmin
• Blood Cu2+ level
• Rx
• Penicillamine TONY SCARIA 2010 KMC
A green line in gums in copper poisoning is
Clepten line

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Zinc
• Metal fume fever
• Flu like symptoms
• Mimics malaria,
• Sweating and chills +
• Treated with paracetamol
Metal fume fever
• Caused by inhalation of fumes produced when these metals are
heated above their melting point;
• zinc, copper, magnesium, iron, chromium, cadmium, nickel,
manganese, mercury, cobalt, lead, antimony, selenium, beryllium,
vanadium, silver and aluminum

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Cadmium
• Itai itai d/s
• Ouch disease – hurts disease
• Golden yellow teeth
• Bone pain  weak brittle bones
• Proximal tubular necrosis
Thallium poisoning
• Resembles natural death
• Triad of thallium poisoning
• Alopecia
• EYE BROW SIGN loss of outer 2/3rd of eyebrow
• Neuropathy  pseudomotor neuropathy
• Diarrhea
• Hair loss
• Gastro enteritis
• Polyneuritis
• Hemorrhagic spots TONY SCARIA 2010 KMC

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Aluminium phosphide
• grain preservative
Air and moisture
Aluminium phosphide Phospine
Alumininum phosphide
Phosphine
Protoplamic poisonnon-competitive
inhibition of cytochrome
oxidase of myocardial mitochondria
• Metabolic acidosis
• Myocardial necrosis ECG ST
DEPRESSION in II & III
• Cardiogenic shock

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• Garlicky odour
• Esophageal strictures and fistula
• Silver nitrate test
• the patient is asked to breathe through a piece of filter paper impregnated
with 0.1 N silver nitrate solution for 5 to 10 minutes. If filter paper becomes
black, it suggests presence of phosphine. The blackening is imparted because
phosphine reduces silver nitrate to silver

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Organophosphate poisoning
Irreversible
anticholineesterase
inhibitor
1. Alkyl compounds
—
tetraethyl
pyrophosphate(TEPP),
hexa ethyl tetraphosphate
(HETP), octa methyl
pyrophosphate (OMPA),
malathion etc.
2. Aryl compounds
—
such as parathion,
chlorothion, diazinon (Tik-
20), paraoxon etc
Soman  nerve gas
for chemical
warfare
Classification
Organo phosphate Organochlorines
Alkyl Aryl • DDT
• Aldrin
• Endrin (plant penicillin)
• Endosulfan
• Paraquat
• TEPP—Tetra ethyl
Pyrophosphate
• HETP—Hexa ethyl
pyrophosphate
• Dimefox
• Malathion
• Sulfotepp
• Systox
• Parathion
• Paraoxon
• Chlorothion
• Methyl parathion
• Diazion
• Methyl umbeliferone

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• MOA of OP
• Cholinesterase inhibition  increased Ach
Muscarinic Nicotinic Accumulation of acetylcholine in central
nervous system
• Miosis
• Diarrhea
• Urnation
• Bronchospams
• Emesis
• Diarrhoea
• Salivation
• Easy fatigability and mild weakness
followed by involuntary twitching,
fasciculation and cramps
• Muscles of respiration are affected
leading to Dyspnea and cyanosis.
• Nicotinic action at autonomic ganglia
masks the muscarinic effects 
Tachycardia is produced instead of
bradycardia
• Cardiac arrhythmias
• Pallor
• Blood pressure is raised
• Hyperglycemia
• Pulmonary oedema
• Anxiety, tension and confusion
• Restlessness, insomnia and headache
• Irritability and neurosis
• Excessive dreaming
and nightmares
• Slurred speech and tremors
• Ataxia and convulsion
• Depression of
respiratory and circulatory centers
• Coma
leading to death.
Breaking down of ACh

16-04-2018
OP binds to esteratic site & forms covalent
bond
Edrophonium & tacrine binds to anionic siteTONY SCARIA 2010 KMC
CF of OP poisoning
• Acute cholinergic crisis
• Intermediate syndrome
• Delayed polyneuropathy
Onset & duration Response to atropine
Type I paralysis (a/c
cholinergic crisis)
24-48 hrs responsive
Intermediate syndrome 1-4 days NO
Type III paralysis (delayed
polyneuropathy)
1-4 weeks NO

16-04-2018
Smell of kerosene
Sweating
Acute cholinergic crisis

16-04-2018
Chromolacryorrhea in c/c OP poisoning
• Increased lacrimation, chromolacryorrhea (shedding of red tears due
to accumulation of porphyrin in lacrimal glands),
• rhinorrhea, sweating

16-04-2018
Intermediate syndrome
• 24 to 96 hours after poisoning  cranial nerve & brain stem lesion
• muscular weakness, affecting predominantly the proximal limb
muscles and the neck ﬂexors.
• Cranial nerve palsies are common.
• Respiratory paralysis

16-04-2018
Delayed polyneuropathy
• 2 to 3 weeks after poisoning
• due to inhibition of enzyme neurotoxic esterase with nerve
demyelination
• ﬂaccid weakness and atrophy of distal limb muscles or spasticity and
ataxia
Diagnosis confirmed by
• RBC cholinesterase/true
• Specific
• RBC
• Gray matter
• plasma (serum) cholinesterase/pseudo/butyrl
• Nonspecific
• Plasma
• White matter
• Pancreas
• Heart
Specific test Sensitive test
RBC cholinesterase Plasma cholinesterase

16-04-2018
Treatment
• Atropine blocks the muscarinic
manifestations and has no effect on nicotinic
receptors (on muscle weakness or paralysis) and
does not affect the rate of regeneration of inhibited
AChE
• Pralidoxime (2-PAM), a nucleophilic oxime, most effective when
treatment is started early and if used within 48 h, and helps in
regenerating AChE associated with skeletal muscle neuromuscular
junctions TONY SCARIA 2010 KMC

16-04-2018
Drugs used in OP poisoning
Atropine Muscarinic symptoms & CNS effect
Pralidoxime Nicotinic symptoms
IV diazepam Convulsion
Oxygen atropine intubation positive pressure
ventilation
Pulmonary edema & bronchospasm

16-04-2018
• When cyanosis + give O2 then only give atropine (otherwisw
ventricular tachycardia)
carbamate
• Reversible anticholinesterases( physostigmine , neostigmine,
pyridostigmine
• Causes carboxylation of serine
• Atropine is the specific antidote
• Oximes are not useful
• Oxime + carbamte  potent inhibitor of AChE

16-04-2018
Organochlorines
• DDT
• Lindane (gamma benzene hexachloride)
• Endrin (plant pencillin)

16-04-2018
Urine alkalinisation /forced alkaline diuresisTONY SCARIA 2010 KMC
Barbiturate poisoning
• a/w cutaneous blisters

16-04-2018
CNS depressants

16-04-2018
Alcohol level
• Blood: Urine = 1:1.35
• Blood: Exhaled air (breath) = 1:2300
• Blood: Saliva = 1:12
• Blood: CSF = 1:1.17

16-04-2018
Acute intoxication of alcohol
State of excitement State of in-coordination: Stage of coma:
50-150 mg% 150-250mg/100ml >300
sense of wellbeing, sober,
euphoria, increased confdence and
excitement
in-coordination and clumsiness’ of
fine and skilled movements
Speech is slurred and the
coordination is markedly affected.
Gait is staggered and the individual
may fall
Dilated pupil
Alcohol induced nystagmus
On painful stimuli the pupils are
dilated which
then return slowly to the
contracted stage called
McEwan’s sign

16-04-2018
Blood levels Symptoms
20 - 30 • Slowness of motor performance and decreased thinking
• 30mg/dl legal limit for driving in india
30 – 80 • Worsening of motor performances
• Further decrease in thinking ability
80 - 200 • Incoordination & stagger on sudden turning
• Judgement errors
• Mood lability
• Loss of capacity for self criticism & decreased skilled motor movements
200 - 300 • Nystagmus
• Slurring of speech
• Alcoholic blackout (anterograde amnesia seen during intoxication /unable to recall events
at this level)
>300 Impaired vital signs & possible death
Alcohol
• Critical level of alcohol in blood is 0.15%.
• The Percentage of blood alcohol in the stage of
• “dead drunk” is 0.5%.
• Ratio between ethyl alcohol in blood to urine is 1:1.33
• In most countries, breath alcohol concentration 35 mg/100 ml is
considered an offence
• Alcohol gaze nystagmus is produced at an average blood levels of 80 mg%
• Term ‘under the influence’ of alcohol is used
• when blood concentration is 80- 100mg%
• The residual alcohol in mouth takes about 20 min to disappear and within
this period breath analyser test may be false positiveTONY SCARIA 2010 KMC

16-04-2018
• Upper limit of alcohol while driving is 30mg %
• 150-200ml of alcohol consumed in an hour is fatal
Methods to detect blood alcohol levels
• Gas chromatography  most reliable
• Breath analysis
• Cavett test
• ADH
• Kozelka & hinc test
• Breath analysis
• Screening method based on henrys law

16-04-2018
Widmarks formula to detect levels of alchol in
urine and blood
• Widmark’s formula-
• For blood a = p.r.c.,
• a= wt of alcohol in gms in body,
• p= body wt in kg,
• c= conc. of alcohol in blood in gm/kg,
• r= constant (0.6 for men, 0.5 for women). F
• Urine, formula is- a = ¾ p.r.q,
• where q is the conc. of alcohol in urine in mg/kg
• Potassium dichromate in alcohol breath test in breathalyser

16-04-2018
Methanol poisoning
Lactic acidosis / high anion gap
• Acute loss of vision
• Pappiledema  retinal arterial narrowning Primary optic atrophy
• Damages mainly retinal ganglion cells
• b/l cystic putaminal necrosis
• Vomiting
• Abdominal pain

16-04-2018
• In methanol poisoning the sensorium is relatively preserved
• Methanol toxic dose = 60 -240 ml
• Metabolic abnormality
• = Metabolic acidosis + Elevated anion gap + Osmolar gap + visual disturbance.
Metabolic acidosis + Elevated anion gap + Osmolar gap + Abscence of visual disturbance = ETHYLENE GLYCOL
POISONING
Treatment
• Gastric lavage + sodium carbonate
• Ethanol
• Competitively inhibits aldehyde dehydrogenase
• Fomepizole
• Specific inhibitor of alcohol dehydrogenase
• Folic acid
• Hastens metabolism of formic acid
• Hemodialysis

16-04-2018
Treatment
Barbiturate poisoning  treated with forced
alkaline diuresis
• Gold coloured urine
• Barbiturate blisters
• Constricted pupil
• Hypothermia
• Coma
• CNS depression
• Cyanosis
• CVS collapse TONY SCARIA 2010 KMC

16-04-2018
Knock out drops
• Chloral hydrate
• Dry whine
• Mickey finn = alcohol + chloral hydrate
CNS stimulant

16-04-2018
Cocaine
• CNS stimulant
• Erythroxylum coca
• Reuptake blocker of all amines
• Increased concentration of dopamine
• Increase NEsympathomimetic effect
• Higher concentration block Na
• used as a LA in eye nose & throat sx
• snorting / smoking / IV injection
Sigmeund freud introduced cocaine and he was addicted to it
Reuptake blocker of all amines
Increased concentration of dopamine
Higher concentration block Na

16-04-2018
• Free basing
• Smoking cocaine
• Mixing street cocaine with free base (chemically extracted pure cocaine)

16-04-2018
Usually inhaled snorting vasoconstriction
• Septal perforation
• jet black pigmentation tongue in long term users
• Cocaine + heroin = speed balls
• Crack = free base form of cocaine
• Even Single use  intensive craving

16-04-2018
Manifestation
• Paranoid ideas
• Auditory & visual hallucination
• Tactile hallucination
• Arterial blockade ischemic myocardial injury
• Vasoconstriction  HTn
• Seizures
CF of cocaine
Acute Sympathetic hyper reactivity • Tachycardia
• Mydriasis
• Sweating
• N & V
Hypomanaic state • Increased psychomotor activity
• Grandiosity
• Elation
• Hypervigilance
Chronic Psychotic episodes • Persecutory delusions
• tactile hallucination  magnan symptom
Black pigmentation of tongue & teeth

16-04-2018
Cocaine
• “Touch (tactile) hallucination
• Magnan symptom (cocaine bugs or Tactile hallucination)
• This may take the form of small animals crawling over the body, so
called formication. This is not uncommon in acute organic states. In
cocaine psychosis this type of hallucination commonly occurs
together with delusions of persecution and is known as the ‘cocaine
bug’.”
Cocaine induced psychotic disorder
• Intravenous users & crack users
• Similar to paranoid schizophrenia
• Paranoid delusions
• auditory hallucination

16-04-2018
• Withdrawal symptoms are mild
• Fatigue
• Dysphoria
• Disturbed sleep
• Cognitive behaviour therapy
• Group therapy
• Narcotic anonymous
Cocaine poisoning
• Tactile hallucination /magnans
symptoms/cocaine bugs
• Amyl nitrate is antidote of
cocaine poisoning

16-04-2018
Cocaine poisoning
Speed ball
• Heroin + cocaine

16-04-2018
Amphetamine
• CNS stimulant
• It acts on NE release in brain along with an action of release of
dopamine & serotonin
Acute Cardiovascular Tachycardia /HTN /cardiac failure/ cardiovascular
shock
CNS Euphoria seizures hyperpyrexia tremors ataxia
pupillary dilation
Neuropsychiatric Anxiety panic insomnia
Paranoid hallucinatory
syndrome
• Mimimcs paranoid schizophrenia
amphetamine psychosis
• Delsuion of persecution
• Auditory or visual hallucination in setting of
clear consciousness
Chronic • Severe & compulsive craving for drug
• Tactile hallucination
Amphetamine
• No withdrawal symptoms
• Rx
• No medication needed

16-04-2018
Cannabis
• Derived from hemp plant
cannabis sativa
• Most commonly used illegal
drug in the world & india
• Active ingredient d-9
tetrahydrocannabinol (THC)
• Smoked / chewed
• Poor water solubility cant be
given IV TONY SCARIA 2010 KMC
Part of cannabis plant used
Bhang Dried leaves & fruit shoots
Majoon sweet prepared from bhang
Ganja Dried flowering tops
Charas (hashish) Resinous exudates from leaves or stem

16-04-2018
Bhang
Majoon Ganja
Charas  dried resinous exudate

16-04-2018
Cannabis intoxication
• Red eye
• Dry mouth
• Mild tachycardia
• Increased appetite
• Synesthesia
• Stimulation of one sensory modality cause sensation
in another modality
• Increased appetite
• Depersonalization
• Derealization
• Bad trip
• Restlessness fear anxiety similar to panic attack
• Also seen in hallucinogen
Burnt rope smell in cannabis intoxication

16-04-2018
Cannabis related disorders
Flash back phenomenon • Recurrence of experience of cannabis use
even in absence of current use
• Also seen in LSD /psilocybin/ psilocin
• d/t high fat solubility  stored in fat vesicle
mobilised from fat vesicle later flashback
Run amok- • the person may psychic disturbance marked by a
period of disturbance followed by violent attempts
to kill people (impulse to murder)
Hashish insanity /hemp insanity • the victim may become insane show
hallucinations, delusion of persecution.
Amotivational syndrome • Unwillingness to perform any task whether at
school or work
• Uninterested lethargic apathetic
Opiods

16-04-2018
Acute morphine poisoning
CF Stage of
excitement
Hallucination
Euphoria
Stage of
stupor
Drowsiness
Stupor
Stage of
coma
• Pin point non reacting pupil
• Hypotension
• Bradycardia
• Cyanosis
• Slow & shallow breathing
• Respiratory depression
P/M White froth from mouth
Rx • Supportive
• Gastric lavage with KMNO4(even if taken IV)
• Specific antidote  naloxone 0.4-0.8mg every 2-3 min till respiratory rate picks up
• Oral naltrexone for maintenance
Opiods
Rx of opioid over dose Rx of opiod dependence
Rx with opioid
antagonist to
overcome resp
depression
• IV naloxone followed by oral
naloxone
• IV nalmefene (may also be used)
Detoxification • Substitution with
long acting agonist
Methadone
• Substitution of
partial agonist
Buprenorphin
e
• Substitution by α2
agonist
Clonidine
Or naltrexone
+ clonidine
Maintenance
therpay
• Methadone
• LAAM
LAAM( levo alpha acetyl methadol ) not used
nowadays d/t toxicity(prolonged QT interval)

16-04-2018
Morphine withdrawal reaction
Most of effects are opposite of morphine intoxication
• Mydriasis
• Hypertension
• Palpitation
• Insomnia
• Diarrhea  dehydration
• Sweating
• Lacrimation
• Rhinorrhea
• Diarrhea
• Piloerction
• Muscle cramps & body pain
• Rx
• Methadone  DOC
• Other drugs  clonidine/ buprenorphine /LAAM
Piloerection  cold turkey

16-04-2018
Hallucinogen (psychedelics)
Hallucinogens /psychedelic drugs
• Lysergic acid diethylamide (LSD)
• King of psychedelic
• Phencyclidine => angel dust
• a/c schizophrenic reaction
• Dissociative anaesthesia
• Psilocybin
• Mescaline
• Ecstasy = ‘rave drug’.
• chemical name is methylene dioxy methamphetamine => MDMA.TONY SCARIA 2010 KMC

16-04-2018
Symptoms of intoxication of LSD due to 5HT
• Pupillary dilation
• Derealisation
• Depersonalisation
• Synesthesia
• Illusions
• Hallucinations
• Bad trip
• Flash back phenomenon Rx with BZD
CF of LSD d/t increased 5HT
Perceptual disturbance in a clear consciousness • Depersonalisation
• Derealisation
• Synesthesia (colours are heard & sound is felt)
• Illusion
• Hallucination
Autonomic hyperreactivity( d/t central sympathetic
stimulation)
• Mydriasis
• Tachycardia
• Sweating
• Tremors
Others Anxiety
Panic
Depression
Confusion

16-04-2018
• Rx of choice for hallucinogen intoxication
• Diazepam
Toxalbumin
• Plant protein resembling bacterial toxin in action  agglutination of
RBC haemolysis and is antigenic
• Inihibit potein synthesis

16-04-2018
Castor (ricinus communis)
• Toxalbumen  ricin
• Inhibits RNA of GI cells  severe diarrhea
• Hemorrhagic inflammation of GIT
• Bloody diarrhea,
• Powder  conjunctivitis

16-04-2018
Abrus Precatorius
• Red coloured with black spot at one end
• active principles abrin, a thermolabile toxalbumin
• Resembles viper venom
• Used as abortificient
• Used to kill cattle in the form of sharp needle  suis
• Rx
• Anti abrin
Semicarpus anacardium (marking nut)
• Juice
• Artificial bruise (dark brown)
• Washerman to mark their clothes
• Active principles
• Semicarpol
• Bhilawanol

16-04-2018
Aconite poisoning
• Sweet poison /mitha vish/monks hood
• Active principle aconitin
• Fatal period  1-5 hours
• Paraesthesia of mouth and tongue,hypersalivation,low bp,hippus
• Binds with voltage gated Na+ channels  first stimulate then
paralyse sensory secretory motor ends
• CVS  bradycardia ,ventricular ectopic , arrhythmiaTONY SCARIA 2010 KMC
Roots of aconite are poisonous

16-04-2018
Calotropis (madar)
• Uscharin,gigantin,calotropin,calotoxin
• Milky madar juice infanticide
• By giving mixed with milk
• Abortion stick
Croton
• Crotin/crotonoside
• Vesicating resin
• Blood stained diraahea
• Used for Abortion and arrow poison

16-04-2018
Cerbra thevetia
• Thevetin  main cardiac poison
• Cerbrin
• Theveotoxin
Nerium oleander
• Cardiac poison
• Nerin,oleandrin

16-04-2018
Gelsemium / yellow jasmine
• Powerful spinal depressant
Capsicum Annuum
• Capsaicin
• Seeds resemble dhatura
• Hunan hand (‘Chilli Willy’)
• painful contact dermatitis seen in people with continuous and prolonged
exposure to chilli peppers containing capsaicin.

16-04-2018
Datura / thorn apple
• Active principles
• All of them are anticholinergic
• Hyoscine (scopolamine)
• Hyoscyamine
• Atropine.

16-04-2018
• Dryness of the mouth (dry as a bone), bitter taste burning pain in
stomach and vomiting.
• Dysphagia (diffculty in swallowing).
• Dysarthria (diffculty in talking) due to inhibition of salivation—
mumbling in quality and is often incomprehensible
Datura  dilation
• Dilatation of cutaneous blood vessels (red as a beet). Face is ﬂushed
and conjunctiva congested.
• Diplopia due to dilated pupil (mydriasis) with loss of accommodation
for near vision, developing into temporary blindness (blind as a bat)
and photophobia. Light reﬂex is sluggish, and later absent
• Dilation of urinary bladder d/t retention

16-04-2018
• Dry hot skin (hot as a hare) due to inhibition of sweat and stimulation
of heat regulating center. There is dry mucous membrane with dry
axillae. Temperature is raised by 1–2°C
• Delirium
• Drownsiness
• Drunken gait

16-04-2018
Treatment
• Fatal period of Datura poisoning is 24 hours.
• Physostigmine
• Gastric lavage with tannic acid, KMnO4 or activated charcoal
Strychnine poisoning
• Strychnus nux vomica
• Actve principles
• Strychnine and brucine
• Used as cattle poison , rodenticide, respiratory stimulant (stimulates
respiratory centre)
• Stimulates CNS (cerebral cortex) generalised convulsions
• Esp anterior horn cells
• All muscles are affected at same time
• Consciousness remail clear till death

16-04-2018
Strychnine plant
Awful taste
Seeds of strychnine

16-04-2018
Amphetamine
• Liquid gold
• Urine of amphetamine abusers is costly
Poisonous snakes

16-04-2018
Characteristics of poisonous snakes
• Nocturnal
• Belly scales are large and cover entire breadth
• Fangs are long and canalized
• Head scales are small

16-04-2018
Hydrophidae
 sea snakes
Myotoxic /
rhabdomyolysis
/polymyositis /
muscle weakness
Elapidae
Cobra and krait
Neurotoxic
Viperidae
Haematotoxic
Oozing of blood
from the site
Hematuria
HemoglobinuriaTONY SCARIA 2010 KMC

16-04-2018
•No swelling
and pain at the
site
Krait
•Paralysis
,drooping of
eyelid
Cobra
Characteristic toxin of different snakes
Neurotoxic Hemotoxic / vasculotoxic Myotoxic
• Elapidae
• Cobra
• Krait
• Coral snakes
• Russel viper
• Saw scaled viper
• Sea snakes

16-04-2018
Non poisonous Poisonous

16-04-2018
Fatal dose of dried venoms
• Krait = 6mg
• Cobra = 12 mg
• Russel viper = 15 mg
• 20 minute whole blood clotting time
• Useful test

16-04-2018
Treatment
• Pressure of 50-70 mm Hg
• NOT RECOMMENDED FOR VIPER BITES local
necrosis
Pressure
immbobilsation
for elapid bites
• Prepared from cobra , krait, russels viper, saw scaled
viper
• Recommended initial dose is 8 to 10 vials over 1
hour
Polyvalent anti
venom TONY SCARIA 2010 KMC
Univeral antidote
• Powdered animal charcoal 2 parts
• magnesium oxide 1 part
• Tannic acid 1 part

16-04-2018
Preservation in autopsy
• Brain (100 g cerebrum / cerebellum)
• CO, CN , OP, opiate, barbiturate, alkaloids, strychnine , organic volatile poisons
• Spinal cord (entire lenth)
• Strychnine
• Heart
• Strychnine digitalis
• Lung (One)
• Gaseous poison /alcohol/chloroform/CN
• Bone (10 cm shaft of femur) / hair (20-30) /nail (all finger and toe)
• Suba/c & cc poisoning of heavy metals Ar,Sb,radium,ThalliumTONY SCARIA 2010 KMC

16-04-2018
• Uterus ,appendages ,upper vagina
• Criminal abortion
• Fat (10 g from abd/perinephric region)
• Pesticides/ insecticides
• CSF
• Alcohol
• Vitreous humour
• alcohol , chloroform
• Bile
• Glutathione /cocaine/barbiturates/methadone/narcotics
• Skin
• Insulin injection /morphine /heroin/cocaineTONY SCARIA 2010 KMC
Special viscera preserved
• Cyanide poisoning
• Spleen
• Heavy metal poisoning
(arsenic/thallium/radium)
• Bone (shaft of long bone) hair and nail
• Alcohol
• CSF in fluride
• Alcohol , chloroform
• Vitreous in fluride
• Gaseous poisons (CO,CN,chloroform)
• lungs
• Strychnine , & gelsemium
• Spinal cord
• Rabies
• Brain in glycerol

16-04-2018
Preservative
blood and urine for chemical
analysis, sodium fluoride is
added as preservative in
concentration of 50 mg/10ml.
Saturated salt solution
Used in all poisonings
except for few
Not in case of acid
poisoning (except
carbolic
acid)/alkalis/aconite
corrosive sublimate
Rectified spirit
In acid poisoning
except in PAPPA
(phosphorus , acetic
acid, phenol,
paraldehyde ,alcohol)
Thymol
Carbolic acid viscera
• 50 % glycerine is used for
viral specimensTONY SCARIA 2010 KMC

16-04-2018
• Sodium fluoride (10mg/ml Na/K fluoride & 3mg potassium oxalate )
• To preserve blood blood also, added to CSF ,vitreous humour and urine if
alcohol estimation is required
• 30mg Na citrate in place of K oxalate
• Blood in poison with fluoride
Viscera to be preserved in case of poisoning
• Stomach and its contents
• Small intestine
• 30 cm in adults
• Full in infants
• One kidney (half of each kidney)
• Blood (10-20 ml)
• Urine (30- 50 ml)

16-04-2018
Urine alkalinisation /forced alkaline diuresis
• Salicylates
• Barbiturates
DNA analysis
• Best organ for DNA extraction is spleen

16-04-2018
Hemodialysis/peritoneal dialysis
Useful in
• Ethanol
• Methanol
• Ethylene glycol
• Chloral hydrate
• Barbiturates
• salicylates
• Arsenic
• Acetaminophen
Not useful in
• Kerosene
• Digitalis
• BZD
• OP
• CuSO4
• Peritoneal dialysis
• Theophylline and Hg poisoning

16-04-2018
Antidotes
Poisoning
• Fe2+
• Thallium
• EDTA
• Succimer(DMSA,dimercaptosuccini
c acid)
• Copper
antidotes
• Desferrioxamine
• Prussian blue
• Heavy metals
• Pencillamine TONY SCARIA 2010 KMC
Stomach tube /ewald tube
• Contraindicated in corrosives (except carbolic acid)
• Relative C/I in kerosene poisoning  aspiration pneumonitis

16-04-2018
Important sections of IPC

16-04-2018
Perjury (false evidence under oath)
• IPC 191
• Perjury & hostile witness
• IPC 193
• Punishment of perjury
• IPC 197
• Issuing or signing a false certificate by a doctor
• Punishable for 7 yearsTONY SCARIA 2010 KMC
• IPC 319
• Hurt
• IPC 320
• Grievious hurt
• IPC 325
• Punishment of grievious hurt

16-04-2018
IPC 320
Grievious
hurt
Emasculation
(22 FK)
Permanent
privation of sight
of either eye
Permanent
privation of
hearing of either
ear
Privation of any
member or joint
Permanent
disfigurement of
the head or face:
Fracture or
dislocation of a
bone or tooth:
8. Any hurt
which:
• i. Endangers life
• ii. Causes the victim to be in
severe bodily pain for
20 days
• iii. Unable the victim to
follow his ordinary pursuits
for a period of 20 days
Dangerous weapon
• IPC 324
Any instrument used
for shooting, stabbing or cutting, or any instrument
which if used as a weapon of offence is likely to
cause death; or by means of fire or any heated
substance, poison or any corrosive substance,
explosive or any substance which is harmful to the
human body to inhale, to swallow or to receive into
the blood or by means of any animal

16-04-2018
Grievious hurt by Acid IPC 326 A
Murder
• IPC 299
• Culpable homicide
• IPC 304
• Punishment of culpable homicide
• IPC 300
• Murder
• IPC 302
• Punishment of murder
• IPC 307
• Attempt to murder TONY SCARIA 2010 KMC

16-04-2018
Suicide
• IPC 305
• Abetment of suicide of child or insane
• IPC 306
• Abetment of suicide
• IPC 309
• Attempt to suicide
Dowry death
• IPC 304B dowry death
• IPC 498 A 
• Harassment for dowry
• Husband or relative subjecting her to cruelty for want if dowry
• Punishable up to 3 yrs

16-04-2018
Dowry death
• 304B  DOWRY DEATH In suspicious circumstances with in 7 years of
marriage & it is shown that soon before her death her
body was subjected to harassment or cruelty in
connection for any demand for dowry
• Imprisonement of not less than 10 years but
which may extend to life imprisonement
• 498 A CRUELTY TO MARRIED WOMEN • Imprisonement upto 3 years & fine
Section 176, CrPC
Authorise inquest for investigation for dowry death by MAGISTRATE
Dowry death prohibition act
• Imrisonement for a term not less than
5 years +fine which shall not be less
than 15000or amount of value of such
dowry which ever is more

16-04-2018
Causing death by negligence
• IPC 304 A punishable for 2 years
• Medical negligence
• Causing death by rash and negligent act
• RASH DRIVING
IPC Section 354 – Punishment for Indecent
Assault/outrage of modesty
• IPC 354 A
• Sexual haraasement & its punishment
• IPC 354 D
• Stalking
• IPC 354 C
• voyeurism

16-04-2018
Rape
• 375  definition of rape
• 376  punishment of rape
• 7 yrs to life imprisonement + fine
• 377
• Unnatural sexual offences
Adultery or artificial insemination
• IPC 497

16-04-2018
Adulteration
• IPC Section 272 – Adulterating Food or Drink (6 months/Rs 1000)
• IPC Section 273 – Selling adulterated food or drink
Drugs
• IPC Section 274 – Adulteration of drugs (in West Bengal – life
imprisonment)
• IPC Section 275 – Selling Adulterated drugs
• IPC Section 276 – Selling a different drug

16-04-2018
Abortions
• IPC Section 312-316: Criminal Abortions
• IPC Section 313 – Causing miscarriage without woman’s consent
• IPC Section 317 – Abandoning Infant
• IPC Section 318 – Concealment of birth by secret disposal of dead
body.
Consent
• IPC Section 87 – Below 18 years – no valid consent for physical
examination.
• IPC 89
• a child < 12 yrs can’t give consent expressed or implied for an act done in
good faith
• IPC Section 88-93 – Legal protection to Medical Doctors.
• IPC Section 89 – Consent from Guardians for age below 12.
• IPC Section 90 – Validity of Consent – fear, Intoxication etc.
• IPC 92  a doctor can operate with out consent in a no-bystanderTONY SCARIA 2010 KMC

16-04-2018
Kidnap
• IPC Section 361 – Kidnapping from lawful guardianship
• IPC Section 362 – Abduction
• IPC Section 363 – Punishment for kidnapping
• IPC Section 366A – Kidnapping an Indian girl below 18 for Prostitution
• IPC Section 366B – Importing any foreign girl below 21 for
Prostitution
• IPC Section 369 – Kidnap a child below 10 years for movable property
Review of IPC

16-04-2018
• IPC Section 31 – A Will
• IPC Section 39 – A person is said to cause an effect “voluntarily”
• IPC section 46  death

16-04-2018
• IPC Section 82 – Act of a child under 7 years of age.
• Incapable of doing offence
• IPC Section 83 – Act of a child a7 – 12 yrs
• Can do an offence if he is mature enoygh to understand and judge the
consequences
IPC Section 82 – Act of a child under 7 years
of age Incapable of doing offence

16-04-2018
• IPC Section 84 – Mc Naughten’s Rule or legal test.
• IPC Section 85 – Act under intoxication.
• IPC Section 87 – Below 18 years – no valid consent for physical
examination.
• IPC Section 88-93 – Legal protection to Medical Doctors.
• IPC Section 89 – Consent from Guardians for age below 12.
• IPC Section 90 – Validity of Consent – fear, Intoxication etc.
• IPC section 92  operate with out consent in no bystander

16-04-2018
• PC Section 118 – Concealing design to commit offence punishable with death or
imprisonment for life.
• IPC Section 176 – Omission to give notice or information to public servant by
person legally bound to give it
• IPC Section 177 – Furnishing false information.
• IPC Section 178 – Refusing Oath or affirmation when duly required by public
servant to make it.
• IPC Section 179 – Refusing to answer public servant authorised to question.
• IPC Section 182 – False information, with intent to cause public servant to use his
lawful power to the injury of another person.
• IPC Section 190 – Threat of injury to induce person to refrain from applying for
protection to public servant
• IPC Section 191 – Giving false evidence.
• IPC Section 192 – Fabricating false evidence.
• IPC Section 193 – Punishment for false evidence.
• IPC Section 194 – Giving or fabricating false evidence with intent to
procure conviction of capital offence.
• IPC Section 195 – Giving or fabricating false evidence with intent to
procure conviction of offence punishable with imprisonment for life
or imprisonment
• IPC Section 197 – Issuing or signing false certificate.TONY SCARIA 2010 KMC

16-04-2018
IPC Section 197 – Issuing or signing false
certificate.
Punishable for 7 years
201 – 204  evidence
• IPC Section 201 – Causing disappearance of
evidence of offence, or giving false information
to screen offender.
• IPC Section 202 – Not informing Police
• IPC Section 203 – Giving false information
respecting an offence committed.
• IPC Section 204 – Destruction of document or
electronic record to prevent its production as
evidence.

16-04-2018
• IPC Section 228A – Disclosure of identity of the victim of certain
offences
• IPC Section 272 – Adulterating Food or Drink (6 months/Rs 1000)
• IPC Section 273 – Selling adulterated food or drink
• IPC Section 274 – Adulteration of drugs (in West Bengal – life
imprisonment)

16-04-2018
• IPC Section 277 – Fouling Water / Spring / Reservoir
• IPC Section 278 – Making Atmosphere noxious
• IPC Section 284 – Punishment for negligent conduct with respect to
poisonous substance
• IPC Section 294 – Punishment for Exhibitionism

16-04-2018
• IPC Section 299 – Defines Culpable Homicide
• IPC Section 300 – Culpable homicide is murder
• IPC Section 302 – Punishment for murder
• IPC Section 304 – Punishment for culpable homicide not amounting
to murder
• IPC Section 304A – Causing death by negligence
• IPC Section 304B – Dowry death

16-04-2018
• IPC Section 306 – Abetment of Suicide
• IPC Section 309 – Attempt to commit suicide
• IPC Section 312-316: Criminal Abortions
• IPC Section 313 – Causing miscarriage without woman’s consent
• IPC Section 317 – Abandoning Infant
• IPC Section 318 – Concealment of birth by secret disposal of dead
body.

16-04-2018
• IPC Section 319 – Hurt, Hurt means bodily pain, disease or infirmity
caused to any person
• IPC Section 320 – Grievous Injury Any of the following injuries are
grievous.
• IPC Section 323 – Punishment for Hurt
• IPC Section 324 – Dangerous weapons / Poisons / Corrosives
• IPC Section 325 – Describes Punishment for Voluntarily Causing
Grievous Hurt.
• IPC Section 351 – Defines Assault: Threat/attempt to apply forceTONY SCARIA 2010 KMC
• IPC Section 351 – Defines Assault: Threat/attempt to apply force
• IPC Section 354 – Punishment for Indecent Assault

16-04-2018
• IPC Section 361 – Kidnapping from lawful guardianship
• IPC Section 362 – Abduction
• IPC Section 363 – Punishment for kidnapping
• IPC Section 366A – Kidnapping an Indian girl below 18 for Prostitution
• IPC Section 366B – Importing any foreign girl below 21 for
Prostitution
• IPC Section 369 – Kidnap a child below 10 years for movable property
• IPC Section 374 – Unlawful compulsory labour
• IPC Section 375 – Rape, Unlawful sexual intercourse by a man
• IPC Section 376 – Punishment for Rape
• IPC Section 377 – Unnatural offences
• IPC Section 497 – Adultery / Artificial Insemination
• IPC Section 498A – Dowry death

16-04-2018
• PREVENTION OF CHILD AGAINST SEXUAL OFFENCES ACT(POCSO) 2012
• child<18y

16-04-2018
• PRENATAL DXTIC TECHNIQUE(PROHIBIT OF SEX SELECTION) ACT 2002
• P-Rs10000+3y
• HUMAN ORGAN TRANSPLANTATION ACT1994/HUMAN
ORGAN&TISSUE TRANSPLANTATION ACT 2011
• 2D-brain stem Death criteria
• doctor, nurse, technician-criminal negligence P-10y+Rs20lakh
• other person P-3y+Rs5lakh
• MCI-1st offence P-3y penal erasure, 2nd offence P-proff death sentence

16-04-2018
PNDCT act 1994 amended in 2002
• Pre conception & pre natal diagnostic act
• Fine of rs 10000 + 3 years of imprisonment

16-04-2018
• Majority is attained
• On completion of 18 years
• If under guardian ship of court only after 21 years
• declaration of 1948- Geneva-Hippocratic oath

16-04-2018
Blaschkos line
• The lines do not correspond to any known
nervous, vascular or lymphatic structures,
but represent the developmental growth
pattern of the skin.
• Generally longitudinally oriented on the
limbs and circumferential on the trunk, but
not perfectly linear.
• Implies a mosaic disorder (e.g., incontinentia
pigmenti, inflammatory linear verrucous
epidermal nevus) (ILVEN).

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