Metallic Poison

Arsenic
◦
Metallic arsenic ( black in color ) is not
poisonous ,
as it
not absorbed the GIT
is
from .

•
Its compounds are
poisonous .

Toxic compounds :

Iii Arsenious oxide or Arsenic trioxide ( Most toxic )

eiii
Copper Arsenite &
Copper Aceto arsenite

Ciii , Sodium 4 Potassium arsenate

ein Arsenic sulphide

µ) Arsenio netted hydrogen

Poisoning :

Iii A Abortion
Aldrich Mee 's line

Aphrodiasis ( ↑ libido )
Arsenio phagist ( Tolerance to Arsenic )

iii , R Red valvaty stomach mucosa / strawberry mucosa

Red drop pigmentation

Reinsch test ,
Marsh test

Rashes on
body .
(iii , s Sub endocardial
Hemorrhage ( Sheehan 's hemorrhage ,
Sankhya / Somalkar ( lnlhite Arsenic ) (Arsenic trioxide;
used
for PML Treatment
( leukemia )

Palm & Sole

Civ ) E Excessive
pigmentation of
cut N Neuropathy
evil I Iron oxide is Antidote

Mimic cholera
( vii , c .

Best sample Acute

•

Poisoning Liver

Poisoning
Chronic Bone .
 Mercury
•

Liquid metallic
mercury
is not
poisonous if swallowed .

◦ Also known as
Quicksilver / para .

Toxic Compounds :

salts
Inorganic :

cii
Mercury chloride ( corrosive sublimate ) ( Most Poisonous )

Iii , Mercurous chloride ( calomel )

( Iii , Mercuric
sulphide ( cinnabar or Vermilion )

(
in Mercuric cyanide ,
oxide & iodide ( Scarlet Red powder )
salts
Organic :

Iii Methyl Mercury

Iii , Dimethyl Mercury
(
Iii ,
Ethyl Mercury
1in Phenyl Mercury

Poisoning ?

◦
Chronic Hg Poisoning Hydrargyrum
•

Mercury
binds with
Sulfhydryl groups resulting in

enzyme
inhibition and
pathological alteration of
cellular membranes .

Elemental toxic to
&
Methylmercury are CNS
mercury
◦ .

Metallic is also irritant

mercury vapor
a

pulmonary
.
•

to
•

Inorganic salts are corrosive skin ,

eyes 4 GIT

Is Cause Contact Dermatitis .

 Minamata Japan related to
•
Disease in was
Hg Poisoning
lenk 's deposited Ant lens capsule
◦ Mercurio -

Hg in .
.

•
Mercurial Erethism
E

Psychiatric Problem

* Fatal Dose = 1-
-2g

Treatment :

Gastric lavage
ii. with 250mL of 5% Sodium
formaldehyde
sulphoxylate
.

iiii BAL is chelation of choice

( iii , DMSA or Succimer

( in ) D-
penicilla mine
*i Maintain Electrolyte 4
fluid balance .
 Lead
Commonest
•

heavy metal as
far as chronic
poisoning is

concerned .

Plumbism / Saturanism
•
Chronic
poisoning .

Toxic
compounds :

poisoning :

iii lead combines with

snlfydryl and
groups interferes with

mitochondrial oxidative phosphorylation , ATPase .

Calcium

oxidation &
dependent messengers
& enhances Apoptosis .

Proximal
Canning Heme
Synthesis , Renal Tubular &

Osteoblast
dysfunction .

deleterious
Iii , In CMS ,
it has
effects on the nerve

cells &
myelin sheaths and also causes Cerebral edema .

Most Route
* common
of Pb
Poisoning Inhalation al .

Lead dust
•

paint ( mlc came in children )

◦
Absorption from drinking water in lead Cisterns .
Plumbism Features :
 Brains
•

of people who are

exposed to

lead as children show reduced brain

volume cortex
up
. in
prefrontal .

Complications :

•
Anemia ,
Seizures ,
Coma .

Fatal dose lead carbonate

40g
•
=
-_

lead Acetate =
20g
Fatal Period = I -2
days

• lab diagnosis by -
lis
Porphyrin ceria due to Cipro porphyrin
III

Iii , Blood lead level DI

peg /
> to -100

Ciii , Proto
porphyrin 35µg / dl
>

( in Urine lead level

mg 1dL
> 0.15 -0.3
 Treatment :

( is Gastric lavage with 1% solid

of sodium or
Magnesium
sulphate .

Iii , Demulcents ,
whole bowel irrigation and repeated
cathartics .

Liii , Calcium chloride

5mg as 10%5011 IV or
.

.
Calcium

gluconate 10mL
of 10% Sold IV.

( in ) Edetate Calcium disodium ( Ca Naa EDTA ) ,

1500
mg / m2 / kg / day ( 50mg / kg / day ) in 4- 6 divided
doses .

'" ' Vite

Peritoneal
Cui , hemodialysis
or in anuria
patients with

chronic renal
failure .

Lviii symptomatic treatment

.
.
 Copper
Copper as metal is not
poisonous
◦ a .

about
copper content
Human is 100 150
mg
-
◦ .

Toxic Compounds :

cis
Copper sulphate ( cus 04 ) -
Blue Vitro L ( Fatal dose =

309m)

di , Cu sub acetate ( Verdigris ) -

( Fatal dose =
15
gm )

Action :

activities
•

Toxicity of Copper is exerted on

enzymes
whose
because it has
depend sulfhydryl and
on amino
groups
high affinity for ligands contain
g Nitrogen and
sulfur
donors .

Symptoms ( Acute Poisoning ) :

Hemolysis 4
Hemoglobin ceria am
present in severe cases .

• Multi
organ dysfunction syndrome may occur due to
both
hepatic & Renal failure or .
 Treatment :

( is No need
for emetics as
vomiting occurs in 5- to mins .

Iii , Gastric lavage with 1%

potassium ferrocyanide .

Ciii ,
Demulcents :
Egg white or
milk .

Cixi Castor oil

1×1 D-
penicillamine
evi , EDTA or BAL in usual doses .

( Viii In severe cases ,

Cortisone 50
-100mg
IM thrice
daily .

PM
Findings :

skin due to Jaundice

cis
yellow .

cii , Greenish blue

froth from mouth & nostrils .

iii , stomach Gastric is

congested with desquamate
'
mucosa on
(
=

and
hemorrhage at places .

Ii ' small Intestine Mucosa shows

sign of moderate irritation
" =

µ, liver = Centrilobular Necrosis & Biliary stasis

evi , kidneys =

Degenerative changes in
proximal tubules
.

Chronic
Copper Poisoning :

Occurs and its

among workers
salts
using copper
•

due to inhalation dust welders

of Copper or
fumes -

may develop
metal Fume
fever .

PM
Findings :

• liver =

Fatty degeneration
4
kidney =

Dega g Epithelial cells

.
.
 Others
Cadmium :

Poisoning occur
from
the inhalation al
of
cadmium dust or
fumes
its salts
or
ingestion of .

•
Act by denaturing proteins / inactivating enzymes
.

with transport mechanism

Interferes calcium .

Toxicity by inhalation in
far greater than
by ingestion
.

Symptom include :
 Thallium :

Toxic include Ii ' Thallium acetate

compounds
•
=

iiii Thallium sulphate .

Symptoms g Poisoning :

In sub acute white

there is
encephalopathy with
•
-
cases ,

stripes across the nails ( Mee lines )

In chronic these symptoms

exposure
•
,

in milder form
appear
.

- Cardinal
features Gastroenteritis
are .

peripheral neuropathy & Alopecia .

• In fatal cases .
death is
preceded by delirium ,
convulsion

and coma .

Fatal Dose Adults 1-

200mg g
-
= -

children =

8mg 1kg body wt .

Period = 24 -

36h1 .