General Toxicology
General Toxicology
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TOXICOLOGY
Toxicum: Poison (Latin)
Toxikom: Arrow poison (Greek)
Logia: Science (Latin)
TOXICOLOGY
It is the science which deals with the
poisons with reference to their
sources, properties, mode of actions,
symptoms which they produce, lethal
dose, treatment, methods of their
detection and autopsy findings.
Branches of Toxicology
1. Forensic Toxicology
2. Clinical Toxicology
3. Occupational Toxicology
4. Environmental Toxicology
5. Analytical Toxicology
6. Behavioral Toxicology
7. Veterinary Toxicology
1. Forensic Toxicology:
A- General Toxicology :
• It deals with the general characteristics,
modes of actions, classification and
treatment of all the poisons.
B- Special Toxicology:
• It deals with the specific poisons
separately in details.
GENERAL TOXICOLOGY
Poison
• It is a substance which, when
administered, inhaled or ingested, is
capable of acting deleteriously on the
human body.
In law the real difference between a
medicine and a poison is
• the intention with which it is given
• .Dose
Poisoning
• It is the condition when toxic effects of a
poison are produced.
• It may be human poisoning or cattle
poisoning.
• The human poisoning may be suicidal,
homicidal, stupefying or accidental.
Different Types of Poisoning
1-Human Poisoning
A- Suicidal:
The poisons used for suicidal
purpose are;
potassium cyanide, hydrocyanic
acid, opium and
organophosphours compounds
B- Homicidal:
The poisons used for homicidal
purpose are; aconite,
organophosphours compounds,
oleander, strychnine.
Human Poisoning
C- Stupefying:
The poisons used for stupefying
purposes are; alcohol, dhatura
and cannabis indica.
D- Accidental:
Accidental poisoning commonly
takes place as a result of (1)
careless in storing poisoning and
non-poisons materials together
(2) quack remedies (3) bites by
snakes and scorpions.
2- Cattle Poisoning
• Cattle poisoning is generally resorted by
chamars for the sake of hides. Rarely, cattle
are destroyed by owners when they are
useless.
• The poison used to destroy cattle are;
abrus precatorius, arsenic, yellow oleander,
and nux vomica.
Classification Of Poisons
Classification Of Poisons
The classification of poisons may be in many
ways.
a) According to their mode of action.
b) If they are increasing or decreasing the
functional activity of a system?
c) .Medico-legal classification
d) .Keith- Sympson’s classification
Classification of poisons
A) According to their mode of action, poisons
are classified into seven groups
1. Corrosives
2. Irritants
3. Neurotics
4. Cardiac
5. Asphyxiants
6. Miscellaneous
1). Corrosives
• These are highly active irritants and not only
produce inflammation but also actual
ulceration of the tissues.
Classified
1. Strong Acids
2. Strong Alkali
A. Strong Acids
i. Mineral Acids e.g. sulphuric acid, hydrochloric
acid and nitric acid.
ii. Organic Acids e.g. oxalic acid, carbolic acid, acetic
acid and salicylic acid.
iii. Vegetable Acids e.g. hydrocyanic acid.
B. Strong Alkali
The examples are sodium hydroxide, potassium
hydroxide and carbonates of ammonium/pot./sod.
2. Irritants
Irritants poisons produce symptoms of pain
in the abdomen, vomiting and purging. On
post mortem examination, redness or
ulceration of the G.I.T is seen.
Classified
Inorganic
Organic
Mechanical
A.Inorganic
i. Metallic e.g. arsenic, antimony, mercury, lead,
copper, zinc and manganese etc.
ii. Non-metallic e.g. phosphorus, chlorine, bromine
and iodine etc.
B. Organic
i. Vegetable e.g. castor oil seeds, abrus precatorius,
ergot, capsicum, semecarpus anacardium (marking
nut).calotropis (madar).
ii. Animal poisons e.g. snakes, cantharides and
poisonous insects.
C. Mechanical
These are mechanical substances such as powdered glass,
chopped hairs and diamond dust etc.
3. Neurotics
• Poisons which act Chiefly on the nervous system.
• Chief symptoms are usually drowsiness, delirium, stupor,
coma and convulsions or paralysis.
• The poisons of this group have specific action on the brain,
spinal cord and peripheral nerves ,the poisons being
known as cerebral, spinal and peripheral respectively.
• A. Cerebral neurotics
• B. Spinal Neurotics
• C. Peripheral Neurotics
A. Cerebral neurotics
i. Somniferous/Narcotics
These are the substances used to reduce the pain and induce the
sleep.eg opium and its derivatives
ii. Inebriants
This group of poisons are characterized by two sets of symptoms-
excitement and narcosis. The classical example is alcohol.eg
Alcohol, anesthetics, hypnotics, fuels & op compounds.
iii. Deliriants
The poisons in this group cause the delirium.
Dhatura, atropa belladonna, hyocyamus niger and cannabis
indica(Bhang).
B. Spinal Neurotics
4. Tofranil
Anti-depressants (clomipramine)
5-Narcotics Opium alkaloids
C)-Keith Simpson’s classification
1- Acute Poisoning
The following steps are taken to
diagnose the poison:
a. Mode of onset of symptoms.
b. Examination of signs/symptoms.
c. Laboratory investigations.
1- Acute Poisoning
a- Mode of onset of symptoms : Sudden
Symptoms rapidly increase in severity & are
followed by death or recovery.
Commonly the following systems with
their symptoms are involved in acute
poisoning.
GIT: Nausea, vomiting, diarrhea.
CNS: Convulsions and CNS depression.
Resp: Difficulty in breathing.
b- Examination of signs/symptoms
i- Blood Pressure
Increased in the poisoning of amphetamines,
cocaine and nicotine.
Decreased in the poisoning of hypnotics, alcohol
and opium
ii-Pulse Rate
Increased in dhatura, alcohol and nicotine.
Decreased in aconite, opium, organophosphorus.
b- Examination of signs/symptoms
iii-Body Temperature
Increased in amphetamines dhatura,
cocaine.
Decreased in barbiturates, opium and CO.
iv- Pupillary changes
Miosis (constriction of pupils) is found in
opium,organophosphate and barbiturates.
Mydriasis (dilatation of pupils) is found in
alcohol,cocaine and atropine.
b- Examination of signs/symptoms
v- Smell of vomitus
Phenol----- ---peculiar smell
Cyanide-------bitter almond
Alcohol -------Ether smell
Acetic acid----Vinegar like smell
vi-Colour of vomitus:
Black vomitus-----H2SO4.
Bluish green ------CUSO4.
Grayish white ----Mercury.
Coffee ground ----Arsenic.
c- Laboratory investigations.
• Ingested food
• Vomitus
• Stomach wash
• Blood
• Urine
• Faeces
2- Chronic Poisoning
Bottle No.1:
It contains stomach and its contents.
Both ends of the stomach are tied with ligature.
Bottle No 2:
It contains
a) 60 ounces of liver with gallbladder
b) One kidney
c) Half spleen
Bottle No 3:
A portion of small intestine in parts at
least 3 feet, ligatured at both ends along
with its contents.
Bottle No 4:
Sample of preservative used.
In case of above all, saturated saline is
used.
Routine Specimens Sent to Histopathalogist
One half brain, heart and one lung. In these
the preservative is formalin or alcohol.
Additional samples
Additional samples are Blood, Urine, Long
bones, Bone marrow, Muscles, Nails, Hairs,
Skin, etc. to the appropriate authority.
The preservative for blood and urine is
sodium fluoride.
Add preservative, seal and label the each bottle as
a) Postmortem No.
b) Date/time of PM examination.
c) Name of the dead body.
d) Signature of the doctor.
DUTIES OF A DOCTOR
IN CASE OF POISONING
1. Medical Duties
2. Legal Duties
Medical Duties
1. Assess the patient’s condition and start
immediate treatment to save his life.
2. Refer doubtful cases to the nearest hospital
without delay.
3. Inform relatives of patient about serious
condition of the patient.
4. Carry out all necessary investigations.
5. Determine the route of exposure and the time
elapsed since the incident.
Legal Duties
1. Record the name, age, sex, occupation
address, date and time & two identification
marks.
2. In case of homicidal poisoning must be
reported to the police.
3. If death occurs due to accidental or suicidal
poisoning the police must be informed.
4. If death is imminent, arrange for dying
declaration.
Legal Duties
5. Collect and preserve the following
specimens properly in separate containers:
Stomach wash, Vomitus, Urine and Blood.
6. Collect the evidence of the poisoning from
the scene of crime.
Utensils used for preparation of poison.
Bottle or container of poisonous food or drink.
Clothes or bed sheet stained with vomitus,
urine or other things.
Legal Duties
7. If death occurs,
Must be informed to police.
Arrange for postmortem examination
and collect the viscera.
8. If there is food poisoning, send the food
to chemical examiner for examination.
9. Medical documents should be prepared.
General Treatment of Poisoning
Aims of Treatment:
1. To relieve the symptoms.
2. To make him alive.
3. To get ride of poison by its metabolism,
excretion or removal.
Steps for Treatment:
1. Clinical evaluation
2. History/Diagnosis of poison
3. Elimination of unabsorbed poison
4. Elimination of absorbed poison
5. Use of antidotes
6. Treatment of general symptoms
7. Maintenance of patient’s general
condition.
1- Clinical Evaluation/Assessment
A- Respiratory system
Findings:
Air way obstruction, mucosal swelling and
secretions, posterior displacement of tongue,
dyspnoea, hoarseness of voice, cyanosis etc.
Management:
Chin lift, intubation (nasopharyngeal or
naso-tracheal tube), tracheotomy, and artificial
oxygen therapy.
B- Cardiovascular system
Findings:
Shock, vasoconstriction, metabolic acidosis
and oliguria.
Treatment:
1. Give I/V Fluids, monitor cardiac function and
record urine output.
2. I/V dopamine to increase B.P (200mg in 250ml).
3. Nor-epinephrine 8mg (in 500 ml) I/V.
4. Inj. Adrenaline S/C
C- Central Nervous system:
For Assessment of level of Unconsciousness
a) The Reed’s classification of a comatose patient
Grade o: Arousable to speech and touching.
Grade 1: Respond to painful stimuli and have
intact reflexes.
Grade II: Do not respond to painful stimuli and
most reflexes are normal.
Grade III: Do not respond to painful stimuli but
reflexes are absent.
Grade IV: Deeply comatose, reflexes absent with
respiratory and circulatory failure.
b) CNS Assessment with GCS
(Glasgow Coma Scale)
Clinical Response Scores
i)Eye opening: E4
Spontaneously 4
To speech 3
To painful stimuli 2
None 1
ii) Best verbal response: V5
Orientated 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
b) CNS Assessment with GCS
Clinical responses Scores
iii) Best motor responses M6
Obeys commands 6
Localization to pain 5
Normal flexion to pain 4
Spastic flexion to pain 3
Extension to pain 2
None 1
The response of the patient is expressed by summation
Coma Score (E+V+M)= 03 to 15
Maximum Score =15 (conscious)
Minimum Score =3(Deeply comatose)
2-HISTORY/DIAGNOSIS
Correlate the history with physical examination.
Ask time and amount of poison taken.
Describe the exposure- where, when, why, how
much, and witness of the event etc.
Obtain confirmatory history from the witness.
Symptoms occurred between ingestion &
presentation (vomit, dyspnoea, convulsion and
level of consciousness).
What therapy was given before.
Past medical history- allergy to any drug,
psychiatry or any trauma.
3-Removal of unabsorbed poison
a) Inhaled poison:
When a poison has been inhaled such as CO, or coal gas,
CO2, automobile exhaust, gas from septic tank;
1. Patient should be removed to fresh air.
2. A clear airway should be ensured.
3. Artificial respiration should be given at once.
b-Injected poison:
4. Application of tourniquets (ligatures) proximal to the
point of application.
5. Multiple incision & suction.
6. Examples of injected poisons are hypnotics, insulin,
snake-bite (two marks) & insects bite (1 mark).
c- Contact poison
If the poison be spilled or sprayed on skin, eye or
wound or be inserted into vagina, rectum or
bladder, wash it with plain water, if special antidote
is known, poison can be neutralized.
d-Ingested poison:
In ingested poisons there are 4 methods.
1-Emesis (vomiting),
2-Gastric lavage,
3-Activated Charcoal and
4- Catharsis.
1. EMESIS/INDUCING VOMITING
Indications:
These are used when:
• Poison is absorbed Emesis has failed.
• Gastric lavage is contra-indicated.
• Poison has been administered by
other route than the oral.
• After emesis or lavage to neutralize
residual poison.
Classification/Types Of Antidotes
Antidotes are of the following types:
1. Mechanical/Physical Antidote
2. Chemical Antidotes
3. Physiological Antidotes
4. Pharmacological/Receptor Antidotes
5. Dispositional Antidotes
6. Universal Antidotes
1-Mechanical/Physical Antidotes
These substances act mechanically and
prevent the absorption of poison. They are
of two types:
a) Demulcents:
Those which form a coating on the mucous
membrane of stomach and retard the
absorption of the toxin through the
stomach mucosa e.g. Beaten egg white,
Starch, Fats and Oils.
1-Mechanical/Physical Antidotes Contd…
b) Diluents: Which dilute the substances
ingested for e.g. water and milk.
c) Bulky foods: Like banana which is used
in broken glass and boiled rice.
d) Adsorbents: Which retard the
absorption of drug by binding to it e.g.
Activated Charcoal.
• These are contraindicated in absent
bowel sounds or intestinal obstruction.
2- Chemical Antidotes
These substances undergo some chemical
reaction with the poison and form another
compound which is either non-toxic or lesser
toxic. e.g.
• Dilute acids for strong alkalis.
• Dilute alkalis for strong acids
• Calcium salts for oxalic acid.
3- Physiological Antidotes
• These are the substances that act on the
biological systems and physiological
mechanisms of the drug oppose the
effects of the poisons; e.g.
• Epinephrine ---- in anaphylactic
reactions of drugs.
• Barbiturates ---in strychnine poisoning.
• Physostigmine—in atropine poisoning.
4-Pharmacological Antidotes/ Receptor
Antidotes:
These are the substances that oppose the
action of a poison by acting on the same
receptor where a poison acts to produce its
action; e.g.
• Naloxone---for Morphine poisoning.
• Atropine---for Organ-phosphorus poisoning.
• Flumazenil—for Benzodiazepine poisoning.
5-Dispositional Antidotes
Composition:
• Activated charcoal (Burnt toast)--- 2 parts
It adsorbs alkali.
• Mg02 (Milk of Magnesia)--- 1 part
It neutralizes acid.
• Tannic Acid ( Strong Tea)--- 1 part
It Precipitates certain Glycosides and metals.
Dose: 1 table spoonfull mixed and stirred in glass
of water.
B. Chelating Agents
These are specific antidotes against some
metallic poisons.
These produce a firm non-ionized cyclic complex
(chelate) with cations.
These compounds can form stable, soluble, non-
toxic complexes with metallic poisons.
Mechanism of action
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