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General Considerations of Poisioning

The document provides an overview of poisoning, including its types, classifications, and treatment methods. It outlines various forms of poisoning such as homicidal, suicidal, and accidental, as well as the factors influencing the action of poisons. Additionally, it emphasizes the medico-legal responsibilities of doctors in handling poisoning cases, including the preservation of evidence and reporting to authorities when necessary.

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Priya Sah
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21 views33 pages

General Considerations of Poisioning

The document provides an overview of poisoning, including its types, classifications, and treatment methods. It outlines various forms of poisoning such as homicidal, suicidal, and accidental, as well as the factors influencing the action of poisons. Additionally, it emphasizes the medico-legal responsibilities of doctors in handling poisoning cases, including the preservation of evidence and reporting to authorities when necessary.

Uploaded by

Priya Sah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPSX, PDF, TXT or read online on Scribd
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GENERAL CONSIDERATIONS

OF
POISONING

Dr. Abhishek Karn


Dept. of Forensic Medicine & Toxicology
 Forensic Toxicology: deals with the
medical & legal aspects of the harmful effects of
the chemicals on human being.

 Poison: Any substance, which when


introduced into the living body, or brought into
contact with any part thereof, will produce ill-
health or death by its local or systemic action or
both.
Nature of poisoning:

1. Homicidal poisoning
2. Suicidal poisoning
3. Stupefying poisoning
4. Abortion poisoning
5. Accidental poisoning
6. Rare poisoning
7. Cattle poisoning
8. Arrow poisoning
9. Aphrodisiac poisoning
1.Homicidal:
 Ideal: Organic compounds of Fluorine &
Thallium.
 Commonly used: Arsenic & Aconite.

2. Suicidal:
 Ideal: Opium & Barbiturates.
 Commonly used: Organophosphorous.

3. Stupefying: Dhatura, Cannabis indica, Chloral


hydrate.

4. Abortion: Calotropins, Oleander, Aconite, Lead,


Mercury, Arsenic, Potassium permanganate.
5. Accidental: Household poisons.

6. Rare: Insulin, Bacteria.

7. Cattle poisoning: Oleander, Aconite, Arsenic, Zn-


phosphide.

8. Arrow poisons: Snake venom, Aconite, Curare etc.

9. Aphrodisiacs: Opium, Cannabis, Cocaine,


Strychnine, Arsenic.
CLASSIFICATION: (according to the chief symptoms)
A. Corrosives
B. Irritants
C. Systemic
D. Miscellaneous

A.CORROSIVES :
1. Strong Acids:
i. Mineral acids: H2SO4,HNO3,HCl
ii. Organic acids: oxalic, carbolic, acetic,
salicylic
2. Strong Alkali: hydrates & carbonates of Na, K,
NH4
3. Metallic Salts: ZnCl2, CuSO4, KCN, FeCl3
B. IRRITANTS:
1. Agricultural: Organophosphorous,
Organochlorine

2. Inorganic:
i. Non-metallic: K, I, Cl, Br, CCl4
ii. Metallic: As, Cu, Pb, Hg, Zn
iii. Mechanical: Powdered glass, Diamond
dust

3. Organic:
i. Vegetable: Abrus precatorious,
Calotropins
ii. Animal: Snake & Insect venom,
C. SYSTEMIC:
1. Cerebral:
i. CNS depressants: Alcohols, Opioids, Sedatives,
Hypnotics.
ii. CNS stimulants: Amphetamines, Caffeine,
Antidepressants
iii. Deliriants: Dhatura, Belladona, Cannabis, Cocaine
2. Spinal: Nux vomica, Gelsemium
3. Peripheral: Conium, Curare
4. Cardiovascular: Aconite, Quinine, Oleander,
Nicotine
5. Asphyxiants: CO, CO2, H2S

D. MISCELLANEOUS:
- Food poisoning/botulism
Types of poisoning:
1. Acute: caused by excessive single dose or
several smaller doses of poison taken over a
short interval of time.

2. Chronic: caused by smaller doses over a


period of time, resulting in gradual worsening.

3. Subacute: shows features of both acute &


chronic poisoning.

4. Fulminating: is produced by a massive dose,


death occurs rapidly, sometime without
preceding symptoms.
Factors Influencing the Action of Poisons

1. Quantity of the poison.


2. Physical form-Gaseous/volatile poisons are rapidly
absorbed & show quick action.
3. Chemical form-Pure metallic arsenic or mercury are not
highly toxic but different compounds of these metals are deadly
poisons.
4. Concentration-Usually greater the concentration more will
be the effect except oxalic acid which is more rapidly absorbed
in dilute form.
5. Contents of the stomach-Presence of food delays
absorption except phosphorus where fatty food enhances
absorption.
6. Route of administration
7. Age of individual – Opium and its alkaloids are
better tolerated by elderly whereas belladonna group
of drugs are better tolerated by children.
8. Physique of the person.
9. Presence of any disease
10. Cumulative action of poisons – leads to chronic
toxicity on long term exposure.
11. Idiosyncrasy
12. Tolerance
Treatment of poisoning
1. Immediate resuscitative measures
A. Airway
B. Breathing
C. Circulation

2. Removal of unabsorbed poison from the body


A. Inhaled poison
B. Injected poison
C. Contact poison
D. Ingested poison- gastric lavage/emesis
Gastric Lavage
 Useful within 3 hours after ingestion of poison

 By using stomach tube (Ewald’s or Boa’s tube)


or ordinary soft, noncollapsible rubber tube of
L=1.5 m D= 1 cm with a funnel attach on one
end and a mark at 50 cm from the other end
which should be rounded with lateral openings.

 Patient in left lateral position or head hanging


over edge of the bed and face supported by
assistant.
 The end is lubricated with olive oil/glycerine & is
slowly passed into mouth & through the pharynx &
oesophagus into the stomach till the 50cm
marking.(confirm)

 About 1/4th li. of lukewarm water should be passed


through the funnel held high above the patient’s
head.

 When funnel is empty, compress the tube below


the funnel between finger & thumb & lower it
below the level of stomach, the contents will be
emptied by the siphoning action when the
pressure is released.
 This 1st stomach contents should be preserved for
chemical analysis.

 Gastric lavage can be done with-


-water,
-1:5000 potassium permanganate,
-5% Sodium Bicarbonate,
-4% Tannic Acid,
-1% Sodium/Potassium Iodide,
-0.9% Saline.

 Repeat the wash with ½ li. suitable solution till


clear & odourless fluid comes out
Contraindications of gastric lavage:
 Absolute- corrosive poisoning (except carbolic
acid)
 Relative-

i. Convulsant poisoning,
ii. Comatose patient,
iii. Volatile poison,
iv. Upper GIT disease,
v. Patient with marked hypothermia &
haemorrhagic diathesis

Caution: In drowsy or unconscious patient,


INTUBATE before you attempt gastric
lavage.
3.Administration of antidotes:
An antidote is a substance which can counteract a
type of poisoning.

A. Mechanical or Physical antidotes- (counteracts


poison by mechanical action or preventing their
absorption)

i. Activated charcoal
ii. Demulcents- (forms coating)
eg. milk, barley-water, starch,
egg white, mineral oil
iii. Bulky food- for glass particles.
iv. Diluents- water
B. Chemical antidotes

(counteracts the action of poison by forming


harmless or insoluble compounds or by oxidizing
poison when brought in contact with them)

eg. 1.Common salt for Ag NO3,


2.Egg albumin for HgCl3,
3.Dialysed iron for As,
4.CuSO4 for phosphorous,
5.1:5000 solution of Potassium permanganate,
6.Tannic acid 4% for nicotine, cocaine, aconite
etc
7.Weak alkali for acids.
8.Weak vegetable acids for alkalis.
C. Universal Antidote: it is the combination of:
i. Activated charcoal (2 parts)- adsorbs poison.
ii. Magnesium oxide (1 part)- neutralizes acid
without gas
formation.
iii. Tannic acid (1 part)- precipitates alkaloids &
many
metals.
D. Physiological or Pharmacological antidotes:
(they have their own action on the body to produce
signs & symptoms exactly opposite to those caused
by the poison)
eg. Atropine & Physostigmine.
Barbiturates & Amphetamines,
Strychnine & Barbiturates,
E. Chelating Agents: (Metal Complexing Agents)
- are used for heavy metal poisoning.
- have greater affinity for metals as compared to the
endogenous enzymes.
- complex of metal & the agent is more water soluble
than the metal, so there is higher renal excretion of
the complex.
metal

1. B.A.L
2. E.D.T.A
3. Penicillamine
4. D.M.P.S
5. D.M.S.A
metal
6. Desferrioxamine
F. Serological Antidote: Anti snake venom serum for snake
bite poisoning.
4. Elimination of poison by excretion:

Indications:
i. Severe poisoning.
ii. Progressive deterioration inspite of full
supportive care.
iii. High risk of serious morbidity or mortality.
iv. If normal route of excretion of toxins is
impaired.
v. when the poison produces serious delayed toxic
effects.
vi. If the patient has CVS, respiratory or other d/s.
a. Increasing renal excretion:
-by giving large amount of fluid, tea, lemonade orally,
-urinary alkalinisation for salicylates & phenobarbital.

b. Purging:
-30gm Sodium sulphate with large amounts of water
hastens poison elimination in stool.

c. Whole-bowel irrigation:
-by polyethylene glycol with electrolyte lavage solution.

d. Diaphoretics:
- increases perspiration.
- 5mg of Pilocarpine nitrate s.c
e. Forced alkaline diuresis:
- achieving urinary pH of 7.5 to 9 promotes excretion of drugs
that are weak acids (eg. Salicylates, phenobarbital)
- Sodium bicarbonate 50 to 100 meq added to 1 li of 0.45%
saline administered 250- 500ml/hr

f. Peritoneal Dialysis:
- for alcohols, barbiturates, chloral hydrate, lithium etc

g. Haemodialysis:
- for ethanol, methanol, chloral hydrate etc

h. Charcoal Haemoperfusion:
-for barbiturates, salicylates, phenytoin etc
5. Symptomatic treatment:
-symptoms should be treated on general lines.
-adoption of general measures to support the life of
the patient.

6. Adequate follow-up:
-to treat complication if any.
-in suicidal cases, psychiatric treatment is needed.
Viscera to be preserved in all poisoning cases
1. Stomach with its full contents
2. Half of liver or 500 gms, which ever is more
3. Longitudinal half of each kidney
5. Spleen.
MEDICOLEGAL RESPONSIBILITIES OF A
DOCTOR IN CASE OF POISONING

1. The first & foremost duty of a doctor attending a


poisoning case is to save the life of the
patient. If necessary & the condition of the
patient permits he/she should be sent to a
better hospital for T/t.

2. All the findings including the history, signs &


symptoms, treatment given should be recorded
in details as they may be useful in the court of
law in future.
3. In every suspected case of poisoning, a doctor
whether in private or government service must
preserve all evidence (eg. vomited matter,
stomach wash contents, samples of urine etc).
 Other suspected articles which may be the

source of poison should also be preserved e.g.


– food items, drinks, drugs, empty bottles etc.
 Failure of this duty may render oneself liable to

be charged with causing disappearance of


evidence.

4. If a doctor in private practice is convinced that


the patient is suffering from homicidal poisoning
– he is bound to inform the nearest police
station.
5. A doctor is bound to divulge all information
regarding the case, if s/he is summoned by the
court to give such information.

6. If death is apprehended then arrangement for


recording of dying declaration should be made.

7. In case of death, the police must be informed &


recommendation for postmortem examination
should be made.
THANK YOU

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