DR.

AJIT PATIL’S PGA- CET CLASSES

TOXICOLOGY
SERIES 3

DR. AJIT PATIL

PGA CET CLASSES

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SNAKES ( OPHIDIA ) ( ophitoxemia = snake poisoning )

Classification of poisonous snakes :

1) Colubridae = Elapidae cobra and krait

2) Viperiaedae = viper

On the basis of poison .

1) Elapid - neurotoxic
2) Viper = vasculotoxic
3) Sea snake = myotoxic

Snake venom :
1) It is heterogeneous mixture of protein produced and stored in specialized salivary glands .
2) In elapid ( cobra and krait ) :-
A) Toxin block neuromuscular junction and decrease the output of acetylcholine
B) Toxicity is on CNS , Respiration , Heart .
3) Viper :- viper venom is hemolytic it cause intra vascular hemolysis depression of coagulation
mechanism .
4) Sea snake :-
a) myotoxic
b) It lead to muscle pain , myoglobinuria , hyperkalemia .

ELAPID :-
1) Neurotoxic
2) Lethargy
3) Salivation
4) Muscle paralysis
5) Ptosis
6) Difficulty in speaking , swallowing
7) Convulsion and death
8) No convulsion in krait
9) Krait is most common poisonous snake in india .

Viper :-
1) Cellulitis
2) Intravascular hemolysis
3) Haemoglobinuria
4) Bleeding from body orifice
5) Hematuria

Sea snake : -
1) Myotoxic
2) Muscular pain
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3) Hyperkalemia
4) Increased serum transaminase level

FATAL DOSE :-
1) Cobra = 12 mg
2) Krait = 6 mg
3) Russel viper = 15 mg
4) Saw scaled viper 8 mg

FATAL PERIOD :-
1) Colubrine = 20 min
2) Viparine = 2 to 4 days

Prevention of spread of venom :-

1) Clean the bite area with water
2) Washing with KMNO4 solution
3) Apply tourniquet proximal to site of bite .
4) Tourniquet should be tight enough to occlude lymphatics but not vein .
5) Local heparin infiltration in viper and carbolic soap solution in elapid is useful
6) According to some local emetine or gold chloride injection help to prevent spread .

Treatment of absorbed poison :-

1) In Elapid :-
a) 0.6 mg atropine + 0.5 mg Neostigmine
b) IN paralytic cases SC adrenaline , IM calcium chloride
2) In viper :-
a) 30000 – 40000 unit heparin
300 - 600 gm fibrinogen
3) Snake venom can cross placenta hence can poison foetus .
4) Antisnake venom may be monovalent ( effective against specific snake ) polyvalent ( against cobra ,
krait – prepare at haffkine institute Mumbai , russel viper )

Scorpion :-
Scorpion venom :- 1) Neurotoxic and haematotoxic

ABRUS PRECATRIOUS :-
( ratti , gunchi , indian liquorice
, rosary pea , buddhist rosary bead lucky bean , crab’s eye )
Raw or cooked seeds when swallowed non poisonous but injected its extract cause viper bite like symptom

1) Seed weight 105 mg

2) Active principle :- Abrin
Glycyrrhizin
N – Methyl tryptophan
3) Fatal dose :- 1-2 crushed seed .
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4) Fatal period = 3-5 days

5) Medicolegal aspect
a) Cattle poison
b) Sui poisoning
c) Arrow poison

RICINIS COMMUNIS :-
( Arandi , mole bean , castor oil plant )

Active principle :-
1) Ricin
2) Chief purgative of castor oil is Ricinoleic acid

fatal dose :- 10 Crushed seed

Castor oil is not poisonous as it does not contain ricin

SEMECARPUS ANACARDIUM :-
( marking nut , bhilwa )
1) Black vesicle on skin
2) Fatal dose = 10 gm
3) Fatal period = 12-24 hr
4) Called bruising Nut .

CALOTROPIS :-
( Madar )

Active principle :- uscharin , calotoxin , calotropin , calactin

Sign and symptom :-
1) Vesication and redness
2) Conjunctivitis
3) Burning pain in GIT
4) Stomaitis
5) Dilated pupil

Fatal dose = uncertain

Fatal period = 12 hrs

CAPSICUM :-
( RED PEPPER , LAL MIRCH )

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Medicolegal aspect : -
1) Stupefying poison
2) Hyderabadi goli ( method of putting chilli in rectum )

OPIUM :-
( AFFIM )
1) Opium is dried juice obtained by incision of unripe capsule of white pappy papaver somniferum .
2) Active principle :-
a) Morphine , codeine , thebaine
b) Papaverine , noscapine , narcine
c) Morphine present
3) Poppy seeds ( khas –khas / posto ) are nonpoisonous
4) Poisoning occur due to ingestion of opium
5) Stage I :- STAGE OF EXCITEMENT / EUPHORIA
a) Increased sense of well being
b) Increased mental activity
c) Flushing of face
d) Hallucination
6) Stage II :- STAGE OF SPOOR ( STUPOR / DEPRESSION )
a) Headache
b) Nausea
c) Vomiting
d) Contracted pupil
7) Stage III :- STAGE OF NECROSIS
a) Deep coma
b) Muscle relaxed
c) Pinpoint pupil
d) Areflexia
e) Cheyne –stroke breathing
f) Sweating
g) Hypothermia
h) Froth at nose and mouth

Triad of :-
a) Coma
b) Pinpoint pupil
c) Depressed respiration ( 4-5/ min )
Strongly suggest opioid poisoning

Chemical test = marquis test

Fatal dose = 2 gm
Morphine = 200 mg
Codeine = 0.5 gm
Pethidine = 1 gm

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Fatal period = 6-12 hr

Treatment :-
Antidote = nalaxone 0.4 – 2 mg
Methadone = in chronic poisoning
1) Heroin is diacetly morphine .
2) Brown sugar is crude heroin
3) Morphine being respiratory depressant is contraindicated in head injury .
4) Morphine is drug of addiction called morphinism .

ORGANO- PHOSPHOROUS COMPOUND :-

1) Competitive inhibitor of enzyme acetyl cholinesterase ( irreversible inhibitor of enzyme
cholinesterase ) decreased cholinesterase increased in acetylcholine
2) Bronchial tree (Asthma like symptoms )
a) Bronchospasm
b) Increased secretion
c) Dyspnoea
d) Chest pain
e) Pulmonary oedema
3) Smell is kerosene like or garlicky
4) Increased sweating
5) Increased tears
6) Tears may be red due to porphyrin i.e chromolachryorrhoea
7) Bradycardia
8) Pupil- meiosis blurring of vision
9) Sludge = salivation , lacrimation , urination diarrhoea, GIT cramps , emesis .

DUMBELS = diarrhoea , urination , meiosis , bronchospasm, emesis , lacrimation , salivation .

NICOTINE LIKE EFFECT :-

1) Fatigue , weakness ,cramp , muscular twitching , dysponea ,cyanosis .

Action on CNS :-
1) Irritability , restlessness ,fine tremor of hand
2) Convulsion , coma
3) Depression of respiratory and cardiac centre delayed neuropathy

Severe cases :-
1) Pulmonary oedema
2) Cerebral oedema
3) Cyanosis
4) Pin-point pupil
5) Coma
6) Death

Cause of death :-
1) Asphyxia and paralysis of respiratory failure

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2) Cardiac arrest

Diagnosis :- cholinesterase level should estimated , RBC cholinesterase more accurate than plasma

Fatal dose = 15 mg – 10 gm
Fatal period = ½ to 3 hr

Antidote :-

1) Atropine ( muscarinic receptor blocker, antagonize parasympathetic effect )

2) Cholinesterase reactivator
Diacetyl monoxime
Protopam ( pralidoxime chloride )
Pralidoxime iodide

Commonest poisoning in india :-

1) In carbamide e.g baygon P2AM ( pyridine aldoxy methiodate ) is not useful
2) Baygon is reversible cholinesterase inhibitor

METHYL ALCOHOL :-

sign and symptoms :-

1) Blurring of vision
2) Diminition of visual field
3) Retrobulbar neuritis resulting from toxic effect of formaldehyde and formic acid
4) unconsciousness or coma
5) convulsion and death

fatal dose :-
1) 60 -200 ml
2) 15 ml can cause blindness
3) Fatal blood alcohol level 80 mg / 100 ml

Antidote :- Ethyl alcohol

ALCOHOL :-
1) Absolute alcohol is 99 % ethyl alcohol
2) Methylated spirit or denatured alcohol is 95 % ethyl alcohol , 5 % methyl alcohol .

3) a) Rum , whisky ,gin brandy vodka 40-50 %

b) Beer 3-10 %
c) Champagne 10 – 16 %

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4) Methyl alcohol :-
a) It is obtained by destruction distillation of wood or molasses
b) It’s metabolic product is formaldehyde
c) Methyl alcohol can cause optic nerve atrophy can lead to permanent blindness

Absorption and metabolism :-

1) Alcohol can be absorbed from GIT from stomach and 80 % from small intestine .
2) Blood = brain ratio of alcohol is 10/9
3) Blood = urine ratio of alcohol is ¾
4) Blood = breath ratio of alcohol 1: 2100 ml
5) Alcohol is chiefly metabolized by liver with the help of alcohol dehydrogenase

6) Acute poisoning
1)Stage of excitement :-
a) Blood alcohol level 0.05 – 0.1 % ( 50 – 100 mg / 100 ml )
b) Feeling of well being
c) Person usually talk well laugh
d ) Face flushed
e) Conjunctiva injected
f) Pupil dilated
g) Pulse increased
2) Stage of incordination : ( 0.1 – 0.3 % 100 -300 mg /100 ml )
a) Incordination of thought speech action
b) Impaired memory
c) Slurred speech
d) Staggering gait
e) Pupil dilated
f) Slow reacting
g) Breath smell of alcohol ( punch drunk syndrome )
3) Stage of necrosis ( coma ) 0.3 – 0.5 % 300 – 500 mg /100 ml
a) Deep sleep
b) Pupil contracted
c) On pinching the muscle of face or neck pupils dilate and again becomes contracted
on releasing the pitch ( macewan sign )

4) Stage of medullary paralysis :- ( 500 MG / 100 ML 0.5 %)

a) Pupils are dilated skin is cold clammy

b) Abolition of reflexes
c) Pulse becomes imperceptible

Fatal dose = 150 – 200 ml of absolute alcohol

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Fatal period = 12 – 14 hr

Treatment :- ethyl alcohol 1 ml/ kg /day in methyl alcohol poisoning

Chronic alcohol poisoning :-

1) Gastritis
2) Pancreatitis
3) Fatty liver
4) Cirrhosis of liver
5) Malabsorption
6) Loss of memory
7) Korsakoff psychosis : disorientation, multiple neuritis ,loss of memory , hallucination
8) Wernickes encephalopathy : due to thiamine deficiency caused by alcoholism

Medicolegal aspect : -
1) Death is rare due to ethyl alcohol
2) Smell of alcohol ( aromatic / fruity )
3) As per Bombay prohibition act =
a) Sec 22 A RMP can prescribe alcohol
b) Sec 84 it is crime to be found drinking or drunk in drinking place ( fine upto 500 )
c) Sec 66 = if blood alcohol concentration is more than 0.05 % accused has to be proved that
consumption of alcohol was medical or otherwise
d) Sec 85 = it is crime to be found drunk or disorderly on street or public place
e) Sec 40 A = govt can appoint an officer to issue permit for use of alcohol
4) Estimation of alcohol in blood urine or breath is important in all medico legal cases
5) In blood it is estimated by widmark formula
a= CxPxR
a = amount of alcohol consumed in gm
C = ALCOHOL estimated in blood in gm / kg
P = Weight of person in kg
R = is constant ( 0.85 for M / 0.55 for F )
6) In breath alcohol is estimated by drunkometer / breath intoximeter / alcometer / analyser
7) Dipsomania = irresistible desire for alcohol at periodic interval
8) Roughly 130 ml of whisky / brandy / rum and 1.6 litre or beer produces 100 mg % blood alcohol
9) Moderate dose of alcohol better the cardiac health by increasing HDL and decreased LDL
10) Safe limit of alcohol 280 gm in men / per week
140 gm in women / per week
Collection of blood in alcoholic patient ;-
11) For 10 ml of blood 10 mg sodium fluoride 30 mg potassium oxalate is used while collecting blood do
not swab with spirit since otherwise reading will be higher
12) Methanol is oxidized by the liver to formaldehyde which is 33 times more toxic than methanol
13) Formaldehyde is oxidized to formic acid which is 60 times more than methanol and is responsible for
the associated metabolic acidosis and retinal toxicity
14) In chronic alcoholism wernickes syndrome and korsakoff psychosis is seen .

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BARBITURATE :-
Classification
1) Long acting = sodium barbitone , phenobarbitone, mephobarbitone
2) Intermediate = butobarbitone , amylobarbitone
3) Short acting = cyclobarbitone , secobarbitol , pentobarbital
4) Ultra short acting = thiopentone , hexobarbitone
5) In case of severe poisoning =
a) Coma
b) Areflexia
c) Absence of bowel sounds
d) EEG shows alpha coma waves
6) Pupil show alternate constriction and dilation of pupil
7) respiration is slow
8) Hypotension
9) Hypothermia
10) Oliguria
11) Albuminuria
12) Blister on skin ( barbiturate bullae )

Fatal dose = 4-5 gm

Fatal period = 1-2 days
Lethal dose level =
1) long acting 10 mg /100 ml
2) intermediate acting 7 mg /100 ml
3) short / ultra short 3 mg /100 ml

DHATURA :-
1) dhatura alba ( white flowers ) Thorn apple
dhatura niger ( black )
2) Active principle = dhaturine atropine , hyoscyamine
3) They block acetyl choline and produce sympathomimetic or parasympatholytic actions .
4) Sign and symptoms :-
A) ‘ Dry as bone ‘ ‘ red as beet ‘ ‘ blind as bat ‘ “ hot as hare “ mad as wet hen “
B) Dryness of mouth and throat
C) Difficulty in talking
D) Dysphagia
E) Dysuria
F) Dilated cutaneous blood vessel
G) Diminution of vision
H) Dry skin
I) Drunky unsteady gait ( staggering )
J) Dysarthria

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K) Delirium

Carphologia :-
a) Pulling out imaginerary threads from hand or pulling imaginary needles
Cornpicker pupil :-
Unilateral mydriasis caused by pollen

Visual and auditory hallucination are seen .

Mydriatic test :-
Drop of stomach content is put in rabbit eyes
Antidote ;-
1) Pilocarpine 15 mg
2) Prostigmine 1 mg sc
3) Physostigmine
4) Barbiturate
Medicolegal aspect :-
Road side person ( used for road site crime like robbery theft kidnapping )

SEMICARPUS ANACARDIUM ( MARKING NUT / BHILAWAN ) : -

1) Active principle = semecarpol and bhilawanol
2) Juice applied to skin produce irritation painful blister followed by itching and eczema
3) It is also used by washerman to mark clothes

CROTON TIGLIUM ( JAMALGOTA )

1) It contain crotin , crotonoside , crotonoleic acid , methyl crotonic acid .
2) Fatal dose :-
Child = 1 seed 3 drop oil
Adult = 4 seed 20 drop oil

COCAINE :-
coke / snow /white lady /cardiac neurotoxic cerebral delliriant poison

1) Obtain from leaves of erythroxylum coca

2) Sign and symptom :-
Initially it act as stimulant and then depressant
3) Stage I :- Stage of early stimulation euphoria dryness of mouth tachycardia
4) Stage II :- hallucination hyperthermia ( cocaine fever ) dyspnoea convulsion
5) Stage III :- Stage of depression muscle paralysis areflexia coma death

Chronic poisoning :-
1) Tongue teeth are black
2) Anorexia loss of weight
3) In women erotic tension and nymphomania
4) In men sexual perversion
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Magnus symptoms / formication

Feeling of grains of sand lying under skin

Cocaine bugs :-
Feeling of small insects creeping on skin
On repeated dose cocaine accumulate in fat and CNS from where it is slowly released .

Fatal dose = 1 gm
Fatal period = 2 hr
Antidote :- amyl nitrite

1) In amphetamine formication ( tactile hallucination ) is seen in chronic abuse whereas delusion of

prosecution occur in acute intoxication
2) But in case of cocaine poisoning both formication and delusion of formication together seen in
chronic stage
3) Combination of cocaine and heroin taken by injection is known as speed ball

STRYCHNOS NUX VOMICA

( NEUROTOXIC SPINAL EXCITEMENT POISON )
Active principle :-
1) Strychnine
2) Brycine
3) Loganin
Mechanism of action :-
1) Stimulate all part of CNS especially anterior horn of cell of spinal cord
2) Causes increased reflex excitability
Sign and symptoms :-
1) Seeds are nonpoisonous as pericarp cannot be digested
2) Strychnine convulsion :-
a) Initially clonic ( intermittent )
b) Then tonic ( sustained )
3) Ophisthotonous = head and heel touch the ground
4) Emprosthotonous = only back touching
5) Pleurosthotonous = arching sideways
6) Risus sardonius = 9 fixed monkey like grain , spasm of jaw muscle /0
7) Eyes prominent dilated pupil

STRYCHNINE POISONING TETANUS

All muscles simultaneously affected Neck and jaws are affected first
Fever not usual Usually present
Death within few hr Delayed
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FATAL DOSE :- 1-2 crushed seed

Fatal period :- 1-2 hr

Antidote :- barbiturate , phenobarbitone

ACONITE : -
1) Mithajahar / mitha bish / blue rocket / monkhood
2) Active principle :- aconitine , aconine , picraconitine , pseudoaconitine
3) Mechanism of action :
a) Stimulate and depress myocardium , smooth muscle skeletal muscle
b) Tingling and numbness initially at area of contact burning sensation from mouth
to stomach followed by hyper salivation
c) Pupil show alternate contraction and dilatation ( hippus reaction )
d) Ventricular fibrillation bundle branch block
e) Paralysis of respiratory center
Fatal dose :- 1 gm root
Fatal period = 6 hr
Treatment = injection strychnine digitalin and atropine

NICOTINE ( TOBACCO ) { CARDIAC POISON }

Active principle ; nicotine and nicotianine

Mechanism of action :
1) Stimulate and depress and later paralyse cells of peripheral ganglion brain ( especially
mid brain ) and spinal cord
2) Nicotine is very toxic it contract pupil in small doses and but dilate in large doses
Sign and symptoms :
1) Pupils initially contracted later dilated
2) Pulse ,BP , RR increased
3) Confusion and incordination
Chronic poisoning :
1) Bronchitis, pharyngitis , pulmonary emphysema
2) Lung cancer
3) Cancer of lip ,burger disease
4) Tobacco amblyopia , optic atrophy
5) Precipitate angina
Fatal dose = 15 -30 gm of crude tobacco
Fatal blood level 1 mg / 100 ml
Fatal period = 1-10 min

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OLEANDER :-
1) Nerium odorum ( white oleander )
2) Cerbera thevetia ( yellow oleander )

Active principle
1) Nerin oleandrin
2) Cerebrin thevetin nerifolin thevetoxin
Sign and symptom :-
1) Dilated pupil
2) Weak pulse decreased B.P

fatal dose :- 15 -20 gm

Fatal period = 24 hr

Medicolegal aspect :-
1) Commonly used for suicide
2) Commonly used for abortion
3) Commonly used as cattle poison

CANNABIS SATIVA OR INDICA ( INDIAN HEMP )

( NEUROTOXIC CEREBRAL DELIRIANT POISON )

1) Can be used as aphrodesic agent

2) Increased duration of sexual act
3) Poisonous preparation
a) Bhang = ( siddi , patti , sabji )
1) Dried leaves shoots
2) Taken as beverages ( thandai )
b) Majun
Prepared from bhang after treatment with sugar
c) Ganja
1) Flowering tops of female plant
2) Brown in colour
3) Smoked with tobacco
d) Charas ( hashish )
1) Resin ( secretion ) from stem and leaves
2) Dark green or brown in colour
3) Smoked with tobacco
4) Most potent among cannabis preparation

1) Stage of excitement :-
a) Person is pleased cheerful
b) Increased appetite
c) Depression of higher center
d) Typical smell is like burnt rope

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2) Stage of narcosis :-
a) Dilated pupil
b) Loss of sexual power
c) Mental deterioration
d) Sometimes person turn criminal
Fatal dose : 2 gm / kg for charas
8 gm / kg for ganja
10 gm /kg for bhang
30 mg / kg for cannabinol
FATAL PERIOD :- 12 HR

Complication :-
1) Flash back phenomenon ; patient experience the feature of cannabis use without using it
2) Flash back phenomenon is also seen in LSD , PSILOCYBIN , PSILOCIN
3) Amotivational syndrome apathy loss of interest lack of ambition
4) Hemp insanity / cannabis psychosis

Running amok :-
Due to hallucination person start killing a person or killing everybody that cames his ways

Cannabis intoxication
1) Red eye
2) Mild tachycardia
3) Increased appetite
4) Dry mouth
5) Light headness
6) Euphoria ( sense of floating in air )

PARACETAMOL :-
Fatal dose = 10 gm
Antidote = N- acetyl cystine
Sign and symptom :- liver damage

1) FATHER OF TOXICOLOGY = PARACELUS

2) FATHER PF MODERN TOXICOLOGY = MATHIEU ORFILA
3) DRUG AND COSMETIC ACT 1940 : main aim is to control quality purity and strength of drugs . act
has been further amended by drugs amendment act 1964 to include ayurvedic and unani drugs .
4) Drugs and cosmetic rule 1945 :- these rules have classified drugs into schedule as follows
a) SCHEDULE C :- BIOLOGICAL AND SPECIAL PRODUCT
b) SCHEDULE E ;- LIST OF POISON
c) SCHEDULE F :- VACCINES
d) SCHEDULE G :- HORMONES
e) SCHEDULE H :- DRUGS TO BE SOLD ON PRESCRIPTION OF RMP ONLY
f) SCHEDULE J :- LIST OF DISEASE FOR CURE OF WHICH NO DRUG SHOULD BE
ADVERTISED

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g) SCHEDULE L :- ANTIBIOTICS , ANTIHISTAMINES , OTHER CHEMOTHERAPEUTIC

AGENT
Activated charcoal :-
1) Mechanical antidote which absorb poisons and thus prevent their absorption
2) Activated charcoal is best used in poisoning with amphetamine , antidepressant , antiepileptic
,antihistamine , barbiturate , benzodiazepine, chloroquine , cimetidine , opium , theophylline ,
strychnine , phenothiazine , quinine , chloroquine .
3) Activated charcoal is c/I in poisoning with phenol corrosive heavy metal hydrocarbon
4) Universal antidote :-
1) Charcoal 2 parts 50 % adsorb alkaloid
2) Magnesium oxide 1 part 25 % neutralize acid
3) Tannic acid 1 part 25 % precipitate alkaloid
Chelating agents :-
1) Used in heavy metal poisoning
2) They form complex with metal which is more soluble in water than the metal itself
3) Dimercaprol ( B.A.L )

SYNONYM : -
a) Dimercaprol
b) Dicaptol
c) Dithioglycerol
d) British anti lewisite
4) Dimercaprol used in poisoning by
a) Gold
b) Copper
c) Bismuth
d) Nickel
e) Arsenic
f) Antimony
g) Mercury
5) Dimercaprol is used adjuvant to calcium disodium edetate in lead poisoning and adjuvant to
penicillamine in copper poisoning ( Wilson disease )
6) Contraindicated in iron and cadmium (cd ) poisoning , tellurium , selenium , vanadium , uranium ,
mercury vapour

Calcium disodium edentate ( ca na2 EDTA )

( EDTA = ETHYLENE DIAMIN TETRAACETIC ACID )
1) it is used in lead poisoning
2) it is also useful in ZN , MN , FE ,,CU , radioactive metal
3) it has no role in mercury poisoning

PENICILLAMINE :-
1) drug of choice for copper poisoning and Wilson disease
2) also used as an adjuvant to ca na2 EDTA in lead poisoning
3) BAL in mercury poisoning

DESFERROXAMINE : - drug of choice for acute iron poisoning .

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DEFERIPONE :- drug of choice for siderosis ( deposition of iron in tissue )

Elimination of already absorbed poison from circulation :-
a) Forced diuresis with or without alteration of urinary ph
1) Alkaline diuresis useful in :
Barbiturate
Salicylate
Chlorpropramide
Diffunisol
Sulfonamide
2) Acid diuresis :- used for amphetamine , cocoaine , strychinine , phencyclidine , quinidine
3) Saline diuresis :- useful for alcohol , thallium , bromide , lithium , fluoride , chromium ,
potassium , isoniazide
4) Haemodialysis : useful in
1) Alcohol
2) Aspirin
3) Acdtone
4) Atenolol
5) Acetaminophen
6) Barbiturate
7) Bromide
8) Boric acid
9) Chloral hydrate
10) Ethylene glycol
11) Fluoride
12) Lithium
13) Trivalent arsenic
14) Theophylline
15) Thiocyanate
5) Haemodialysis is not useful in :-
1) Copper sulphate
2) Benzodiazepine
3) Organophosphate
4) Kerosene
5) Digitalis poisoning
b) In all poisoning where haemodialysis is indicated peritoneal dialysis is also used with one or more
indication of mercury poisoning
c) Haemodialysis is absolutely indiacted in methanol poison .

Colour changes of skin and mucous membrane :-

1) Sulphuric acid , hcl , oxalic acid :- grey later turning into black
2) Nitric acid :- mostly yellow
3) Hydrofluoric acid :- reddish brown

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4) Carbolic acid :- greyish white

5) Oxalic acid :- grey later turning into black
6) Cresol :- brown leathery
7) Chromic acid potassium chromate :- orange leathery
8) Mercuric chloride :- bluish white
9) Zinc chloride :- whitish

Poison Preservative
1) All poison including carbolic acid Saturated NACL
but excluding other acid
2) Poison with acid except carbolic Rectified spirit
acid
3) Blood for grouping Sodium citrate in water containing
formalin
4) Blood for alcohol poisoning Potassium oxalate (anticoagulant )
sodium fluoride ( enzyme inhibitor )
5) Blood for fluoride poisoning Potassium oxalte sodium nitrate ( in place
of sodium fluoride )
6) Blood for oxalic acid poisoning Sodium citrate ( in place of potassium
and ethylene alcohol poisoning oxalate )
7) Blood for CO poisoning Liquid paraffin
8) Urine Saturated salt / rectified spirit / thyrnol /
sodium benzoate
9) Tissue for histopathological 10 % formalin
examination
10) Sample for uric acid ( GOUT ) Alcohol
11) Autopsy specimen for urological 50 % glycerin
examination

 Sodium fluoride is added to CSF , vitreous humour and urine if alcohol estimated is
required .
 Bone , nail ,hair ,are preserved in poisoning with arsenic , antimony radium , thallium .

ZINC :-
1) It cause metal fume fever
2) Influenza like syndrome
3) It cause fever , headache , muscle ache , malaise , flu- like illness
4) Temperature returns to normal with sweating chills , simulating malaria
5) Paracetamol is required for symptomatic treatment
6) Metal fume fever is caused most commonly by zinc

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7) Metal fume fever is also caused by copper , manganese , nickel , mercury .

CADMIUM :-
1) Cadmium causes itai –itai disease
2) Proximal tubular necrosis , proteinuria , painful bone lesion
3) Osteomalacia , bone pain , pathological fracture
4) Golden yellow staining of teeth
5) Emphysema and anaemia

COPPER:-
1) As a metal is not poisonous
2) Poisonous salts are copper subacetate ( fatal dose 15 gm )
3) Copper sulphate ( fatal dose 30 gm )
4) Fatal period with copper salts is 1-3 days
5) Acute poisoning
a) Metallic taste
b) Increased salivation , thirst
c) Colic abdominal pain
d) Nausea
e) Blue green vomiting
f) May be renal failure
6) Chronic poisoning :-
1) Purple ( blue – line on gums )
2) Blue green vomiting
3) Urine , hair , froth mucosa , perspiration become blue –green
4) Greenish discoloration of dental margin of gums Clapton line

CARBON MONOXIDE :-
1) Carbon monoxide react 200 times more tightly with hemoglobin than oxygen
2) Cause anemic type of hypoxia OR 82 %
3) If COHb > 80 % it cause rapid death from respiratory arrest
4) Upper limit of safety of CO in air is 0 .01 % Hb saturation with CO is less than 10 % then there is
no symptom
5) Post mortem finding :
a) Bright cherry red discoloration of skin mucous membrane , tissue internal organ

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b) Bilateral symmetrical necrosis and cavitation of basal ganglia ( especially globus

pallidus putamen ) is most characteristic feature in delayed death ( may be
confused with PM finding of parkinsonism )
c) Test :-
1) Hoppe seyler test
2) Kunkel ( tannic acid ) test ( Delhi 2016 )
6) COHb 30 % = mild poisoning
COHb 30 -40 % = moderate poisoning
Beyond 40 % = severe poisoning

SPECIAL GASES :-
1) Sewer gas – H2S , CO2 and methane
2) Marsh gas - methane
3) War gas –
Tear gas = i) bromo – benzyl cyanide ( BBC )
II) chloro – aceto phenone ( CAD )
III) ethyl - iodoacetate
4) Blister gas :- mustard gas and BAL ( lewisite gas )
5) Laughing gas :- N2o ( nitrous oxide )
6) Sickening gas :- diphinyl – amine – chlor – arsine

NARCOANALYSIS :-
it is test to detect truth by making person subconscious drug used are
1) Sodium pentothal
2) Sodium amytal
3) Scopolamine
4) Sodium siconal
Poison which retard putrefaction are :
a) Strychnine
b) Carbolic acid
c) Heavy metal like arsenic
d) Zinc chloride
Poison causing proximal tubular necrosis :
a) Lead
b) Mercury
c) Arsenic
d) Cadmium
e) Bismuth
f) Phenol ( carbolic acid )
g) Oxalic acid
h) Ethylene glycol

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 Conjunctiva are yellow in picric acid poisoning

 Conjunctiva and cornea are grey blue or blue black in chronic silver poisoning
 Marquis test is used in morphine poisoning
 Corneal ulceration and conjunctiva inflammation occur in copper dust exposure .

 Hot –shot : A dose of narcotic with poison used to kill fellow narcotic addict .

Neurotic poison can be subdivided into following categories :

a) Somniferous poison :
Produce narcotic analgesia by acting on brain e.g opium
b) Inebriant poison :
Produce generalized CNS depression e.g ethyl alcohol , methyl alcohol , barbiturate
chloral hydrate
c) Deliriant poison : produce delirium as major symptom e.g dhatura belladonna hyoscyamus cannabis
indica
d) Pin- point pupil is seen in :
a) Organo phosphorous poisoning
b) Pontine haemmorhage
c) Opium poisoning

 Gastric lavage is c/I in kerosene poisoning

 Poisoning by irritant may be mistaken for gastroenteritis
 Gastric lavage is indicated in all cases of acute poisoning ideally because of fear of aspiration
 Haemodialysis is absolutely indicated in methyl alcohol poisoning .
 In salicylate poisoning treatment recommended is forced diuresis

CHLORAL HYDRATE :-
1) Action of chloral hydrate is so rapid that it has been given the name of knockout drops .
2) Chloral hydrate is also known as dry wine or sukka sharab .
3) Combination of chloral hydrate with alcohol is known as mickey finn
Remember :
1) Parkinsonism like symptoms are seen in manganese poisoning .
2) Postmortem finding resemble with parkinsonism in carbon monoxide poisoning .

Extra point about parkinsonism :-

1) Bradyphrenia ( slow brain )
2) Bradykinesia ( slow movement )
3) Fastinating gait
4) Mast like face
5) Glabellar tap ( Myerson sign )
6) Lewy bodies ( degenerated neuron )
7) Death of dopamine neuron in substantia nigra ( substantia nigra is part of
midbrain )
8) Choice of drug is levodopa
9) Levodopa is combined with carbidopa to inhibit peripheral metabolism of
levodopa
10) Dopamine doesnot cross blood brain barrier
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11) Levodopa crosses blood brain barrier

3) Priapism ( painful erection of penis ) is seen in phosphorous poison
4) Priapism is seen in cantharide poisoning ( Spanish fly )
5) Phossy jaw is seen in white phosphorous poisoning
6) Semecarpous anacardium is commonly used by washerman to put marks on clothes
7) Rat snake is nonpoisonous snake
8) Semicarpus anacardium produce injuries which commonly simulate contusion .
9) Morbid jealousy / Othello syndrome
a) It is also know as delusional jealousy
b) It is psychological disorder
c) In which person is preoccupied with the thought that their spouse or
sexual partner is being unfaithful without having any real proof
d) It is seen in alcoholism
10) question : - unknown patient present with pyrexia , constricted pupil , hypotension , cyanosis
stupor profressing to coma poisoning is due to :- PHENOBARBITONE
( remember barbiturate poisoning causes hypotension )
11) Barbiturate excretion in urine is by alkalinazation .
12) Japanese detergent suicide technique involve mixing of common household chemical to produce
H2s and other poisonous gases .
13) Bronchopneumonia and pulmonary edema are complication of kerosene poisoning
14) Ethylene glycol when ingested affect kidney by forming oxalate
15) In kerosene aspiration pneumonitis , corticosteroid , prophylactic , antibiotic ,emesis , induction ,
gastric lavage and use of activated charcoal are not recommended .
16) Rave drugs :-
a) These are the drugs which are commonly abused in rave parties for their
euphoric and hallucinogenic property
b) Ectasy ( also called MDMA , LOVE DRUGS , HUG DRUG )
MDMA = 3.4 methylene –dioxymetha amphetamine
c) Gamma = hydroxybutarate ( liquid ectasy or scop water )
d) Rophynol ( also called roofie ropes races )

AMPHETAMINE :-
1) Powerful CNS stimulant
2) Act o n norephinephrine release in brain along with action on release of dopamine and serotonine
3) Symptoms of acute poisoning
a) Cardiovascular
Tachycardia
Hypertension
Cardiac failure
Cardiovascular shock
b) CNS
Euphoria
Seizure
Hyperpyrexia
Tremor
Ataxia
Papillary dilatation

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c) Neuropsychiatric
Anxiety
panic
Insomnia
Restlessness
Irritability
d) Paranoid hallucinatory syndrome closely mimic paranoid schizophrenia , amphetamine
psychosis
e) Auditory and visual hallucination
f) Chronic abuse it causes cycle of runs ( heavy use of several days )
Followed by crushed ( stopping of drug use )
g) Tactile hallucination ( formication )
h) Liquid gold is long used for urine of amphetamine addict which is collected and sold
because of 40 % of amphetamine is excreted unchanged in urine

CARBON DIOXIDE :-
1) Atmospheric air contain 0.4 % carbon dioxide
2) Mechanism of action :- CO2 snow is corrosive
3) Sign and symptom :-
a) Upto 2 % increase in rate and death of respiration
b) Upto 5 % labored breathing
c) At 20 % respiratory discomfort
d) At 40 % dyspnoea , discomfort , muscle weakness , fall in b.p
e) At 50 % dyspnoea tightness in chest ringing in ear fullness in head drowsiness
unconsciousness and coma
f) At 60 -80 % immediate unconsciousness and rapid death

Fatal dose and fatal period :-

1) Minimum fatal concentration is 25- 30 %
2) High concentration of 60- 80 % may cause rapid death

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