G. TOXICOLOGY

TOXICOLOGY

Toxicology is the science which deals with the poisons in reference to their source, properties, mod of action symptoms which they produce, Lethal dose nature of fatal results, treatment, method of their detection estimation and autopsy findings

(I) Clinical Toxicology (II) Forensic Toxicology  In our part of world - Certain poisons

(easy detection) in west - Pharmaceutical products.

(difficult) 

deals with the medical and legal aspects of harmful effects of poisonous substances on the human body

see 337- J (Qisas and Diyat)

Whoever administers to, or causes to be taken by any person, any poison or any stupefying, Intoxicating or unwholesome drug, or such other thing with intent to cause hurt to such person, or with intend to commit or to facilitate the commission of an offence, or knowing it to be likely that he will thereby cause hurt may, in addition to the punishment of arsh or daman provided for the kind of hurt caused, be punished, having regard to the nature of the hurt caused with imprisonment of either description for a term which may extend to 10 years.

POISON It is a substance which when administered , inhaled or ingested is capable of acting deleteriously on the human body.Almost anything is poison.No boundary between drug and poison.IN LAW INTENT IS THE DIFFERENCE

TOXINOLOGY

 It is the science which deals with the toxins, products of plants, animal and bacteria fungi which are harmful to human body.

SUICIDAL POISIONS KCN,HCN, opium, barbiturates, organ phosphorus

poising, oleander etc. AN IDEAL SUICIDAL POISON must be cheep Easy to purchase (available) Capable of being administered in any food/drink) Pleasant taste, no repulsive smell. Lethal dose should be small, Lethal period-short Painless

• Arsenic, mercury, antimony, aconite, thallium, maddar, strychnine , powdered glass, insulin etc.

• AN IDEAL HOMICIDAL POISON• Cheap• Easily Available,• Colorless, odorless, and tasteless,• Must be capable of administered in

food/drink.

Symptoms should resemble some disease.

Lethal dose should be small Fatal period -Long Should have no antidote for it. Should not be delectable at

autopsy.

Alcohol , Dhatura, Cannabis Indica cigarette containing organic material , certain drugs like Narcotics.

Takes place as a result of carelessness.

Quack remedies Bites by poisonous animals Food poisoning

ACCORDING TO MODE OF ACTION (6 GROUPS)1- CORROSIVES (Strong acids & Alkalis)2- IRRITANTS.(a) Inorganic (i) non metallic(Phrs. Cl , Br , I ) (ii) Metallic (Arsenic , mercury, Lead copper. etc.)(b) Organic (i) vegetable(castor oil croton oil Abrus ) (ii) Animal (Cantharides, Snakes , Scorpios, Spiders etc.(c) Mechanical (powdered glass, Chopped hair , Dried sponge, Diamond dust

b- Spinal (Nuxvomica gelsemium)c- Peripheral (Curare conium)4- CARDIAC (Digitalis , oleander , aconite) 5- ASPHYXIANTS (CO, CO2, Sewer gas, War gases.6- MISC. (Different pharmacological products (Analgesics, antipyretics, antihistamines , antidepressent etc. 

(i) Entral ( oral, perrectum) (ii) Parentral (a) Injection

(I.D, I.M, I/V, S/C. ) (iii) Inhalation (iv) External Application. (v) Natural orifices.

(1) LOCAL (direct action) Corrosive and irritants (2) REMOTE (systemic due to absorption (a) specific (b) non specific) (3)LOCAL & REMOTE (carbolic acid) (4) GENERAL more then one system is involved and beyond limits like arsenic and mercury

1- DOSE2- FORM3- METHOD OF ADMINISTRATION4- CONDITION OF BODY

1-DOSE Small dose (Therapeutic results.) Large dose (Toxic result.)

2-FORM OF POISON

A- PHYSICAL STATE (gas, Liquid and solid) coated pills take more time.B- CHEMICAL COMBINATION ( inert like strychnine with tannic acid , led carbonate + copper arsenate )C- MECHANICAL COMBINATION (Acid diluted with water)

3- METHOD OF ADMINSTRATION.

(A)- INHALED (rapid) (B) Intravenous, (I/V, S/C, I/M)

4- CONDITION OF THE BODY 1. Age 2. State of health 3. sleep & intoxication

ACUTE POISONING - symptoms suddenly appear - Person is in good health previously -symptoms do not conform to an ordinary illness - Other persons who have taken same item

effect in same manner. -Symptom rapidly increase in severity. -Followed by death or recovery -Poison can be detected ingredients of food

medicine, fluid, vomit, gastric lavage Blood, urine and stools.

  Symptoms develop insidiously and gradually

- There is exacerbation of symptoms after intake of suspected food, medicine or fluid.

- There is remission or complete disappearance of symptoms after removal of patient from the source. poison can be detected in routine samples and things being used by the patient

main symptoms being malaise generalized weakness, deterioration of health , repeated attacks of undiagnosed G.I irrigation.

Usually Homicidal intent

Evidence of poisoning depends on Postmortem examination Chemical analysis Experiments on suitable animals Moral and circumstantial evidence NOTE: poison retard peutrifactions

1- P.M. EXAMINATION Same procedureSmell from clothes, bodyFroth from nose and mouth Stains on lips chin etc,Colour of skin and and postmortem lividityMarks of injectionsG.I system should be especially watched for hyperemia, softening, ulceration, perforation

2-CHEMICAL ANALYSIS:Detection of poison in paranchyma of organs (proof)Finding of poison is food.

3-EXPERIMENTS ON ANIMALS:Dathura cat,s eyes4-MORAL & CIRCUMSTANTIAL EVIDENCEClues regarding recent purchasesBehavior of the victim/ suspectedAny suicidal noteH/O fight, financial problems.Disposal of dead body in haste.

DUTIES OF A DOCTOR IN CASE OF POISONING

Must record preliminary particulars as name, age, sex, occupation, address, date and time, brought by whom, history, dying declaration.

Doctors duty is to treat the patient. If in private practice- no need to report but if summoned

by police/ count must divulge the case If poisoning is accidental (hotel/ water tank) must notify it If doctor is convinced about homicide must inform police If in is Govt. setup must inform police about all the cases

coming to hospital Record keeping should be meticulous. Must collect the samples like stomach wash. Vomiting,

urine, blood for analysis.

Any suspicious article like utensils, bottles & containers, food or drink near the person.

Clothes and bed sheets of victim. If soiled by vomitus etc.

If the patient is serious arrangement for dying declaration

IF THE PATIENT DIES THEN Must not issue death certificate before informing the

police and Any opinion about nature of poison should be given

after the report from chemical examiner If doctor is performing autopsy viscera should be

preserved and sent for C/E

TREATMENT OF POISONING: If poison is known then treat specific poison if not known on general lines of management Main aim to stay the patient alive by

supporting respiration and circulation Assisted by getting rid of poison by

metabolism, excretion Use of antidote by getting rid of poison

OBJECTIVES: Removal of unabsorbed poison Use of antidote Elimination of absorbed poison Treatment of general symptoms Maintenance of patient's general

condition

REMOVAL OF UNABSORBED POISON: Depending upon route of entrya. INHALEED POISON: (CO,H2,S) Remove from sources to fresh air Artificial respiration Keep airway patent (posture drainage)b. INJECTED POISON: (hypnotics, insulin,

sedatives) A tight tourniquet proximal to point of injection Must be relaxed for one min after 10 min Wound may be excised and poison removed

c. CONTACT POISON: Spilled or sprayed on skin, eyes or wound Best way is to wash it out with water Neutralize it by an antidote.

d. INGESTED POISIONSRemove from stomach as much as possible

by Vomiting, and stomach wash. If patient is conscious and cooperative and

vomiting is not contra indicated. Induce it by tickling the fauces and by use of Emetics

Contraindications are; (corrosive, petroleum, distillates, coma,

Strychnine ) ( cardio-resp. diseases, Advanced pregnancy.

Warm water. Mustard powder ( Table spoon = 15 gm) Two table spoons of NaCl + 200ml tepid

water) Apo morphine 6 mg s/c followed by

nalaxone Hcl 5-10 mg i.m/i.v causes vomiting in 3-5 min.

Facilitate gastric lavage by removing contents

Produce gastric/intestine reflux (Tab)

GASTRIC LAVAGE If not contra indicated-may be life saving but

should be undertaken within 6 hours. Contraindicated in corrosives ( exception in

carbolic acid. Certain measures should be taken such as Strychnine poisoning ( control fits ) Kerosene poisoning ( airway should be

sealed ) Hypothermia ( Body temp should be

maintained.

in prone or semi prone position Head should be down. Flexible rubber tube about 12.7mm diameter And 1½ met . in length. Lips to cardiac end 45 cm. Air should be injected (sound heard) ¼ litters of water (35 C ) First – funnel is up them down. Subsequent washings e ½ liters of water 1st washing is preserved. Appropriate antidote should be used. Color of fluid is noted till it return unchanged. Last fluid should be kept in stomach.

Mg2So4 or Na2So4 ( purging) NaHCO3 ( Aspirin poisoning ) Activated charcoal (absorbs Alkaloids) Liquid paraffin (demulcent) KMnO4 – (oxidizing agent)IN CHILDREN  8 – 12 fr 25 CM Stomach wash with 50ml glass syringe

DEF:- Remedies which counteract or neutralize the

effects of poisons without causing appreciable harm to body .

IT IS USED WHEN a-A poison may not have been completely

removed b- The poison is already absorbed. The poison has been administrated by routes other than ingestions.

1.Mechanical or physical.2.Chemical.3.Physiological or Pharmacological4. Universal.

1.MECHANICAL OR PHYSICALImpede the absorption of poison such as demulcents, bulky food and activated charcoalDemulcents: fat, oil, milk, egg albumin (used in corrosive, irritants) fatty substance should not be used in fat soluble poisons (phosphorus, organo phosphorus)Bulky food; banana, for glassActivated charcoal (alkaloidal poison, strychnine)Dose is 30-60gm in children60-100gm in adults5-10 % the amount of poison ingested

By direct chemical reaction By oxidizing-to non toxic compound asa. Dilute acetic acid _ alkalisb. Dilute alkalis as milk of magnesia _ acids

(bicarbonates are not used _ rupture of stomach)

c. tannin (strong tea)_ alkaloids, glycosides, metals

d. KMnO4 oxdieses (barbiturates, phosphorus, cyanide),(1:1000)-dilution, (100-150ml left in stomach)

Produce effects which are opposite to that effects of the poison as

a. Atropine for pilocarpine Diazepam for strychnine Naloxone for morphine Atropine and oximes for organ phosphorus N-acctylcystine for paracetamol Mazicon for Benzodiazepines (however antagonism is always not

complete and undesirable side effects may be there)

Firm non ionized cyclic complex BAL (British antilewsite),(dimercaprol) 3

mg/kg 4Hr contra indicated in liver damage For next two days 6mg 3days

EDTA(Ethylene Diamine Tetra acetate) arsenic 1gmxBDx5days S/IV uniform(Renal damage-contra indicated)

VERSENATE (Arsenic) Pancillamine (Hg,lead,copper,)

orally,30mg/kg-(2gm) Desfuroxamine (iron)

Excretion through urine (excessive water in take, alkalinizations of urine)

Peritoneal dialysis Haemodialysis Exchange transfusion

Rx OF GENERAL SYMPTOMS Apply it when indicated Morphine for pain, O2 for resp. support Cardiac stimulants for failing heart Saline infusion for dehydration Administration of glucose ---> liver damage Electrolytes imbalance by K-Na etc

Warm and comfortable Avoid risk of infection Administration of antibiotics Psychiatric counseling

Baby Powder: Boric Acid Toys: Copper, Lead Cuticle Remover : KOH Baking Powder : Tartaric acid Domestic fuels : Kerosene oil Fire extinguisher products: Ccl4, methyl

bromide Match sticks: antimony, phosphorus, Kcl Drain cleaner: NaOH Dettol : phenol

Fluorescent lamps: Beryllium Furniture pol.ish: turpentine Lavatory cleaner: Acids Shoe pol.ish: Nitro benzene Medicine: Aspirin, Paracetamol,

Barbiturates, Anesthetics, Stimulants

It can be graded in the following way based upon the amount of substance.

Extremely toxic : 1mg / kg or less. Highly toxic : 1.5mg /kg Moderately toxic : 50-500mg/kg Slightly toxic: 0.5-5.0gm/kg Non toxic : 5-10gm/kg Harmless : more than 10gm/kg

Thank you