Learning Objectives• By the end of the lecture student should be

able to • Classify poison ( accord mode of action)• Neurotics action and• Classification • Heroin, ways of administration • Stages • Sign/ symptoms / post mortem findings• Treatment• complications

NeuroticsNeurotics CNS PoisonsCNS Poisons

According to mode of actionAccording to mode of action

1- Corrosives

2- Irritants

3- Neurotics

4- Cardiac

5- Aphyxiants

6- Miscellaneous

CINCAM

•Neurotics:Neurotics: Act on nervous system.

Symptoms,Symptoms, Headache, drowsiness, giddiness,

delirium, stupor, coma, convulsions or paralysis.Post-mortem findings,Post-mortem findings, are not markedly visible to naked eyes.

Cerebral PoisonsCerebral Poisons

a. Somniferous (sleep inducers)b. Inebriants (drunkenness)c. Deliriants (hallucinogens)

Somniferous poisonsSomniferous poisonsincludes Opium and its alkaloids.InebriantsInebriants includes,

A. AlcoholB. AnaestheticsC. Sedatives & Hypnotics D. FuelsE. Insecticides

DeleriantsDeleriants These includes Dhatura, Bellodona,

Hyoscymus, Cannabis Indica, and Cocaine.

B. SpinalSpinal poisons are those which act on spinal cord, eg. Nux-Vomica

C. PeripheralPeripheral are those which acts on peripheral nerves, eg. Crurae

SOMNIFEROUS POISONS (OPIOIDS)

They are known as somniferous or narcotics because they i. Reduce pain ii. Induce sleep

Important poisons

i. OPIUM

ii. Heroin (Brown sugar) Synthetic derivatives of opium (Diaccetyl morphine)They are strong analgesic and narcotics but cause severe addiction.

Excitement

Narcosis

iii. Pethidine (Meperidine)

(Addiction is very high and treatment is difficult.

Analgesic

Euphoria

OPIUM AND MORPHINE

OPIUM (AFIM):- It is dried juice obtained by incision of unripe capsule of white popy (Papaver somniferum)

• There are two groups of alkaloids i. Phenanthrene ii. Isoquinoline

Phenathrene group

Isoquinoline group

(They are mild analgesic but no narcotic effect)

i. Morphine about 10%

ii. Codeine about 0.5%

iii. Thebaine about 0.3%

iv. Dionin

v. Heroin (Diaccetyl Morphine)

Papaverine about 1%

Narcotine about 6%

• Ripe and dry capsule of popy contain very little opium.

• Poppy seeds (khaskhas) are creamish in colour and contain no opium.

• They are used as food and oil for cooking.• The alkaloids of opium are used in medicine are

i. Morphineii. Codeine

iii. Apomorphine: It is used as emetics

They act as narcotics and sedatives

• Question: Question: How Is Heroin Used?How Is Heroin Used?• Answer: Answer: Heroin is usually• injected,• sniffed/snorted, or• smoked• InjectedInjected , a heroin abuser may inject up to four times a

day. • I/V injection: onset of euphoria (7 to 8 seconds),• I/M intramuscular injection : onset of euphoria (5 to 8

minutes).

Sniffed or smokedSniffed or smoked, peak effects are usually felt within 10 to 15 minutes.

• Smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

SIGNS & SYMPTOMS

Acute poisoning CNS There are three stages.

i. Excitement

ii. Stupor

iii. Narcosis

A. STAGE OF EXCITEMENT: Absent if amount taken in large amount.

i. Sense of well beingii. Laughter, hallucination.iii. Increase in H.Rateiv. Convulsions in children may occur

B. STAGE OF STUPOR:-

C. The stage of excitement is followed by i. Headache, Giddiness, diminished sensibility.ii. Strong tendency to sleep awareness only by painful stimuli.iii. The pupils are contracted, lips cyanosediv. Pulse & respiration normal.

C. STAGE OF NACROSIS: i. Deep comaii. Muscle relaxediii. Pupils contracted & no reaction to light iv. BP is lowv. Skin is cold, profuse perspiration &

temperature is low less than 35oC

CAUSE OF DEATH

i. In fatal termination cyanosisii. Fine froth escape for month. iii. Breathing is sighning & irregular (2-4/m)iv. Coma deepens & death results from asphyxia

due to respiratory paralysis.

FATAL DOSE

Morphine 200 mg opium 2gm10 ml of tincture of opium.In children 1 – 3 drops of tincture of opium.

DIAGNOSITC POINT:i. Breath smells of opium

pointed pupils with no reaction t

olight.i. Moist perspiring skinii. Low temp < 35oCiii. Cyanosis, froth at month & nose.

D / D:i. CVAii. Metabolic conditions

a. Uraemic comab. Keto accidosis, diabetic coma

iii. Alcohol poisoningiv. Organophosphorous compounds

TREATMENT: In early stages the patient should be kept awake by walk.

1. Emetics – ineffective – due to depression of vomiting centre.

2. Stomach wash a. with tepid water.

b. with KMNO4 : 1: 5000 strength till the washed water with original pink colourc. Some KMNO4 should left in stomach to oxidize alkaloids that is secreted in stomach after absorption.d. In the absence of KMNO4, wash stomach with.

i. Tea or tannic acidii. Mixture of powder Charcoal & water.

IMPORTANT: Gastric lavage

should be done if the drug is taken by Hypo dermic or S / C injection as alkaloid is re-secreted into stomach after

absorption.

TREATMENT: SPECIFIC:

i.i. Nalorphine I/VNalorphine I/Vii. (Specific antidote to opium alkaloid &

morphine 5 – 10 mg I / V after every 15 minutes till pupil begin to dilate & responce become normal & pt is aroused Maximum dose 40 mg.

NaloxoneNaloxone (pure antagonist) 0.4 – 0.8mg I/m or I/V to be

repeated every 10 to 15 minutes Maximum dose 10 mg.

i. Antibiotic in case of prolonged coma.ii. Artificial respirationiii. Keep the body warm.iv. Symptomatic treatment

P/M APPEARANCE

i. Externalii. InternalExternal : i. Smell of opiumii. Face nail or bluish black. iii. P/M lavidity is black.iv. Froth at nose & mouth moderate in amount.

INTERNALLY:i. Stomach may contain lumps of opiumii. Trachea, bronchi are covered with froth &

lungs are oedematous. Blood is dark. Blood, bile & brain should also be preserved.

M / L ASPECTS: Mostly suicidal easily availability & painless.Homicidal rare due to bad smell and taste mostly use in infanticide .Accidental poisoning due to over dosage.

Complications

• SummerySummery• By the end of the lecture student should be

able to • Classify poison ( accord mode of action)• Neurotics action and• Classification • Heroin, ways of administration • Stages of addiction • Sign/ symptoms / post mortem findings• Treatment• complications

Help them don’t reject them

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