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NMT 11
Specific Toxicology
 
Chapter 2
Corrosives

Stomach Skin Smoke (Lung)

Scheme:
1- Effect of Poisoning.
2- F.D
3- F.P
4- Action
5- C/P
6- P.M.P
7- Ttt
(+/-)
8- Source & Uses
9- Kinetics
10-Diagnosis ( Investigations)
11- D.D

Inorganic (Typical) Organic (Atypical)
1- Strong 1- Mild
Local
2- Local 2- Mixed
Remote
3- XXX Emesis/Lavage 3- √√√ Emesis & Lavage
Chapter : Corrosives

4- E.g.: -H2SO4 4- E.g.: -Carbolic acid
-HNO3 Potash -Oxalic acid
- HCL

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NMT 11
Specific Toxicology
 

H2SO4 (Acid ) Potash (Alkalies)
1-Source & - Chemicals -Chemicals
Uses: Batteries Cleaning
Laboratories
2-Diagnosis -As before -As before
(Investigation)
3-Condition Child
Of Poisoning: Workers
Accidental Addicts Accidental Children
Therapeutic (Milk)
Suicidal XXX XXX
Face (Revenge)
Homicidal Disfigurement XXX
Blindness
4-Fatal Dose: K2CO3 Na2CO3
4 c.c ×2
15gm 30 gm
5-Action: Local ONLY:
A-Hygroscopic effect: A-Hygroscopic effect
(Absorbs Water From Air) ( Milder)

Stomach Skin Smoke
B- Coagulative necrosis B- Liquefactive necrosis
(Slimy & Soapy appearance)
6-C/P: Laryngeal edema& Asphyxia -√√√ NH3 Fumes.
-Smoke Eschars (Colored ulcers) -Eschars
-Skin H2SO4 Æ Black White
-Stomach 1-Pain & Swelling √
Chapter : Corrosives

4S
2- Swallow (Dysphagia) √
Speech (Dysarthria) √
Shock (Neurogenic) √
Stomach (Perforation) Rare

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Æ √ 7-Cause of > In acids Death & fatal Period: S A D / P C > In alkalies Stricture Shock Asphyxia Dehydration Perforation Cachexia& (Neurogenic) (Few hrs) (12 Hrs) (Days) Emaciation (Weaks) Immediate 8-P.M.P: SUSÆ1.Eschars (Black) Chapter : Corrosives + Brain   3 . √ 5-Dehydration 6-Shock 7-Oliguria 6.PÆ -B. √ -Temp Æ -Temp Æ √ -Pulse Æ Rapid weak -Pulse Æ √ -B.P Æ √ -Resp. Æ Shallow rapid -Resp.NMT 11 Specific Toxicology   3-Vomiting (Acidic Haematin) 3 Vomiting (Alkaline Haematin) Café Brown Soapy 4-Constipation 4-Diarrhea 5.Ulcers & 1. √ 7.Eschars (White) SESÆ 2.Ulcers Perforation + 2.

G Æ XXX 3.Gastrectomy + Morphine 3.Dilatation + >2 weeks Laprotomy 5-10 mg IV for pain + Friable Tissues Antibiotic 4-Jej.Dialysis.Local Antidote Æ .E.deposition 5-Cortisone+ Antibiotic To prevent Stricture 2.Demulcent -NeutralisationÆ XX due to….Supportive & Symptomatic ttt: Surgical Operations S A D / P C + Pervious + 1. Diuresis & Heamoperfusion Æ XX 5.NMT 11 Specific Toxicology   + 3.Internal & External signs + of asphyxia Narrowing of lower end of esophagus + PM changes.Physiological Antidote XX Æ Doesn’t reach Blood Chapter : Corrosives Syptomatic ttt: Skin ttt: -Wash by water -Antibiotics -Skin Graft   4 . 9.Internal & External signs of asphyxia PassagesÆ3. 4.Colon Bypass Stuff 2.C..ttt: 1.

Homicidal: XXX Due to characteristic Smell 6-Action: Mild Æ Mixed Chapter : Corrosives 1-Local: 1-Local: Coagulative necrosis 1-Stomach Æ 1.Delayed Æ 15 Days 3-Diagnosis -As Before -As Before (Investigation) 4-Source & -Coal –tar -Rhubarb Uses: -Disinfectant -Ink Remover (Dettol) 5-Condition of 1-Accidental: -Children 1-Accidental -Workers Poisoning: -Workers -Children -Cheap 2.Mild Corrosives + Local anaesthesia Coagulative necrosis.NMT 11 Specific Toxicology   Carbolic Acid “ Phenol” (4) Oxalic Acid “4 Points” (‫)اﺑﻴﺾ‬ Renal Local Coagulative Failure anaesthesia Necrosis ‫ﻳﺒﻴﺾ‬ Similar to -CNS Æ ‫اﻟﻨﺤﺎس‬ Ink ‫اﻟﻤﻠﺢ اﻟﺴﻜﺮ‬ -CVS Remover "‫ﺑﻴﺤﺐ اﻟﻠﺒﻦ" أﺑﻴﺾ‬ Ca ‫ﻓﻴﻪ‬ 1-Fatal Dose: 4 gm 15gm 2-Fatal -Early Æ 4 Hrs -Rapid Æ 15 min Period: -Delayed Æ 4 Days .   5 .Suicidal: -Easily Obtained Similar to Sugar & Salt crystals -Local Anaesthesia 3.

CNS Æ as before Oxalate 2.Æas before 2. 3-Smoke ÆCharacteristic Smell Æ3.Æin chronic Toxicity ONLY.ÆWhite Eschars Eschars 3-Smoke ÆSmell 3.White Eschars.SmokeÆ…….CVS affectionÆ as before 3-Collecting tubules Æ Renal Failure 7-C/P: 1-StomachÆPain & Vomiting 1-Æ Pain & Vomiting Rapidly White due to Ca oxalate Local Anaesthesia XX Crystals 2-Skin ÆChocolate Brown 2..NMT 11 Specific Toxicology   2-Skin Æ Eschars (Brown) Æ2.CVS Æ as before Ca in Blood Crystals 3.Ms” 6-Renal FailureÆas before Peripheral Asphyxia Chapter : Corrosives +Urine Green in color 2-CVS(as before)ÆArrhythmia Once exposed to airÆ Oxidation 3-Collecting TubesÆ + White Hydroquinone Ca Oxalate Crystals   6 .Renal failure Æ as before 1-Contraction of Ms. 2-Remote: 2-Remote: +Ca Ca 1. 4-CNS Æ as before +Miosis Remote: 5-CVSÆ as before 1-Contraction (as before) +Arrhythmia Convulsions” Resp.

No fear from perforation 3-Local Antidote: 3-Local Antidote: Milk (Demulcent) -DemulcentÆ ‫ﻟﺒﻦ‬ -Alcohol 10% Æ ‫آﺤﻮل‬ Form To precipitate (Dissolvent) Ca Oxalate Oxalic acid -MgSO4 Æ ‫ﻣﻠﺢ‬ 4-D.NMT 11 Specific Toxicology   8-ttt: 1-Supportive & Symptomatic 1-Supportive & Symptomatic ttt: ttt: As before + -RFÆResp. 4-D.No Vomiting -Done -Thickened Stomach Î √√√ So. Æ √√ 5-Physiological Antidote: 5-Physiological Antidote: IV Ca Gluconate 9-Cause of 1-Respiratory FailureÆ Central 1-Respiratory FailureÆ Chapter : Corrosives Death: Asphyxia Peripheral Asphyxia 2-Renal FailureÆ Direct 2-Renal FailureÆ Obstructive 3-CVSÆ Cardiac Arrest 3-CVSÆ Arrhythmia   7 . & H. & D. & D.Failure as before Met-hemoglobinanaemia -RFÆRenal Failure Corrected by Diazepam Vit C Or Methylene Blue 1mg/Kg 2mg -Convulsion Æ as before 2-Elimination of Poisons From 2-Elimination of Poisons From GIT: (ECG) GIT: (ECG) . & H.

Organo-Phosphorus 4. Signs Asphyxia of Asphyxia + + PM picture PM picture + + C\P Æ 6-Kideny C/P Æ 4-Kideny Affection Congested Tense + Ca Oxalate Crystals Enlarged Capsule 5-Dilated Heart 11-D.Ulcers 2-Sup.D: 3C In Stomach: Coma Cyanosis Constricted Arsenic Æ White Powder Pupil Chapter : Corrosives Diff.& Ext.& Ext. Carbolic Acid 3.P: SUSÆ1-Smell SUSÆ1.Sup. Morphine Reinsch Test 2. Signs of PassagesÆ 3-Int.M.Ulcers + Thickened Stomach + + SES Æ3-Brown Eschars SES Æ2-White Eschars + + Brain Æ 4-Brain Edema + Brain Congestion + + PassagesÆ 5-Int. Pontine hge   8 . from Ca Oxalate By 1.NMT 1 Specific Toxicology   10-P.

NMT 11 Specific Toxicology   Oral: Role of Milk:- H2SO4 Carbolic Acid Oxalic Acid Demulcent Coagulation Precipitation To spare stomach proteins Chapter : Corrosives   9 .

Derived from the capsule not the seeds Opium Morphin Heroin Opium Morphine Smell (meconic.B.a) XXX Ingested Injected 10 . Plant poisons Alkali+Acid because Plants are not called {Alkaloids} Salts Alkalies because they don't turn litmus paper blue Plants+Acid Salts 3V OPIUM (Morphin) 5C General↓ Characters of plants: 1)Alkaloids Doesn't turn litmus paper blue 2)Flower Far action 3)Local Antidote 1-Charcoal (adsorption) 2-Tannic acid (PPt) 3-H2O2& KMNO2 (Oxidation) 1-Source Papaver somniferum (Puppy) white oxidation in presence of air ‫ﺑﻨﻲ‬ N.

of poisoning Children Workers Acc Therapuetic √ Addicts √ Suc Addicts Homicidal XXX 5-Fetal dose Morphine 100mg 6-Fetal period Mid day 12 hours 11 .2-Uses 1-Pain killer 2-Shock 3-Morphin addicts 3-Diagnosis Search for Morphine+ Meconic a As before 4-C.

Urine retention 12 . ↓Resp 2-↑Vomiting center Vomiting smell of opium 3-↑VCC (Visual constrictor Center) Pin point pupil (fixed) 4-↓Cortex (sensory) Euphoria Dysphoria(due to over dose) 5-↓Cough center Pulmonary edema (smell (Stertorous resp) of opium) 6-↓Center of heat ↓Temp 7-↓Consciousness{CNS} Coma.Action+ C/P 3V Action 5C C/P ↑ & ↓ 1-↑Vagus ↓ BP.Cyanosis.Central asphyxia 8-↓Colon & Bladder Constipation. ↓Pulse.

P.M.M.P SUS 1-Smell of opium 2-No seeds in stomach + SeS 3.P XX + C/P XX 13 .Needle + Brain 4-Brain edema (Pontine Hge) + Pontine Hge + Passages 5-Int&Ext +Pulmonary edema + P.

Coma
D.D. : 3 C Cyanosis
Constricted pupil

Carbolic acid Morphine O.P Pontine hge.

History History History No History

Smell characteristic Meconic acid Garlic No smell

Low temp. Sub normal low hyperthermia

Irregular pulse Slow & full slow -----------------

Constricted pupil Fixed P.P.P Constricted Constricted

normal normal convulsions quadriplegia

Chemical analysis Chemical analysis Chemical No Chemical
analysis analysis
Urine : Green

TTT :
1) S&S Resp.
2) ECG √√√ - even if injected
- cuffed endotracheal tube (v.imp.)

Due to ↓ cough reflex

avoid asp. pneumonia
3) local antidote:
a) charcoal
b) tannic acid
c) H2O2 , KMNO2

4) D & D & H

5) physiological antidote Antagonists → Atropine (1-2 mg)
Competitors
14

5) physiological antidote

Competitors

Agonist – Antagonist Antagonist

* levallorphan 1 mg/15min. * Naloxone 0.4mg/kg/15mi.

* Nalorphin 10mg/15min * Naltrexone

Cause of death : Central Asphyxia

Atropine , Hyoscyamine & Hyoscine

Diagnosis: Tropine + Tropic acid

Search for them in similar way as before

Sources: 1) Datura fastiosa
2) Datura stramonium release Atropine
3) Atropa belladona Hyoscine
4) Hyoscyamine Hyoscyamine

Uses: 1) ophthalmology

2) GIT

3) Anaesthesia ↑ R.C
↓ Secretions
4) Toxicology Morphine
O.P. aconite

15

F.D.: Atropine & Hyoscyamine 100 mg

Hyoscine 30 mg

F.P.: Datura Day 24 hrs

Cause of death : central asphyxia

C.of poisoning:

Acc. Suic. Homicidal

- Children - Addicts - Road poison
( hyoscine )
-Therapeutic
- Assaults
-Addicts
MAN
Rape Robbery
Marijuana

Atropine Nutmeg
( hepatotoxic)

+ Jaur

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Muscarinic 2) Peripheral similar to atropine & hyoscyamine but weaker Clinical picture: Plant Poison 1 Dry as bone 2 Red as beet root 3 Hot as hare 4 Blind as bat 5 Mad as wet hen 6 Bladder lose its tone 7 Heart runs alone 17 .Actions : Atropine & hyoscyamine Hyoscine 1) CNS ↑ ↓ High 1) CNS ↓ 2) Peripheral receptors (used in case of mania . Obstetric analgesia ) ACH.parkinsonism. Motion sickness.

4) Mydriasis & Fixd Non reactive Pupil 5) Constipation & Urine retention 6) ↑ Pulse .P. & external signs of asphyxia (dry air passages) + P 4-Putrefaction **N. & ↑ Resp.P.: SUS 1-Seeds + SES + B 2-Brain edema & congestion + P 3-Int.→ Resist putrefaction 1-Metal 2-O. Secretions ( bronchial) (dysphagia.B.thirst&haorsness of voice) 2) V.D. CNS : CHAIR * Occupational Delirium * Drunken Gait Staggering Gait. = Unsteady Gait P.M.Peripheral actions : 1) ↓ Secretion Sweat . Rush 3) ↑ Temp. Saliva .P 3-Nicotine 4-Strychnine 18 . ↑ B.

2.S& S→ Resp. act centrally & Peripherally central action (it can cross BBB) 19 .v.imp.ECG + local antidote · Cold foment→ for atropine fever (v.imp.v.) · Catheter→ for urine retention (v.) · Sedative & tranquillizers→ in stimulation stage (v.) · Stimulants→ in depression stage 3-D & D 4-physiological antidote A-Pilocarpine 10mg (peripheral action only) B-Eserine (physostigmine) 2mg Easy To Pass BBB peripheral action So.imp.TTT: 4×2 1.v.

Pupil Dilated & fixed Changeable (Mc Ewin′s sign) 4.D. May occur 6.Vomiting ----.d: Sympathomimetic 30 mg.D.F.Diagnosis: as before + search for coccaine metabolism in urine.Delirium Occupational Tremors on withdrawal 7. Atropine Ethyl alcohol 1.Chemical analysis +ve +ve Cocaine 3C 3S Catecholamines Sympathomometic CNS then Cutaneous anathesia 30 mg ‫ﺴﺎﻋﺘﻴﻥ‬ F.Smell ----.Sources: Leaves of erythroxylon.Skin Hot.d F. 20 . 4. 3. ↑↑ ↓↓↓ 3.F.p 1.p: ‫ ﺴﺎﻋﺘﻴﻥ‬2 hrs. dry & flushed Moist & pale 5. 2. Characteristic 2.Temp.

Central asphyxia (‫)ﺴﺎﻋﺘﻴﻥ‬ 21 .S: ↑. BP. 3. Cyanosis. NS stimulation then ↑ pulse. utaneous anaesthesia 2. C. cardiac arrest depression. 4. ↑.Cardiac arrest (minutes) 2. Cause of death: 1. 2. ↓. CNS: CHAIR + Central asphyxia. psychosis + Hallucination + Delusions + Illusions + Euphoria + Alertness ↑. Theraputic 5. (psychosis) 3.Condition of poisoning: Accidental Addicts Workers Children Suicidal Homicidal Action 3 C/P Stimulation Depression 1.V. Coma. Rate & depth. atecholamine release & 1.: ↑. Quality not Cutaneous Quantity anaesthesia. Resp. uptake. Cutaneous anaesthetic effect.

M. Correction of: Hypertension 1.V.Charcoal.Tannic acid.Physiological antidote Inhaled Nose Wash with saline.Care of respiration.Site of injection + B 2.Putrefaction Rapidly destroyed after death.Care of C. 3.M.P 4. 2. Injected Wash with ice.H2O2 & KMNO2. 22 .Local antidote 1.S. Convulsions 2-ECG √√√ 3. Treatment: Imp.D & D √√√ 5. 4.P. + 2.Internal + External signs of asphyxia + P.Brain edema + congestion + P 3.P S U S + S E S 1.S & S 1.

F. 2. 6.Atrial arrythmias. A. 4.C. of poisoning Accidental Theraputic Children Suicidal √√ Homicidal 23 . 3.Source Digitalis Lanata Or ~ ~ purpurae.CHF 2.F.Uses 1.d ‫ ﺜﻼﺜﻴﻥ‬30 mg digitalin 5 mg digitoxin.p Day 24 hrs.Diagnosis as before + ECG + Electrolytes + Digitalis search for 5.P Digitalin Digitoxin. Digitalis Dysrhythmias Dye vision Diarrhea Drowsiness Dermatological 1.

A. frank pyschosis. 2. GIT Irritant Nausea. 2. hallucination. 1. vomiting. V. contractility 2. 5. Heart Autoimmunity Dysrythmias (details in next table). ↑renal blood supply (diuresis Na K (acute toxicity) & ↓B. Extrasystole. A. restlessness. tachycardia. fibrillation. tachycardia.P. Sinus arrest. C/P of Heart: Tachycardia Bradycardia Atrial Ventricular 1. HR Intracellular Extra cellular 3. –ve chrono ↓. Sinus bradycardia.Action: Mode of action Therapeutic Inhibition of Na-K ATPase enzyme 1. A. 3. colic. 2. diarrhea 4. 3. 3. Eye Dye vision Green-yellow vision / Photophobia / blurred. ↑. 24 . fibrillation. flutter. 2.) Ca K (chronic toxicity) Yeast Toxic Dose C/P 1. V. A-V block. 1. confusion. +ve ino. CNS Drowsiness. 3. Skin Allergy Urticaria & Gynecomastia.

No ulcers Stomach irritant.P: S U S 1.L.P.ECG √√√ 3. 2. 4.Putrefaction.Dose 40 mg/ 20min (IV infusion). + Dilated C/P 4.Heart Hypertrophy Pulmonary congestion Treatment: of Digitalis toxicity 1.D.Physiological Antidote Digibind (Fab) 40 mg 1.S & S Care of the heart Anti-arryhthmic drugs Electrolyte APPL K KCL Lidocaine K Insulin + glucose Atropine Phenytoin & Mg / MgSO4 (1-2 mg) Pacemaker Ca Na2EDTA 2.Tannic acid. & H √√√ fragment antibody 5. 2. 3.P 3.Tablets or leaves or seeds.M.A. + S E S + B + P + P. as before √√ 1.M.Action ↑digitalis excretion & reversed tissue binding.H2O2 & KMNO2. 25 .Charcoal. 3.Preparation ‫ﺨﺭﻭﻑ‬ Digitalis injected Ab Fragment it formed against digitalis 2.

C.P ∆9 T H C Tetra Hydro Cannabinol 2.Investigations As before + ∆9 THC 3.Source: Cannabis/ indica Hashish Marjwana Banjo A. of poisoning Accidental Abusers Suicidal √√√ very rare Homicidal Action: Psychoactive: CNS & 1.D 2-8 gm (2 cigarettes) 1.P alf day 12 hrs F. Personality (Mood) 4. Dose 2. Type 3. ashish ( Systems) F. Previous exposure 26 .

) sweets due to ppt. C. to PPt. Space & time disorientation. 3. Traffic accidents.25 mg/kg Red Eye ↑. Sexual Hallucination. 2. 27 . HR ↑appetite ↓sperms + THC (Conjunct. (specially ↓testosterone cong.C/P Psychological Eye Resp.S GIT Reproduction & Neurological 1.V.>250 mg: 1. angina (not marked as (Euphoria) in males) 2-250 mg/kg Central THC asphyxia Inc. senses: · Smell · Sound · Touch · Colour 3->250 mg (details later) C/P (followed) : Psychological & neurological 3. Impaired attention & concentration. induced Sense of well cough to hypoglycemia) ↓ovulation being.

S & S Care for respiration. 28 .Charcoal 3.M.Tannic acid 2.Brain edema & congestion.P: S U S + 1. 2.M.Central asphyxia.Physiological antidote Caffeine + Tea (strong) (CNS stimulant) Because the patient is nearly comatosed. & ext.Local antidotes 1.Cause of death: 1. + P.H2O2 & KMNO2 5.P + C/P Treatment: 1.D & D & H √√√ 4.Int. S E S + B 2.Smell.ECG √√√ 3. + P 3. 2. signs of asphyxia.Car accidents. P.

‫ﺳﻢ ﻓﺮان‬ Children 5) Condition of poisoning: -Accidental Workers Therapeutics -Suicidal X (Severe Pain) -Homicidal X (Severe Pain) 6) Investigations: ‫اﻟﺨﻮارج واﻟﺘﻘﻄﯿﻊ‬ 7) Action: 1-Spinal Cord à Synaptic resistance ‫( ﻗﺒﻞ ﻧﺎﻇﺮ اﻟﻤﺤﻄﺔ‬Glycine) 2-Stimulus à Contraction of all muscles (No reciprocal innervations) 3-Stimulation of CNS à 30% 29 .P: ‫( ﺳﺎﻋﺘﯿﻦ‬2 hrs) 4) Uses: -Stomachic sense ‫ﻓﺎﺗﺢ ﻟﻠﺸﮭﯿﺔ‬ .D: Thirty (30 mg) 3) F. Strychnine S 1) Source: Strychnus nux vomica seed (Crushed powder) 2) F.

P: SUS 1-Powder or Crushed seeds + SES + Brain 2-Brain Edema & Congestion + Passages 3-Int. & Ext.Pr.Pulse . 8) Clinical Picture: Face (Risus Sardoincus) 1-Severe Exhaustion 1-Spasm of Muscles Extensors of body (2) Death Flexors of U. à Peripheral asphyxia Contraction (1) Death 2-Sympathatic Stimulation .L.Temp. . Signs of asphyxia + PM Picture 4-Resist Putrefaction 5-Earlier Rigor Mortis (No ATP “ Exhaustion of ATP) + C/P 30 . + Mydriasis + Bulging .M.Bl. Ms. 3-Suffer till end à Concious 9) P.Resp. 2-Sensory Stimulus Contract Stimulus Stimulus ‫أي‬ Imp: Opisthotonus Position 10 min of Rest ‫ﻓﻲ ال‬ Resp.

ECG à√ By Cuffed endotracheal tube Because I give him Anaesthesia Charcoal 3-Local antidote kM2O4. H2O2 Tannic Acid 4-D. & H. 2. tetani 2-Bitten tongue + froth 3-Deathà Days 3-Normal face not cyanosed as in 4-Trisumus à Lock jaw strychnine + Rising 5-Gradual 4-One attack only (Not Several) 6-In state of relaxation.D: 1) Tetanus 2) Epilepsy 1-History of Wound 1-Loss of conscious 2-Bacterial à Cl. & D. à Care of Resp.S.Pr 1-+ve Trauseau Sign ( ‫)ﺟﮭﺎز اﻟﻀﻐﻂ‬ Triad: Foot edema 2-+ve Chroslek (Facial àTremors) Proteinurea 5) Meningitis 1-Neck rigidity 2-CSF examination 11) TTT A B C Anaesthesia Barbiturates Calm of dark room (Ether inhalation 1st Then IV anaesthesia) 1. & S. à √ 31 . 10) D. the muscles are Tonic 3) Tetanyà Carpopedal Reflex 4) Eclepsia àFemale Pregnant ( Ca) Bl.

5-Physiological antidote à S M M Succinyl Choline Mephensine MgSO4 (10%) (10 mg) (1mg) Glycine Black Motor End Plate 32 .

Bone ) Excretion Urine GIT: AS……..DS (descending colon) HG…….C.Kinetics ( Hair .T.B 1.Remote Organ Failure ( as before ) 33 . Tooth .Caecum Antimony…….P : A-Local GIT N C Nausea Colic + Metallic taste V D Vomiting Diarrhea Salivation Except Plumbism Æ Conistipation B. Nail .N. Metallic poisoning Scheme:- Distribution H.Action: Mixed Remote: (binds to SH Enzymes & Prevent its action) Plumbum Mercury Arsenic Antimony Fe&Ph Blood&Brain Micturition Liver (Napleon) Antimuscles Liver Of the heart 4.Stomach Living st 1 Dead 2– Diagnosis Reinch test ( except lead ) 2nd Lead ( X-Ray ) Local ( GIT ) 3.

Local antidote: Adsorption Precipitation ‫ﻟﻸﺑﻴﺾ‬ ‫ﻟﺒﻦ أﺑﻴﺾ‬ (Mercury) Arsenic Fe(OH)3 Antimony Tannic acid H2O (‫)ﻣﻴﻪ‬ MgSO4 (‫)ﻣﻠﺢ‬ Ph ‫ﻧﺤﺎس‬ Iron (acidosis) NaHCO3 34 .S&S B.Ulcer + Intact mucosa in between B.ECG C.Resist & Delay putrefaction (due to dehydration & bactericidal effect of Metals) 7.physiological antidote → Chelators 3-Penicillamine 4.Organ Failure (1 Week) 8.M.P) 1 week (Remote) Organ Failure 6.BAL 2.EDTA E.Dehydration & Shock (1 Day) B.D&D 1.P.Cause of Death: A.Local Antidote D.Fatality 1 Day (local) Dehydration & Shock Period (F.P superficial A.5.Treatment: A.Desferol C.

Household Salts overdose .of Poisoning: .25 mg/dl in Urine >100 mg/dl in Urine C.Ingestion of soluble Accidental . D Vit.P: Local 1 Day 1 Day Remote 1 Week Brain 1 Week Kidney 35 . D L Caecum (excreted) Alkalies Acids I Parathormon Z Deposition T E Diagnosis: Living Living X-Ray Reinch test Intestine Liver Bone ‫ﻣﺪورة‬ >0.Environmental -Vaginal plugs Homocidal Rare Rare by Insecticide Suicidal Ingestion of Corrosives F.Occupational . Blood Brain Black offensive Micturation Mucus ‫ﻣﻴﻪ‬ stool Plum bum Mercury Kinetics: Distribution: H+N+T+B Distribution: H+N+T+B Ca M O B Ca Ca I Vit.

TEL child (immature Mecuric Macurous (in petrol) BBB) Workers -Chloride Chloride Calomel Cleaning -Fluminate Colon of children Firearm -Cyanide Pink Disease Cidal 1.Bullets 1.Oxides On iron ×××× (to prevent rust) .D: .Oleute Ovum .Subacetate S.Painful 3.Batteries 3.Environmental: Air (exhaust fumes) Metals Salts Food (flies) Non toxic if ingested H2O (pipes) Skin by injected Toxic Lung by inhalation 2.F.C ×××× Haematoma Diuretic .Pipes 36 .Pencils 2.Arsenic Ants Organic Inorganic .Lamps 4.Industrial & household: .TEL (2 drops) ‘Two’ 1 gm ( Mercury Mono ) .Printers 3.Bald (alopecia) Uses: 1.BP 5.Blood Pressure 2.Pink extremeties 2.‫ﻣﺶ ﻋﺎرف أﻗﺮأهﺎ‬ 4.Rest 10 gm ‘Ten’ Sources: 1.

3)Resist & Delay Putrefaction 3)Resist & Delay Putrefaction 37 .M.F (as before) P.P: S U S 1) Superficial Ulcers 1)Ulcers + Specially Caecum S E S X X X X X X + B + 2)Encephalopathy (Brain edema & Congestion) P X X + P. of *Kidney Failure mental deterioration ) 2)Blood Haemolysis R.M.Action : Local : (GIT) Local: GIT Remote : Remote: Kidney Brain Blood haemolysis C/P: metallic taste a)Local: M N V M N V S C D black & Offensive stool salivation S C D + Dehydration &Shock mucous + blood b)Remote: (Merconial 1)Brain dysentery) Encephalopathy (all sympt.

A 2) Precipitation 2) Precipitation: Salt MgSO4 ‫اﻷﺑﻴﺾ ﻟﻸﺑﻴﺾ‬ ‫ﺑﻴﺎض اﻟﺒﻴﺾ‬ Not milk Death 4) D&D √√ 3) Mercuric Mobilization followed by Mercurous immobilization to allow The chelators to work efficiently Na Formaldehyde 5) Physiological √√ Sulfoxalate antidote Chronic Lead Poisoning 6 Bs Æ Body Organs Plumbism =Chronic toxicity • Purely motor neuritis: C/P : Convulsion 1)Brain Encephalopathy Mental Paralysis Motor Muscle atrophy Wrist & foot drop = Peroneal ms+ Median n (extensors) 2) Buccal Stomatitis Blue line 38 .TTT: 1) Care of shock 1) S&S 2) Care of dehydration 1) Care of shock 3) Care of CNS 2) Care of Kidney 4) Care of Kidney 2) ECG √√√ √√√ 1) Adsorp Charcoal 1) Adsorption Charcoal 3) L.

D Intestinal Obstruction Constipation 4) Reproductive System ♀ Abortion by 2 ways Ecbolic ‘ Uterine cont.’ ♂ Impotence Ovum Death Sterility 5) Bone Arthralgia Lead Lines by X-Rays 6) Blood& Vascular Pallor V.3) Bowel Colics D.C Anaemia Fragility Microcytic hypochromic anaemia Haemolysis Punctate basophilia Mature RBC Ribosomal RNA Immature RBCs Enzyme Lead Treatment: ‫ ﺟﻮﻩ اﻟﻌﻈﻢ ﺑﺪل ﻣﻦ اﻟﺪم‬Pb ‫ﻳﺪﺧﻞ‬ + 1) Prophylactic Ca+2 Check up Clothes Containers 2) Prevention of further exposure 3) Physiological antidote Chelators Most imp EDTA 39 .

4) Symptomatic: Brain Encephalopathy + Anticonvulsion Paralysis Physiotherapy & Splint Bowel relaxant Colics ?????? Purgative Blood Iron or Blood Transfusion Chronic poisoning (Mercury) ‫ﻣﺘﺴﻮل‬ Mercuralism C/P: 1) Mercurialentis 2) GIT Mercurial dysentery Mucous + blood + Vomiting + Diarrhea 3) Renal failure Olig + ABC : anuria 4) Oral Salivation Gingivitis Grey line (Mercury) Cancrum Oris Gangrenous 5) Skin weeping dermatitis (oozing dermatitis) 6) Cerebellum kinetic tremors 7) Psychic shyness loss of confidence erytheism TTT: cloth 0) Prophylactic container check up 40 .

1)Prevention 2)Physiological antidote 3)Symptomatic ttt:- *psychological *BAL skin ointment *Nervous *BAL eye drops Metallic poisoning Anti muscle of heat Anti mansoni & Ampoules Napolion ponapart + ‫ارز‬ Arsenic Antimony Diagnosis: Reinch test ‫اﺷﻜﺎل هﻨﺪﺳﻴﻪ‬ Amerphous powder Kinetics: Ascending & descending colon Stomach F.P: 1day dehydration & shock 1day 1 week liver failure dehydration & shock Heart failure Source: 1-‫اﻟﻄﻴﺐ‬ As2 S3 (yellow) 1-Antimony sulphide (‫)آﺤﻞ‬ 2-‫اﻟﺸﺮﻳﺮ‬ As2 O3 (White) 2-Antimony oxide (‫)اآﻞ‬ 3-Organic Syphilis 3-Antimony chloride Corrosive 4-Inorganic salts lead arsenate 4-Tartar emetic Insecticide Cu arsenite 41 .D: 100 mg 100mg F.

Occupational Accumulation in organs • Suicidal Rare hypersensitivity • Homicidal Common Industrial exposure Advantages: 1) Colics (gastroenteritis) 2) Color • Hom. of Therapeutic Poisoning: overdosage • Accidental Household • ACC. H’ 42 . 3) Can escape (4hrs) Rare 4) No Characteristic • Suic smell/odour Disadvantage: Detected after putrefaction In ‘B. renal failure irritation + dialysis USES: 1-‫اﻟﺒﻴﻮت‬ glass 1-Insecticide ceramic 2-War gases Paint paper 2-Insecticide 3-war gases C. 5)Arseine gas 5-Stibine gas haemolysis ttt haemolysis RF blood CNS transf. N.

.....D D.V & Diarrhea 5)Temp ↓ ↑ P....P: SUS Ulcer SUS 1) Ulcers + + 2) SES SeS + B 3) Heart + 43 .M...D: Arsenic Cholera 1)Toxic √ X 2)Bacteria X √ 3)Colics √ X 4)Vomiting V.Actions: 1)Local: GIT GIT 2)Remote: SH group enz SH group enz Liver Heart Heart Liver Kidney Kidney C/P: 1)Local: 1) Local m n V s C D Rice watery stool The Same D&S due to toxic capillarities stress of intestinal 2) Remote: Heart Failure mucousa 2)Remote: Liver Failure D.

P + P.M putrefaction + C/P congested liver C/P: Sometimes complications Kidney 8% toxic jaundice Heart TTT: 1) S & S • Care of shock • Shock • Care of liver • Heart 2) ECG √√√ √√ Except antimony Chloride Corrosive 3) Local 1)Charcoal (Adsorp) 1)Tannic acid antidote 2)Fe(OH)3 (percipt) 2)Charcoal 4) D & D √√ √√ 5) Physiological BAL antidote DMSA EDTA 44 .

etc…) 4)Symptomatic ttt BAL eye drops & ointments 45 . clothes 1)Prophylactic containers 2)Prevention 3)Physiological antidote (BAL. Chronic Arsenic A R S E N I C Coryza + perforated -Alopecia nasal septum .Aplastic anaemia Skin Nails Sensory neuritis falls ‫زﻳﺎدﻩ‬ Melani ‫ﻓﻲ اﻟﻠﻮن‬ Warts ‫ﻓﻲ اﻟﺤﺠﻢ‬ + GIT manifestation + Organ Liver Heart Kidney TTT:.

Chronic Antimony ‫اﻟﻔﻼﺣﻴﻦ‬ (Pustules) Heart GIT + Organ Liver Kidney Arsenic Cholera 1)Toxic √ x 2)Bacteria x √ 3)Colics √ x 4)Vomiting & diarrhea Vomiting diarrhea Diarrhea vomiting 5)Temperature ↓ ↑ 46 .

(As before) (No Reinsch) F.D 1w 200mg/kg liver & kidney C. Phases Phosphorescent garlic Phosphorus Fatty liver + kidney ---------------- Ca Source:.P 1d D&S F.1)‫( اﻻﺻﻔﺮ‬Yellow) Rat posion + Fertilizers 2)‫( اﻷﺳﻮد‬Black) Zinc phoshide Rat poison 3) ‫( اﻷﺣﻤﺮ‬Red) Matches 4)‫( اﻟﺸﻔﺎف‬phosphene gas) Melting Kinetics:.of poisoning:- Children • Acc workers • Suic √ • Homicidal x smell 47 . Fat soluble Smell Diagnosis:.

Ca in blood C/P:.Glycogen & Liver Acute fatty liver Kidney 3) ↓Ca in blood + Ca in bone Bone sequestration & necrosis . n c 1)Local:.Action:- 1)Local GIT Protoplasmic (Disturb metabolism) 2)Remote + Fat deposit Necrobiosis Fatty .(GIT) v D (1ry phase) Garlic ( Smoking stool Apparent Syndrome) phosphorescent (luminous) Recovery 2)Remote (liver) → (2ry phase) (Kidney) →  3)↓Ca Cramps & convulsions 48 .

M + C/P TTT :.A 2)CuSo4 (precipitate) 3)H2O2 (Oxidation) (O2 ‫)ﻋﺪو‬ KMNO4 phosphate ↑↑ 4)D&D 1) Physiological Antidote X NO Chelators ‘ Not True Metal’ Ca Gluconate ‘Due to Ca Deficiency’ 49 .P.P: SuS 1)Smell + 2)Ulcer + luminous SeS 3)Resist putrefaction + 4)Fatty liver & kidney B + B + P. Shock & Dehydration 1)S & S Liver Kidney ↑↑ 2)ECG √√ 1)Charcoal ↓↓3)L.M.

↓BP CNS CVS R Recovery (unkown reason Cellular hypovolemic Hypoxia shock Convulsions Tachycardia Tachypnea O ↓O2.P: 1d 1w liver failure Actions: 1)Local 2)Remote 3) Capillary permeability 50 . ‫ ﺑﺎﻟﺘﺮﺗﻴﺐ‬Stages IRON C/P: Intestinal (GIT) plasma loss I ↑Capillary permeability ↓O2.V.D: 200mg/kg F. ↓BP C.S Severe↓↓ cyanosis+metabolic acidosis(anaerobic metabolism) N Necrosis of liver S Stenosis of GIT (fibrosis pyloric) (due to deposition of Fe) Diagnosis:- + X-ray F.

of poisoning:.C. Mainly children Acc Therapeutic (predisposed) Suic √√ Homicidal XX P.P:- SUS 1)Ulcers + 2)Tablets SES + B 3)Brain + P + P.M. Shock 1)S & S Liver 2)ECG 3)LA NaHCo3 charcoal 4)D & D √√ 5) Physiological Antidote Desferol (until wine rose color of urine disappear) 51 .M.P 4)Resist putrefaction + C/P 5)Liver (necrosis) TTT:.

F R. But without IODINE Gastic lavage) Corrosive (as carbolic a) R.F (I2) Allergy (renal & resp.f) F. Chronic Iron Toxicity Haemosiderosis Lung siderosis Liver +Brown (Site of injection) (As carbolic a.d 2gm Sources & uses Antiseptic Diagnosis ‫ﺧﻮارج وﺗﻘﺎﻃﻴﻊ‬ F.P 1day Respiratory failure + Allergy 1w Renal Failure 52 .

Brown urine 3)Allergy Angioneurotic edema (pulmonary edema) P.P:- Sus 1)Ulcers + 2)Eschars Ses 3)Renal failure + 4)Respiratory Failure B + P + P.M.GIT C D D&S 2)Remote:.M. Corrosive (Coagulative necrosis) Stomach Skin 2)Remote Renal failure 3)Allergy Respiratory failure C/P:- N V Brownish + corrosions 1)Local:.P + C/p 53 .Action:- 1)Local:.

A Demulcent 4)D & D √√ 5)Physiological Antidote 54 .TTT:- Shock 1)S& S RF RF Allergy (Cortisone + Anti histaminics ) 2)ECG XÆ NEVER as it is A Corrosive 3)L.

.: 1 min 55 .Na-nitro prusside 5Cs Coma Volatile ttt of HTN Cyanide (Hydrocyaanic acid) (prussic acid) Source: A) ‫زراﻋﺔ‬ Cyanogenic plants ‫اآﻞ و ﻗﺘﻞ‬ Cidal B) ‫ﺻﻨﺎﻋﺔ‬ Cameras Graphic arts Metallurgy Kinetics: Smell: (bitter almond oil) D.: .Acid & drop. Spies Lab.D.Cytochrome oxidase .Salt 300 mg. of Poisoning: child Acc.D: CN Red Asphyxia CO Cold C. F. X (smell) Execution USA F. workers Homic.P. workers Suic.

Action: 1) Cytochrome oxidaze enz. Pulse Arrest 56 . Anoxia (Hisotoxic) Asphyxia (Red) Acidosis (Anaerobic) 2) Corrosives ( GIT) C/P: 1) Large dose death 2) Small dose Cytochrome oxidase O2 Corrosive CNS CVS Corrosive Headache Coma Convulsions Tachycardia Tachypenia BP.

A √√ 1/2 dose Physiological Antidote NT Kelo CT Nitrite thiosulfate cyanor cobalamine thiosulphate 1) NT Nitrite thiosulfate c c Na Nitrite a. 3) Brain oedema &congestion.Met Hb + Vit C Æ Oxy Hb. signs of Asphyxia ( Except blue Æ Red) TTT: ***0) Physiological antidote. 57 . d. & Ext. 1) S&S Care of resp.Oxy Hb Met Hb Amyl (inhalation) + Cyanide b.M. 4) Int.Cyanomet Hb + Na Thiosulfate Æ Na-thiocyanate ( non- toxic) + Met Hb.P.P: 1) Smell. 2) ECG √ 3) LA H2O2 or KMnO4 ( Oxidation)* 4) D&D&H √ 5) Phys. 2) Ulcers (slats).Met Hb Cyanomet Hb Cytochrome-oxidase c.

2) Dicobalt EDTA Kelacyanor Directly chelate cyanide Dose: 300-600 mg 3) C T thiosulfate oH (cobalamine) a.Vit B12 Vit B12a (Reduced) 58 .Vit B12a + Cyanide cytochrome Æ Vit B12 + Free Enzyme Oxidaze (Cyanocobalamine) Na thiosulfate b.

GIT 5% Lung 5% Skin • Distribution: organs with H2O content + Optic nerve • Metab. slow excretion Æcummulation effect Alcohol Alcohol Methanol formaldehyde formic acid dehydrogenase dehydrogenase folic more dengerous acid than methanol CO2 + H2O • 10% excretion as it is 5% mouth 5% urine C. of poisoning Acc. Child workers (fumes) Mainly because its Addicts not fit for drinking 59 . Methanol MICC (Wood alcohol) Because it’s derived from wood Source: ‫ﻣﺼﺎﻧﻊ‬ solvents ‫ﺑﺎرات‬ adulterated (‫)ﻣﻐﺸﻮش‬ denaturated Uses: • In factories. & Excretion Æ90% liver. • Unfit for drinking Kinetics: • Absorb.

D. Antidote Æ Ethanol Æ compete with methanol Dose ½ ml/kg 2hr 2days Better : folic acid ( leucovorin Ca) 60 . Less than 10 hrs ( few hrs) Action: Methanol formaldehyde formic acid 1)CNS 2)Optic n. Atrophy 5) Pancreatitis pipe stem atrphy TTT: Phys. 100 ml Æ death 15 ml Æ blindness F.P: 1) Smell 2) Brain 3) Asphyxia 4) Optic n. Death.F. atrophy 3)Acidosis C/P: M Mydriasis Metabolic acidosis (kaussmal respiration ) ‫ﺟﻌﺎﻧﺔ ﻟﻠﻬﻮا‬ ‫ﻗﺪام‬ I Intestinal n c ‫ورا‬ hge pancreatitis Vd C Convulsions C Coma.M. Central asphyxia P.P.

Drowning Car accid. 61 . Uses: Hospitals & industry Antiseptic House Cologne Bars Beverages F.D: Atropine Diagnosis: Breath Analyzer or Drunkometer C. of poisoning: Children ▪ Accidental Workers Addicts Therapeutic ▪ Suicidal Indirect cause Depression excess intake Head inj. Ethanol EICC EICC D. ▪ Homicidal Expensive Characteristic smell Famous Rape Robbery Sources: Produced fermentation of sugar by yeast concentrated by distillation.D: 800 ml F.P: 10 hrs.

Convulsion & narcosis 3-5 mg/dl √√ 4. ◊ Can't speak hiccough vomiting tremors slurred speech 3. 2.Coma & death (central asphyxia) .Acidosis ‫ﻳﺪﻓﻰ‬ cut.5 mg/ml frontal lobe parietal 2.◊ Convulsion ◊ Hypoglycemia ◊ Conjugate eye deviation ◊ Hypothermia 4.◊ Feel happy (Euphoria).Coma > 5 mg/dl medulla S&S 1.CNS depression ‫ﻳﺪر اﻟﺒﻮل‬ ADH 2.5-1. blood flow 3. ◊ Feeble reaction time.NO Eye Manifestations ↓temp ↑sweat V.M irritation ‫ﻳﻔﺘﺢ اﻟﺸﻬﻴﺔ‬ secretion of ** Toxic dose** GIT 1.D evaporation C/P: 1. ◊ Can't see (diplopia).Incoordination 1.Excitation 0.5-3 mg/ml occipital cerebellum 3.Sign (Mcewen's) 62 .Smell ** . ◊ Fool behaviour (sexual crimes).◊ Can't stand (ataxia) staggering.Action: Local Systemic Skin cooling ‫ﻳﻨﻴﻢ‬ CNS M.

Brain oedema & congestion. signs of asphyxia.V NaHCO3 for Acidosis. 3. 2. Int. **** BICARBONATE Brain edema Bl. B6 (pyridoxine) + Alcohol metabolism I. Stomach congestion & irritation. Hypostasis blue Flushed TTT: •Care of respiration •ECG •NaHCO3 (acidosis) •D&D •Vit. & ext. Smell.PMP: 1. 5.Glucose Glucose or Mannitol “Osmotic Agent” 63 . 4.

tract chem.GIT irritation. Condition of poisoning: Accidental Children Workers Suicidal – ♀ Homicidal F. Pneumonia(asp) Cough & dyspnea bact.CNS depression Coma.P: 1 day central asphyxia > 1 day chemical pneumonia Action Clinical picture 1. Cyanosis (CA) 64 .Resp. colic & diarrhea. Uses: Fuel. Kerosene Kitchen Cough + Colics + Cyanosis Cuffed tube + Charcoal + Culture antibiotic Source: Petrolleum. Diagnosis: X-ray chest. vomiting. 3.D: 20 ml F. pneumonia 2. Nausea. solvent (factors).

PMP: • Smell • Stomach congestion • Brain edema • Int. & ext.Antidote • D&D • No physiological antidote 65 . signs of asphyxia • Lung consolidated patches TTT: • Care of respiration S&S • Antibiotic after culture & sensitivity ECG • No emesis LA • Cuffed endotracheal D&D • Charcoal Phys.

-ACC. Toxic gases Carbon monoxide • Source : C + O → CO 1)Charcoal 2)Car fumes 3)Coal mines 4)Cigarettes 5)Fire • Kinetics : silent killer ( odourless / colorless / smokeless ) • D.of poisoning : Ocupp. -Homi.D. : Red asphyxia CO CN Cold • Diag. : Spectroscope + Gas chromatography -Dilution test -kunkels test -Infra red analysis • C. Children adult -Suic. Rare 66 .

association .dissociation (shift to the lift ) Red Asphyxia Anaemic Anoxia • C.D.1 % in air → 50 % CoHb • F.P. : 2 hrs. Key word S&S 0-10 % 20 % Two systems • CNSÆ headache • CVS Æ Dyspnea(severe excercise ) 30 % Three Systems • CNS Æ throbbing headache • CVS Æ Dyspnea (more) • Muscles >>> weakness 40 % Four systems • CNSÆ more &more Fail to escape • CVSÆ dyspnea • Muscles Æ incoordination • GITÆ vomiting 50 % Flaring of • Shock symptoms + 70 % Starting death • Convultions/coma/cheynestokes resp. : Conc.P. : 0. >70 % Immediate death 67 . • Action : 1)Co + Hb (300) 2) .• F.

1-fresh air antidote.C) or (‫)ﻋﺼﺎﻓﻴﺮ اﻟﻜﻨﺎرﻳﺎ‬ 1) Bed Rest ↓ O2 to ms. & ext.* 3) Hyper baric O2 2-100% O2 3.hyper baric O2 4) BL.) (MA. 2) Blanket Phys. brain & heart complication • TTT. signs of asphyxia ( blue red ) 3) lung . NO SCHEME (GAS) 0) Prophylaxis ( ventil. Pic. Transfusion 5) Mannitol (brain oedema ) 6) Helthion 688 . • Complications : Brain Heart Affected Kidney Necrosis Liver Degeneration Muscles • Pm. : 1) brain oedema & congestion 2) int.

Carbon Dioxide Æ small dose Æ ↑ RC ***Cyanosis ( CNS ↓↓↓ ) Source : factories (soft drinks ) & fire Action : Simple asphyxia 69 .

Morphine. Carbolic Acid. 4.F.D. 4.P. ( Organo-phosphorus) Insecticide O.    Chapter 1: O.Kinetics: -Parathion Æ Paroxone ( Toxic).A ( Opposite Atropine) 1.P.C.Source & uses: Parathion Insecticides 2.P 2. O. 3 C Coma Cyanosis Constricted pupil 1.D. Pontine Hge. 3.: Pair x 10= 20 mg 70   . of poisons: Children Acc Workers Feed Suicidal √ Homicidal X (Garlic smell) 5.: Parathion Pair hours 6. -Smell Æ Garlic ‫رﻳﺤﺔ اﻟﺜﻮم‬ 3.F.D.

Central: : 2.    7. Phosphorylated Enz.Action: Choline Choline esterase esterase (Irreversible binding) Ach O. Nicotinic: N-M Junction Secretion of bronchi Salivation : Sweat =Skeletal ms. Muscarinic: Multiple glands S L U D Defecation syndrome P.P.C/P: 1. Lacrimation Urination 3. 8.P Muscles ( smooth ms.) Broncho spasm Bowel Bladder 71    .P Circulation Acetylated Enz.

    9.P. Central asphyxia.Cause of death: Asphyxia 1. Peripheral asphyxia. ( Para nitro phenol) 2. Brain Edema & congestion √SeS + 3. Internal & External √B Signs of asphyxia + + √P Pulmonary + Edema √P 4.N.Diagnosis: 1. 2. Resist Putrefaction + C/P 72    . Garlic smell √SUS + 2. ‫ﺑﻮل‬ P.Post-mortem picture: 1. 3. ‫دم‬ Choline estrase < 30% 11. 10. Bronchospasm & Secretion of bronchi ( Mascarinic).

    12. Physiological Antidote: a.V.P Types: PAM Peripheral& Nicotinic DAM Obidoxime More effective & Better 73   .D√√ 5. Care of respiration √ 2. ECG√√√ 3. Oximes 1gm /I.TTT: 0. L. Action: reactivate the enzyme Should be taken Early before ageing Of enzyme Cholinesterase Oximes Oximes O. Atropine 1-2mg/15 min Except nicotine Central + Mascarinic action only b. Prophylactic Clean Clothes Containers Cholinesterase (Period examination of level in blood) 1. H2O2 /Charcoal Oxidizing agent 4.P O.A. D.

Phosphorylation ? Æ No 2. 3. CNS: then √ 2. Cholinesterase. Pass B. Potent? Æ No 1) Reversible effect on Enz. Cancer + Cutaneous inflammation O. 2)Oxime & Cerbamate forms a bad compound 4.F. CNS +CVS 2.P except) 1.     Carbamates Baygon (typically similar to O. Uremia (Renal failure) √ 5. CVS ( arrhythmia) V. Cholemia + Uremia Chlorinated hydrocarbons 3. PAM & DAM? Æ No 5. Cholemia ( liver failure) √ 4. Prolonged action? Æ No (Because it’s reversible) 3.B.C (organo-choline) Action C/P 1.B ! Æ No !! 1. Cancer √ (Particularly Hepatoma) 74   .

    P.M.P 1) Asphyxia S U S (External & internal signs) + 2) Brain edema S E S + 3) Liver √B + 4) Kidney √P + √P + √ C/P TTT: Resp CNS 1) Case of CVS Liver Kidney 2) ECG 3) L.A 4) D & D 5) Physiological antidote X NO!! 75   .

N (Acute Tubular Necrosis) Aspirin (R.G 3) Anti-inflammatory Cortisone .D.rheumatic P.T.Uses: 1) Analgesic 2) Anti.Diagnosis X-ray (Aspirin cake) .F. Synthetic Drugs Aspirin .Source: Salicylic acid . 1 day Conditions of poisoning Child Mainly ACC Therapeutic Hypersensitivity Action & C/P Abdominal pain (ulcer) Arterial bleeding Allergy A.F) cause of death Aural (ear) Acid-base balance Agitations (CNS : ) Respiratory failure 76 .

Bleeding (-) Prothrombin synthesis 3) Allergy .F . Action C/P 1) GIT N C Ulcers V D Bleeding 2) (-) Platelet aggregation . hyperventilation Respiratory alkalosis (central action) 2) PH Neutral (Kidney) 3) Metabolic acidosis Kidney Kid of Salicylic Acid X Kreb's cycle * For MCQ actions & C/P are classified into: Mild Moderate Severe “Salicylism” -Ear -Dehydration -All the remaining -Abdomen 1) hyperventilation points 2) Vomiting 3) Secreting 77 .Tinnitus / vertigo 6) CNS : .Rash & urticaria 4) R.√√ 7) Acid-base balance 1) Resp.√√ 5) Ear .

P. K & Blood Transfusion 2) ECG 3) L.M.P: SUS 1) Ulcers + SES 2)Tablets + 3) Brain edema B + 4)Internal & External P Signs of asphyxia + + Pulmonary edema P 5) Renal tubular necrosis R Ttt: 1) Case of Kidney Respiratory Acidosis NaHco3 Allergy Antihistaminic Bleeding Vit.A NaHco3 4) D & D Forced alkaline diuresis (Done to anything that causes acidosis) 5) Physiological antidote No!! 78 .

Nausea in urine ARF Central lobular Necrosis 1) Source synthetic (Aniline) 2) F.of poisoning Acc Child Suic Rare SH sulphate glucouronide 5) Kinetic: . PARACETAMOL N-Acetyl Cysteine Physiologic antidote N A C II Ache III I.p Few days Therapeutic 4) C.d 10/10gm 3) F. Paracetamol Non-Toxic Toxic (NAPQI) When there’s absence of SH SH Glutathione Centri-Lobular Necrosis Mercapturic Acid (Non-toxic) 79 .

M.hypochondrium ↓ Urine output 3)R. Pain in lt. Action C/P 1)GIT I.F III. Hepatic failure (as before) ARF (as before) P. n c V d 2)Liver Failure II.P SUS 1)Congestion (intestinal ulcer) + 2)Tablets SeS + 3)Brain edema √B + 4)liver (centri-lobular necrosis) X P + 5)Kidney failure XP + √ C/p 80 .

acetyl cysteine (mucolytic) 3 letters 3days NAC 1) Dose 140mg/kg loading dose 7hrs For 3 days 70mg/kg/4hrs 14hrs For 72 hrs (after that death from .A Charcoal 4)D& D √ 5)Physiological antidote N.G √√√ 3)L. centrilobular necrosis) 2)Action ↑ SH (for sulphate & glutathione) 81 .C. Treatment: liver 1)S&S care for Kidney CNS 2)E.

P Long 4gm 4day Short 2gm 2hours 82 .D & F.impulses (epileptic) 2)Intermediate 5-6hrs (mid of long acting) Amytal ‫ﻣﻬﺪئ‬ 3)Short 2-3hr (second) Seconal + Suppression of pain (analgesia) 4)Potent short (ultrashort) PairX10=20min Pentothal Presurgery (anaesthetic) Sodium Psychoanalysis F. BARBITURATES G A B A ARF Grading of coma Arrest Bronchopneumonia Bowel Bullous 1)Source:. Child 1) Acc Therapeutic Addicts 2)Suicidal √√ 3)Homicidal Rape & Robbery 3)Types: Long sleep 1)Long-acting (6-12hrs) Luminal (Phenobarbiton) Lower elect. Barbiturates 2) C.of poisoning:.

Central asphyxia *Shock *Muscle hypotonia *Dilated reactive pupil .VMC 2)CVS ↓ .Myocardium ↓BP. Cyanosis. Action C/P 1)CNS ↓↓ Coma.Arrest -Vascular ms tone 3)Lung Hypostatic pneumonia 4)Skin Bullous 5)Bowel Constipation & urine retention 6)ARF √√ √ Cause of death: G A B A Coma Arest Bronchopneumonia ARF 83 . ↓Pulse :.

P.M.P:
SUS

1-Tablets +

2-Brain SeS
Oedema +
&congestion B
3-Asphyxia +

(Int& Ext signs) P

4-Pnumonia +

5-Kideny P.M
+
6-Blisters C/P

Treatment:-
Respiratory
1) S & S CVS
Bronchopneumonia (Antibiotics)
Renal

2)ECG √√ √

3)L.A Charcoal
NaHCo3

4)D & D Forced Alkaline Diuresis (Any acidic drug)

5)Physiological antidote X

82

Adrenaline

AMPHETAMINE
Alkaline
Forced acidic dieresis

1)Source Synthetic (ephedrine)

2)Uses
a)Anorexia Anorexient

b)Dexidrine Depression

c)Retaline Rise up (Analeptics)

d)Benzidine Bl.vessels constrictor

e)Hyperkinesis (ADHD)
C. of poisoning: Therapeutic
1)Accid Child
Addicts
2)Suic
Actions :

↑ CNS ↓ MAO I.

↑ release & ↓ uptake

C/P :

1)CNS ↑↑↑

2)CVS ↑↑↑

3)Resp. ↑↑↑

4)Muscles (Movement) Hyperthermia

85

Cause of death :

1)Resp. failure

2)C.V.F (cardiac arrest )

P.M.P :

1) Tablets SUS

+

2) Maxtone Forte SES

(site of inj) +

3) brain edema & congestion √ B

+

4) Asphyxia (int.&ext. signs) √ P

P.M + C/P

TTT:

1)S&S Resp.

Shock

2)ECG √√

3)L.A Charcoal

4)D &D forced acidic diuriesis

5)Physiological Antidote Phentolamine

Diazepam & chlorpromazine

86

A 4)Benzodiazepine 4)D &D 5)Phenothiazine 5)Physiological Antidote -Flumazenil (2mg) Benzodiazepine -Benzotropine (2mg) Phenothiazine -Physostigmine Anti-cholienergic TCA Glutathamide 87 . of Poisoning : 1)TCA * ACC.C.: 1)TCA 1)S&S 2)Glutathamide 2)ECG 3)meprobamate 3)L. Rare 5)Phenothiazine TTT. Theraputic 2)Glutathamide Child 3)meprobamate 4)Benzodiazepine * SUCC.

tremors cause CV↓↓ DF pupil. urine Parkinsonism stimulation except TCA constipation. dry skin. then meprobimate Benzodiazepine Phenothiazine depression have no TCA arrhythmia Glutathamide but cause pulmonary edmema 88 .CNS ↓↓ CVS ↓↓ Allergic Anticholinergic Extra pyramidal (A & B) (A & G) All cause ↓ All cause Rash e.g atropine Neck rigidity & except TCA Arrythmia & Articaria (dry mouth.

Moral (Mental) • Satiety (Anorexia) • Murder • Skin manifestions • Liar (Needle Picks abcesses) • Dishonest • Sexual (Impotence) • Indifference • Miosis Morphine • Constipation ONLY • Crimes 89 .Diagnosis of Opium Addict: Nalorphine Æ Withdrawal Symptoms ( Within 15 min) 4.Route of Administration: -Morphine Æ Injection -Opium Æ Ingestion Smoking + Goza -Heroin Æ Snuff Inhalation Injection 3.Physical B.Congenital Morphinism 2. Addiction Opium 1.Mechanism of Action: -Endogenous Æ Endorphine & Encephaline -Exogenous Æ Morphine If No Endogenous nor Exogenous Æ Withdrawal Symptoms 5.Medical .C / P : A.Condition of addiction: .Non –Medical .

6. TTT: 1) ‫اﻷهﻞ‬ Æ Admit Addiction + Hospitalization (High secrecy) 2) ‫ اﻟﻤﻤﺮﺿــﺔ‬Æ Nutrition Drugs 3) ‫ اﻟﻨﻔﺴـــﻴﺔ‬Æ Rehabilitation 4) ‫ اﻟﺴﻤـــﻮم‬Æ Gradual Withdrawal ‫ ﻣﺮات ﻓﻲ اﻟﻴﻮم‬4 / ‫ أﻳﺎم‬3 A-Codiene B-Methadone SC Mouth M 30 mg 1 mg = 2 mg Heroin = 4 mg Morphine m 10 mg Tranquillizer in Case Dose : 1/3 : 1/10 : m + C 10 mg + of 1/20 Convulsions C 10 mg Then STOP 90 .

Alcohol C / P: 1-Physical ‫ أﺻﻔﺮ‬+ ‫أﺣﻤﺮ‬ 2-Mental 3-Withdrawal 4-Nervous (3P) -Conjunctivitis -Dipsomnia -Delerium .B: Hagica sexual potency ) Feotal Alcohol Syndrome Chronic -Delerium tremens ‫هﻼوس ﺑﺼﺮﻳﺔ‬ Subdural He (terrifying) Tremors -Pain in Muscles -Auditory hallucinations Myopathy ‫هﻼوس ﺳﻤﻌﻴﺔ‬ Korsakoff psychosis ‫اﻟﻤﺆﻟﻒ‬ ‫ﺑﻴﺄﻟﻒ ﺣﻜﺎﻳﺎت‬ -Wernicks Encephalopathy ‫اﻟﻤﻬﺰوز‬ -Ataxia -Nystagmus -Tremors 91 .Preipheral -Drunken nose ‫ﺷﺮﻩ آﺤﻮﻟﻰ‬ tremens Neuritis -Bronchitis ‫أﺣﻤﺮ‬ (Mixed lat. More -Gastritis -Dementia -Tremors motor ) ‫ﻋﺘﻪ آﺤﻮﻟﻰ ﻣﺒﻜﺮ‬ - ( intellectual of Hallucinations -tremors mental power) -Fatty Liver ‫أﺻﻔﺮ‬ -Convulsions -impotence ‐Delusions of jealousy  -Pachymeningitis ( sexual desire + N.

‫ اﻟﺴﻤـــﻮم‬Æ A + P 1) Antabuse (Disulfiram) 3) Promazine + Diazepam 2 gm ( If Convulsions) 1 ½ gm 1 gm ½ gm Æ Year Alcohol Acetaldehyde Action: Acetaldehyde Syndrome (Acetaldehyde + Antabuse) Vomiting Flushed Palpitation Conj. Red ‫ اﻟﻤﺸﻜﻠﺔ‬Æ .Drawsiness 2) Temposil 92 .TTT: 1.‫اﻟﻨﻔﺴﻴـــﺔ‬ 4.‫اﻻهــــــﻞ‬ 2.‫اﻟﻤﻤﺮﺿــﺔ‬ 3.Rotten Egg odour .

1 gm (1 × 2) after 3 weeks 93 .5 gm (1 × 2) ‫ﻳﺨﻠﺺ ﻋﻼﺟﻪ‬ 0.TTT: 1) ‫اﻷهـــﻞ‬ 2) ‫اﻟﻤﻤﺮﺿــﺔ‬ 3) ‫اﻟﻨﻔﺴﻴــﺔ‬ 4) ‫ اﻟﺴﻤﻮم‬Æ Gradual (Convulsions ‫)ﻧﺒﺪأ ﺑﺠﺮﻋﺔ ﻣﺘﻌﻤﻠﺶ‬ 0. Barbiturates ‫ﺑﻄﺊ وﻣﻬﺰوز‬ 1-Condition of addiction: ‫ﻋﻼج ﻟﻜﻞ ﺣﺎﻻت اﻻدﻣﺎن‬ 2-C / P: A-Physical‫ﻣﻬﺰوز‬ B-Mental (Moral) ‫ﺑﻄﺊ‬ C-Withdrawal -Poor thinking‫ﺑﻄﺊ ﻓﻲ اﻟﺘﻔﻜﻴﺮ‬ -Convulsions √√√√√ -Ataxia -Poor memory -CHAIR -Tremors -Slurred Speech ‫ ﺑﻄﺊ ﻓﻲ اﻟﻜﻼم‬-Insomnia -Nystagmus -Hypersomnia -Drowsiness 3.

Cocaine ‫ ﺷﻜﻼ وﺧﻠﻘﺎ‬..Secretions -Aggressive -perforated nasal ÆMentally septum -Toxic Psychosis VC Adulterations ‫ﻣﻐﺸﻮش‬ -Needle pricks 2-TTT: 1) ‫اﻷهـــﻞ‬ 2) ‫اﻟﻤﻤﺮﺿــﺔ‬ 3) ‫اﻟﻨﻔﺴﻴــﺔ‬ 4) ‫ اﻟﺴﻤﻮم‬Æ No special TTT Symptomatic ONLY 94 .‫ﺳﺖ وﺣﺸﺔ ﺟﺪا‬ 1-C / P: A-Physical B-Mental C-Withdrawal -Cocaine bugs -Irritable -Loss of weight (Tactile Hallucinations) (Cachexia) .

Amphetamine ‫(ﻋﺎﻳﺰة ﺗﺨﺲ‬Paranoid) ‫ﺳﺖ ﺑﺎراﻧﻮﻳﺎ‬ 1-C / P: A-Physical B-Mental C-Withdrawal -Insomnia + talkative -Hyperphagia -Loss of weight +Euphoria -Hypersomnia . Antidepressant . Palpitations -Parabnoid Schizophrenia -Depression -Erythema -Persecution ‫اﺿﻄﻬﺎد‬ Psychosis 2-TTT: Syptomatic (Antipsychotic.Bl..Pr.) 95 ..

+ S.Coagulation Death Shock & Renal Failure TTT: 1) A + B Assurance Bed rest Anti-tetanus Antibiotics 2) S.Haemolytic . VC Suck Solid ice Anaesthesia ineffective 3) H2O + KM2O4 To detoxify the venom locally 96 . Animal Poisoning Snake Scorpion Snake Cobra (CNS) Horned Curare Like Hyltic .Cytolytic Æ Hgic Resp.Failure .

4) Specific antidote + Supportive Antivennins Cobra Hyltic Mono Poly -Resp.Transfusion -Renal 97 . –Bl.

) 98 . Botulinium Exotoxin A B C D E F G Heat labile (destroyed by boiling at 100°c for 1 min. Food poisoning Atropa-belladonna 1)Toxic food stuff Aconite Amygdalin (found in seeds of fruits before being full size ) 2)Food Allergy 3)Contaminated Food Bacteria Virus Protozoal Chemical Staph. histolytica Insecticide Preservatives BOTULISM -Bulbar -Ocular -Tetraplegia . Rota Giardia Metallic Salmonella Ent.Prevent ach. BACTERIA Gram –ve (anaerobe) Cl.

= 1μg vials trivalent 4hrs F.ms asphyxia 1 2 3 4 F.P. C/P: 1)Bulbar 9 (glossoph. Constipation + Urine retention.) → pain in ??? 12 (hypogloss.Actions: .D.) → dysarthria 2)Prevent Ach. Dry Mouth & Skin Consious till the end Dilated Fixed pupil 3) Ocular paralysis Diplopia 4)Tetraplegia descending &bilateral limbs resp.) → dysphagia 10 (vagus) → dysphonia 11 (access.=1DAY antitoxin 2 vials of trivalent antitoxin to be repeated after 4 hrs 99 .Ach.

A. : 1)S&S Care of Resp.TTT. 100 . Charcoal 4)D & D √√√ 5)Physiological antidote (2vials of trivalent antitoxin to be repeated after 4hrs. 2)ECG Cuffed EndoTracheal tube (due to bulbar paralysis) 3)L.) .