TOXICOLOGYPART-2

-DR.AKIF A.B

1) Q. The poison that can be detected in hair long after death is:

A) Lead

B )Mercury

C Arsenic

D Cannabis

Ans. C Arsenic

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

CLINICAL FEATURESARSENIC

Aldrich mee lines

- Rain drop pigmentation/rash/Red velvety Mucosa

Sub endocardial hemorrhage

Excessive pigmentation

Neuritis

Iron Oxide + BAL : Treatment

Mimics Cholera

Important Points Of ARSENIC

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

2) Arsenic poisoning presents with symptoms mimicking:

A Cholera

B Dhatura poisoning

C Barbiturates poisoning

D Morphine poisoning

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

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

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.

4) Barbiturates excretion in urine may be increased by:

A Diuretics

B Alkalinization

C Acidification

D Dialysis

Ans. B Alkalinization

Barbiturates & salicylates excretion ↑ by alkalinisation of urine. Acidification is not recommended.

ALKALINISATION OF URINE- 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

ACIDIFICATION OF URINEDone in case Of alkaline substances like : Strychnine

Morphine

Mnemonic : ‘ine’ containing

substances

SALINE DIURESISDiuresis with 0.9%NaCl Amitabh =Alcohol

Bacchan = Bromide

Corporation = Calcium

Limited = Lithium

5) Urine appears ‘Liquid Gold’ in which poisoning:

A) Heavy metals

B ) Barbiturates

C )Organophosphorus

D ) Lead poisoning

Ans. BARBITURATES

-It causes severe CNS depression.

- Constricted Pupils

-Happus Reaction : Alternate dilatation and constriction of Pupil.

-Liquid gold urine

-Hemodialysis can be done

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

Ans. Lead

LEAD POISONING-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

LEAD POISONINGA = Anemia/AmenorrhoeaB = Basophilic stippling/Burtonian linesC = Colic/ConstipationD = Drop(Wrist/foot)E = EncephalopathyF = Facial pallor

Basophilic stippling

Blue dots on RBCs

Burtonian lines- Blue lines on Gums.

Drop(Wrist/foot)

Diagnosis Of Lead Poisoning

LAB PARAMETER VALUES REMARK1) 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

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

Ans. C Phenobarbitone

Pyrexia + contracted pupils = Phenobarbitone poisoning;

Pyrexia + dilated pupils = Datura poisoning.

8) All the following are features of chronic lead poisoning EXCEPT:

A Encephalopathy

B Burtonian line

C Cutaneous blisters

D Constipation

Ans. Cutaneous blisters

LEAD POISONINGA = Anemia/AmenorrhoeaB = Basophilic stippling/Burtonian linesC = Colic/ConstipationD = Drop(Wrist/foot)E = EncephalopathyF = Facial pallor

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

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;

ALCOHOL-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%

ALCOHOLTypes % of alcohol

Rum 50-60%

Whisky/ Brandy 40-45%

Port/Sherry 20%

Wine 10-15%

Beer 4-8%

ALCOHOL- 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

ETHANOL TOXICITYBlood Alcohol levels Features

<30mg% Driving Limit

70mg% Limit for punishment

>80mg% Nystagmus

> 150mg% Motor inco-ordination

>400mg% Coma & Death

ETHANOL ESTIMATION

WIDMARK FORMULA

A = P C R

Wt. of alcohol Body wt.

Conc.of alcohol

Constant, Males=0.6

Females= 0.5

ETHANOL ESTIMATION-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

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

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,TachycardiaBronchodilation ConstipationDeath

DATURA-Principle : Hyoscine/Atropine/Hyoscyamine/Scopola

-So all anti-cholinergic effects are seen

-Lethal Dose = 100-125seeds

-Seeds resembles chilly seeds

Antidote: Physostigmine/Pilocarpine

DATURADATURA SEEDS

CHILLY SEEDS