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STUDY OF
NEUROTIC POISONS/
SYSTEMIC POISONS
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Definition:- Neurotic or systemic poisons are the substances which act on nervous system
and various systems of the body and produce harmful effect in the body or death.

They are classified in various groups according to their specific action on the body system .

1. Cerebral poisons- These poisons act on brain & produce Harmful effect or death.
Cerebral poisons are again divided in to sub groups according to their mode of
action.
E.g:-
 Alcohol
 Opium (Afim) & its derivatives:
-(Morphine, Codeine , Di-acetyl morphine (Heroin, Brown sugar,
Smack), Pantazocin, Mepeverine)
 Barbiturates
 Belladonna,Dhatura
 Cannabis & its derivatives:- (Bhang,ganja,Charas or Hashish,
Marijuana)
 cocaine
 chloral hydrate
 Kerosene
 ether
A) SOMNIFEROUS OR NARCOTIC POISONS (OPIOIDS)
They induce sleep and relieve severe pain
e.g.-
 opium & its derivatives-
Morphine, codeine,
Di-acetyl morphine (Heroin, Brown sugar, smack),
Mepeverine (Pethidine) Pantazocin (Fortwin)
B) INEBRIANT POISONS:-
They produce Excitement & Narcosis. e.g.- Alcohol, ether.

C) SEDATIVE & HYPNOTICS. :-

Sedatives drugs produce calming effect, reduce anxiety& tension without sleep, but in large doses
sedative drug act as hypnotic & produce sleep resemble natural sleep. e.g.-

 Alprazolam
 Clonazepam
 chloral hydrate
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 Barbiturate

D) DELIRIANT POISONS-

The substance which act on

CNS & produce delirium e.g.-

 Dhatura,
 Belladonna,
 cannabis Indica
 Cocaine

E) STIMULANTS POISONS- These are analeptic drugs produce stimulant effect on CNS. E.g.-

 Amphetamine
 Cocaine
 Ammonia
 Strychnine
 Nicotine
 Nikethamide
 Bemegride
 coffee (Caffeine -Coffea Arabica,)
 Tea (Theophylline- Tea Leaves-Theasinensis),
 Theo bromine (Cocca seeds- Theobroma Cocca)

F) FUELS- fuel is derived from petroleum. Petroleum contains gas & liquid constituents.

 Petroleum is oily liquid found under the ground in several parts of the earth.
 Chief fuels are- Kerosene, Petrol, Naphtha, lubricating oil, Vaseline, paraffin, ether, benzene.

2. Spinal poisons: These poison Act on Spinal cord and produce

convulsions (Opisthotonus condition and Ricinus-Sardonicus Appearance
(Devil’s face)

e.g.:- Nux vomica (Strychnine, Brucine, Gelsemium)

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3. Cardiac poisons: these poison acts on Heart muscles and produce toxic
effect and death due heart failure. E.g.:-

 Aconite,
 Tobacco (Nicotine),
 Digitalis,
 Oleander (Kaner),
 Cyanide Compounds & Hydrocyanic acid (prussic acid).

4. Peripheral poisons: These poison acts on Nerve endings.

E.g.:- Conium, Curare.

5. Asphyxiate poisons: These poison act on respiratory systems & produce

Asphyxia & death.

E.g.:- irrespirable gases-

 Carbon mono oxide (CO)

 Carbon di oxide (CO2)
 H2S and War gases.

ALCOHOL POISOINING

Definition: - It is a type of Neurotic (Inebriant) Poison.

Physical Properties:-

 It is transparent, colorless, inflammable, volatile liquid having spirit like odor& burning taste.
 It is produced by fermentation of sugar by yeast.
 Alcohol is a drug of Addiction & present in various fermented & distilled beverages.
 It is the active ingredient of many social beverages.
 Common alcoholic beverages are – (wine, whiskey, Gin, Rum, brandies &beer)
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Concentration of Alcohol:

 In whisky, brandy, Gin, & Rum 42 – 50 %

 wine 10- 15 %
 Beer- 4 –8 %.
 Absolute Ethyl alcohol contain 99.95% alcohol
 Methyl Alcohol (Industrial methylated spirit) is a mixture of 95% alcohol & 5% wood
naphtha.

Action:-

• It is Central Nervous System (CNS) depressant poison.

• Cause death from cardio respiratory failure.

Fatal Dose: -
(Consumed in 1 hour)

• 150 to 250 ml of absolute alcohol- In Adult

• 60 ml of absolute alcohol -In Child.
• About 500mg% concentration in Blood

Fatal Period:-12 to 14 hours

Clinical Features:-

A. Specific Symptoms:

 Congestion of conjunctiva,
 flushing of face
 Excitement,
 Pupil dilated
 Delirium,
 staggering gait
 impaired memory
 Muscular Inco ordination
 Deep unconsciousness

B. General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract: - Nausea, vomiting, diarrhea, burning sensation in mouth, throat,
esophagus, stomach and abdomen, pain in abdomen, difficulty in swallowing,
hematemesis, Melina.

 Respiratory Tract: - difficulty in breathing, suffocation, impaired respiration, hoarseness

of voice, Cyanosis, respiratory failure, skin cold and clammy.

 Central Nervous System :- Headache, vertigo, pale anxious face, Digginess, drowsiness,
insensibility, weakness, restlessness, agitation, cramps, numbness and tingling sensation,
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excitement, depression, speech altered, staggering gait, convulsion, impaired memory,

delirium, hallucination, pupil dilated/constricted, impaired vision & hearing, collapse,
shock, unconsciousness, coma.

 Cardiovascular System:--Pulse rapid/feeble/slow, tachycardia, bradycardia, Arrhythmia,

heart block, heart failure.

 Excretory System:- Albuminuria, hematuria, burning micturition, oliguria, Oxaluria,

Carbolurea, anuria, renal failure, edema, anasarca.

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists:-
 Maintenance of air way:- Clear & establish air way by positioning, suctioning or
insertion of oro-pharyngeal airway or endotracheal intubation.
 Maintenance of breathing: Provide breathing by artificial respiration and oxygen
inhalation to improve concentration of Oxygen in Blood and Relieve hypoxia, maintain
tissue respiration.
 Maintenance of circulation: for better circulation fluid therapy is given to combat fluid
loss, prevent shock and maintain Bloodpressor, Nutrition and Electrolyte balance.
( Fluid Therapy:- intra-venous infusions are given like – Dextrose, Fructose, ,Glucose ,
Normal Saline, Ringer Lactate, with multi-vitamins
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid : These are
lifesaving emergency drugs given to provide strength and enhance function of vital
organs (Brain, Heart, Lungs) in life threatening condition and to prevent shock.
--Emergency Drugs- Injections- Adrenalin, Amphetamine, Nikethamide, Bemegride,
Picrotoxine, Cardiazole, Restimuline, Theophylline).
--Corticosteroids—Injection- Hydro-Cortisone, Dexamethasone, Betamethasone,
Prednisolone.
 Disability management ( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by-- Stomach wash with plain water than weak
solution of Potassium permanganate.

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic
 Diuretics:- to increase volume and flow of urine-- Water , Salt, Sugar, Fluids, Tea,
Coffee, Sodium & Potassium bicarbonate solution.
 Purgatives: - to promote defecation – Castor oil, Sodium sulphate, Sodium tartrate,
Lectulose, Methyl cellulose, Liquid paraffin.
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 Diaphoretics:- drugs or substance which increase perspiration- and eliminate toxin from
body- Pilocarpin , Hot water, Tea, Milk, blanket.

c. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –

 IV infusion - Glucose, normal saline, fructose 10%, Dextrose 10

 Injection Thiamine 100mg protect liver function
 Injection sodium bicarbonate with normal saline which prevent acidosis.

d. Symptomatic Treatment & maintenance of patients’ general condition It is line of

treatment which is given according to symptoms and need of the patient to early
recovery and restoration of the health with proper nursing care, (Moth, bowel, Bladder,
skin care), Monitor and maintain vital parameters, Rest, reassurance and Psychotherapy
is given to the patient. Mouth, bowel , bladder and skin care should be given.

Postmortem Appearance:-
• Alcoholic odor in the cavity of body noted,
• Acute inflammation of stomach with smell of alcohol & congestion of mucous membrane

Medico-Legal Aspects:-
 Suicidal
 Accidental poisoning by overdose
 Addiction problem of alcohol which is dangerous for individual and society.

Chronic alcohol poisoning

(Alcohol addiction)

People who cannot stop drinking alcohol for long period then physical and psychological
dependence occurs & alcohol produce disease of various organs which is characterized by –
Clinical Features:-
• Anorexia & Jaundice
• Tremors of tongue& hands
• Insomnia & lack of memory
• Impaired power of judgment.
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• General Anasarca
• Peripheral Neuritis & dementia occurs and patient suddenly dies.

Management:-
• Following Ant abuse drugs are given in chronic alcoholism-
• Disulfiram 250 mg per day.
• Temposil 50 mg daily.
• Chlorpromazine 25-50 mg 6 hourly
(Disulfiram drug blocks alcohol metabolism in liver which leading to accumulate
acetaldehyde in blood which cause unpleasant symptoms. E.g. :- Nausea, vomiting,
palpitation of heart, headache, sweating, abdominal cramps, flushing of face so patient
dislike alcohol.

If Withdrawal symptoms of alcohol appear than give:-

• Injection - Diazepam
• Injection - Chlorodiazipoxide 20 mg QID

METHYL ALCOHOL POISONING

Methanol is obtained from wood also called: - carbinol, wood alcohol, wood naphtha or wood
spirit) found in cleaning material, solvents, paints, varnishes, formaldehyde solution.
During metabolism methanol converted in to Formaldehyde & formic acid which further
metabolized to folic acid & folinic acid, carbon di-oxide and water.
Action:-
CNS depression,
Retinal toxicity & acidosis
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Use: - In industries as solvent. , In laboratories with ethanol as an antiseptic spirit.

Clinical features:- nausea, vomiting, cramps in abdomen, spirit like odor in nostril, mouth,
dehydration, dyspnea, cyanosis, respiratory depression, head ache, vertigo, restlessness, muscular
weakness, delirium, convulsion, coma. Acidosis, scanty urine, pupil dilated & fixed, visual
disturbance, decrease light perception, blindness due to optic neuritis & atrophy from
accumulation of formic acid with in optic nerve. Retinal edema & hyperemia.
Fatal dose: - more than 150 mg/dl in blood
Fatal period:- 24 – 36 hrs
Treatment:-
 Gastric Lavage with 5% sodium bi carbonate & 500 solution left in stomach.
 Orally 2 gm sodium bi carbonate in 250 ml water to combat acidosis.
 Calcium folinate to reduce folinic acid.
 Vitamin therapy:- thiamine (B1), pyridoxine (B6) reduce liver toxicity.
Antidote: -
 Methyl pyrazole (fomepizole) Dose:- 15 mg. per kg.
(it is competitive inhibitor of alcohol dehydrogenase enzyme it block formation
of formaldehyde & formic acid so used instead of ethanol)

 Ethanol:- 10 ml per kg body wt. 10% ethanol in dextrose.

1 ml per kg orally of 95% ethanol in 200 ml orange juice.
(Competitive antagonist ethanol.
Ethanol has higher affinity for alcohol dehydrogenase enzyme than methanol.

Presence of ethanol inhibits formation of toxic metabolites from methanol.)

Medico legal importance:- Accidental.

OPIUM POISONING

Definition:- It is type of Neurotic cerebral narcotic poison

Properties:- Opium is dried juice obtained by incision of unripe capsules of papaver somniferous
plant.
It is Dark-Brown in color and becomes black on standing having Characteristic smell & bitter
taste.

Active principle: Opium has about 25 alkaloids.

E.g. – Morphine, codeine, Theban, Papaverin, Narcosine.

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Action:-It is cerebral depressant & Analgesic in action. Used to reduce pain and induce sleep.

Fatal Dose:-

1-2 gram
(700-1000 mg% concentration in the blood)

Fatal Period:-

8 to 12 hours

Clinical Features:-

A. Specific Symptoms:

 Deep sleep, Hypotension

 Pin point pupil
 Slow Respiration
 Cyanosis& Relaxation of sphincters
 Froth at nose & mouth

B.General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists

 Maintenance of air way

 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
Disability management
( neurogenic states asses level of consciousness)
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B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by- Stomach wash is done with weak solution
of potassium permanganate

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

c. Administration of Antidotes: to Neutralization or counteract the action of

poison. - Given –Injection: -Nalorphine (Nelaxone)- I.V.

d. Symptomatic Treatment & maintenance of patients’ general condition It is line

of treatment which is given according to symptoms and need of the patient to
early recovery and restoration of the health with proper nursing care, (Moth,
bowel, Bladder, skin care), Monitor and maintain vital parameters, Rest,
reassurance and Psychotherapy is given to the patient.

Postmortem Appearance

Mucus membrane of stomach consist smell of opium.

All internal organs are congested like Lungs, Bronchus, Trachea, Brain, Meninges.
Blood , Urine & stool contain Morphine

Medico legal Importance-

 Suicidal
 Accidental
 Addiction problem
 Cattle poison
 Infanticide.

BARBITURATE POISONING

Definition: It is a type of neurotic cerebral sedative and hypnotic poison.

Physical Property:-
White crystalline, odorless powder with bitter taste.
These are Esters of Barbituric Acid or Malonyl Urea
Action:-
 CNS depressants.
• Used as sedative, hypnotic & anesthetic if given intra- venously.
• Also useful in psychiatric disorder, epilepsy & strychnine poisoning.
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CLASSIFICATION: -
These are classified in four groups as follows depending on their action:- E.g.:-
 Baritone,
 Phenobarbitone (Gardinal or Luminal)
 Sodium Amytal &Butobarbitol
 Pentobarbitone&Cyclobarbitone
 Injection Pentothal sodium &Kemithal Sodium
Fatal Dose: - 2 to 5 gm. (Concentration of barbiturate in the blood 3 to 10 mg/100ml)
Fatal Period: - Few hours to 2 Days
Clinical Features:-

A. Specific Symptoms:

• Delirium, Excitement, Drowsiness, Slow Breathing, Confusion.

• Hallucination, Speech slurred, Visual disturbance
• Cyanosis , Pupil contracted and react with light
• Convulsions of Flexor muscles and reflex are lost

B. General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System

MANAGEMENT:-
In general, management of poison is based on following principles:

A. GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid: --
 Disability management
(Neurogenic states asses level of consciousness)
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B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - by-- Gastric Lavage or Stomach wash with warm water
mixed with potassium permanganate and suspension of activated charcoal or suspension of
tannic acid.

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c.Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

 Injection- Bemegride with 5% glucose I.V.

 Daptazole with 5% glucose I.V.
 Injection- Dopamine if shock persists.
 Injection- Amphetamine Sulphate to short the duration of coma

d.Symptomatic Treatment & maintenance of patients’ general condition

POSTMORTEM APPEARANCE
 Foams are present in mouth & nostril. Mucus membrane of GI tract congested
 Drug may be found in stomach, present in blood, urine & stool.

MEDICOLEGAL IMPORTANCE:-
 Suicidal
 Accidental due to automatism

DHATURA POISONING

(DHATURA & ATROPA BELLADONA)

Definition:- It is a type of Neurotic cerebral Deliriant poison.

Properties &Origin:-
Important poisons are:-
1. Dhatura,
2. Atropa belladonna,
3. Hyoscyamus Niger.

 All parts of Dhatura plant are poisonous but seeds & fruits are more poisonous,
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 Fruit (thorn apple) contains 450-500 yellowish brown seeds resembling chilly seeds.
 50 to 60 seeds may stupefy any person. In order to commit robbery
 sometime these seeds mixed with tobacco, and fill in the Cigar, Bidi or Cigarette& smoked.
 Root of Atropa belladonna is toxic.

Active Principle;- Hyoscine, Hyoscymine& Atropine, scopolamine

Action:-Primarily CNS stimulation is followed by depression & paralysis of vital centers in medulla
Fatal Dose:- 60 to 120 mg Hyoscine, Hyoscymine& Atropine, scopolamine

(100 to 125 Dhatura seeds contain 1gm active principle.)

Fatal Period:-Within 24 hours

Clinical Features:-

A. Specific Symptoms:

(8 D symptoms)

 Dryness of mouth & throat,

 Difficulty in talking,
 Dysphasia ,Dilated pupil
 Dry hot skin, Drunken Gait
 Delirium, Drowsiness
 Death may occur due to respiratory & heart failure
 Feeling of suffocation with change of voice

B. General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid -
 Disability management
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( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by Stomach wash with plane water than weak
solution of Potassium permanganate or Tannic acid.

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

c. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –
 Activated charcoal is given oral
 Injection Pilocarpin Nitrate
 Injection Physostigmine I.M. or I.V
d. Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance

Externally congestion of face &conjunctiva, Wide dilated pupils

Inflammation of stomach & presence of seeds or their fragments.

Medico legal Importance

Accidental
Stupefying
Abortifacient
Aphrodisiac.
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CANNABIS INDICA POISONING

Definition: It is a type of Neurotic cerebral Deliriant poison.

Property All parts of the plant are poisonous, but seeds are more toxic.

Cannabis is used in following four forms:-

• Bhang or Siddhi – It is prepared from dried leaves & fruits & it contain 15% Cannabinol.
• Ganja – It is prepared from flower tops of female plant mixed with tobacco & smoked in pipe &
hukka.It contains 15-20% Cannabinol.
• Chars (Hashish) prepared from the leaves branches & stocks of Cannabis Indica plant. It is also
known as Hashish. Contains 25-40% Cannabinol& it is usually smoked.
• Majum – It is sweet preparation which is prepared by Bhang it increase appetite& sexual desire
• Marijuana – extract of cannabis
Active Principle:
Active principle is -- Cannabinol.
After exposure of heat it converts to Tetra hydro cannabinol (THC).

Action:-Primarily CNS stimulant & then produce depression

Fatal Dose:-

Common- 2-10 gram.

(THC- 30 mg/kg body weight)

Fatal Period:- Several days

Clinical Features:-

A. Specific Symptoms:

 Laughing , Singing & Talking loudly

 Hallucination, Delirium& Sleepiness
 Tremor, Headache , Dryness of mouth
 Numbness & Tingling sensation of skin
 Pupil Dilated ,Impaired memory function

B. General Symptoms: the symptoms of all systems of body:

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 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs
 Disability management
(neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - Stomach washes with water & 2-4% Tannic acid

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c. Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

 Ice cold application overhead, cold bath, strong tea & coffee
 Injection Nelaxone 2 mg

d.Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance congestion in the internal organs

Medico legal Importance –

Accidental, Aphrodisiac,
Stupefying.
(It produce insanity & develop Homicidal tendency-- RUN AMOK)
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COCAINE POSONING

Definition: It is a type Neurotic cerebral stimulant poison

Properties-
• It is obtained from leaves of erythroxylum coca plant (divine plant).
• It is colorless, odorless, crystalline substance with bitter taste
• Used as local anesthetic
• It is taken with betel as stimulant & aphrodisiac.
• Increase muscular & mental power &produce comfortless.

Action:- CNS depressant.

Fatal Dose:- 1 gm. Orally.

or 20 drops
Injection-(1-2 ml)
Fatal Period: -few minutes to few hours.

Clinical Features:-

A. Specific Symptoms:

o Excitement with sensation of pleasure.

o Bitter taste of mouth.
o Feeling of happiness and wellbeing.
o Feeling of increase power mentally and physically
o Tingling sensation & numbness of hands & feet.

o Magnon’s symptom’s in chronic poisoning Tactile Hallucination called Cocaine bug or

Cocainism

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
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MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way:-
 Maintenance of breathing: Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid: --Emergency
Drugs-
 Disability management
(neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - by- Stomach wash with plain water then with potassium
permanganate (KMnO4) solution or charcoal or tannic acid solution

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c.Admiistration of Antidotes: to Neutralization or counteract the action of poison. - Given –

o Amyl nitrate by inhalation.

d.Symptomatic Treatment & maintenance of patients’ general condition

Postmortem-Appearance
o Pupil widely dilated.
o Congestion of internal organs of body.

Medico legal Importance

o Accidental case from Addiction.
o Addiction problem by speed ball.
o Aphrodisiac (believed to increase sexual power)
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CHLORAL HYDRATE

Definition: This is colorless crystalline substance having a peculiar bitter-sweet but nauseous
taste and aromatic smell.
Property: It is powerful and reliable hypnotic. Its action is so rapid that its name is given “knock
out drops” In small doses, it produces natural sleep but in larger doses (5 to 6 gm.), it is CNS
depressant and paralyses the vital centers. It is also known as ‘dry wine’ it is used in alcohol to
produce sleep
Therapeutical dose- (0.3 to 1.2 gm.)
Fatal dose: - 5 gm.
Fatal period: - 8 to 12 hrs. to 2 to 3 days.
Treatment: - The stomach should be washed out with warm water containing an alkali which
decompose the unabsorbed chloral hydrate.
Medico legal aspects:-
 Accidental from a large doge used as a hypnotic
 It is often added to liquor for greater kick.
 It is added to beer with homicidal intent
 Long continued use produce addiction
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KEROSINE POISONING
Definition:-It is a type of neurotic cerebral poison.

Properties:-
• It is an aliphatic hydro carbon derivative of petroleum distillates.
• It is colorless or blue color Refined oil.
Action: -
• Petroleum distillates are Irritant because they dissolve fats.
• They also depress the cells of CNS& effect on liver, kidney& bone marrow

Fatal Dose: -
30-100 ml kerosene
15- 20 ml benzene.
150- 200ml turpentine oil.
2-5 GM’s Naphthalene ball

Fatal Period: - within 24 hours.

Clinical Features:-

A. Specific Symptoms:

• Burning pain in throat & hotness in stomach, vomiting.

• Smell of kerosene in vomited material & breathing.
• Dizziness, drowsiness, convulsion, pulse feeble & fast.

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid: --
 Disability management
(neurogenic states asses level of consciousness)
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B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: by - Stomach wash with plain water or with sodium
bi carbonate solution

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

e. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –

• Liquid paraffin orally to prevent absorption

• Emetics & purgatives are given
• Vitamin B- complex to prevent liver damage

f. Symptomatic Treatment & maintenance of patients’ general

Postmortem Appearance
• Inflammation of stomach & intestine
• Odor of kerosene in G.I. Tract & lungs with inflammation& hemorrhage

Medico-legal Importance:-Accidental among child

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NUXVOMICA POISONING
Definition: -It is a type of Neurotic spinal poison

Properties:-
• Nux vomica obtained from the seeds of strychnoseNux Vomica plant.
• The ripe fruit of plant contain seeds which are hard & flat, yellowish &intensely bitter
in taste.

Active principles- Strychnine, Brucine & loganin.

Action:-
• This group of poison act mainly on spinal cord.
• Action resulting in the production of spasm or depressant which produce paralysis &loss of
sensation.

Fatal Dose: - 2 gram in powder form

15 – 30 mg strychnine Alkaloid

Fatal Period:- 1 to 2 hour

Clinical Features:-

A. Specific Symptoms:

o Epigastria pain , restlessness , Bitter taste in mouth

o Twitching of facial muscles, Contraction of Jaw & facial muscles
o Corner of mouth down-backward ,
o Convulsions , Cyanosis, Pupil Dilated
o Ricinus Sardonicus appearance (Devil’s face)
o Body curved backward (Opisthotonus )
o Frothy Salivation
o Mind remain clear,
o Death is painful.

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 24

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists

 Disability Maintenance of air way

 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
 management
(Neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - by- Stomachs wash with 5% tannic acid & Emetics are
given.
b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c.Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

o Injection:- Pento barbital Sodium, or Sodium Amytal I.V.

o Injection --Diazepam

d.Symptomatic Treatment & maintenance of patients’ general

Postmortem Appearance

Strychnine can be detected from viscera’s

Internal organs are found congested & inflamed

Medico legal Importance

o Accidental,
o Suicidal,
o Homicidal,
o Cattle poison.
 25

ACONITE POISONING

(Monk’s hood, blue rocket, Mitha bish)

Definition:- It is a type of cerebro- cardiac poison

Properties & Origin:- There are several varieties of aconite plant, Aconite napellus and Aconite
ferox are commonly used. It grows in Himalayas. All parts of the plant are poisonous but the root is
most potent so used for poisoning. Aconite root is dark brown in color & taste is acrid-sweetish.

Active principle:- Aconitine, Aconine

Action:-
• It is cerebro-cardiac depressant poison.
• It depresses the myocardium, smooth muscles, skeletal muscles, CNS, & peripheral nerves.

Fatal Dose: -
2-5 mg Aconitine,
1 gm. root
(2- 30 ml tincture)

Fatal Period: - 2-6 hours.

Clinical Features:-

A. Specific Symptoms:

 Sweetish bitter taste in mouth.

 Tingling & numbness in mouth& throat spreading to whole body.
 Muscular weakness & spasm of muscles
 Alternate contraction & relaxation of pupil (Hippus sign)
 Death occurs due to paralysis of heart & respiratory centers

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 26

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
 Disability management
( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

Removal of unabsorbed poison: - by- Stomach wash with 0.2% solution of iodine
(KI), or Tannic acid or animal charcoal, milk to precipitate alkaloids.

Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given – Amyl nitrate inhalation (to improve pulse rate).

a. Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance

o Fragment of root may found in stomach.

o Mucosa of stomach & intestine show congestion & inflammation
o Liver, lungs, kidney & brain are congested.

Medico legal Importance

o Accidental- from use as medicine by quacks.

o Suicidal
o Homicidal- mix aconite powder in drinking water to kill enemy(during
Sikkim expedition aconite was mixed in water of fountains & large no. of
British troops died)
o Cattle poison, Arrow poison in hilly tribal areas.
 27

DIGITALIS POISONING

Definition: -It is a type of cerebro- cardiac poison

Properties & Origin:- Entire plant of Digitalis purpurea is toxic. But the seeds of plant are more
toxic.

Active principle:- Digoxin, Digitoxin, Digitalin.

Action:- The glycosides act directly on the Heart muscle & improve the function of a failing heart. It
stimulates & than depresses the myocardium, smooth muscles& CNS.

Fatal Dose: -4 -- 30 mg

Fatal Period: - 1 – 24 hours

Clinical Features:-

A. Specific Symptoms:

• Tachycardia, Fibrillation& flutter.

• Slowing of heart rate, heart block
• Head ache , Confusion
• Depression,, Disorientation
• Delirium, hallucination

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 28

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way:
 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid :
 Disability management
(neurogenic states asses level of consciousness)

B.MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: -by Stomach washes with Tannic acid solution

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

c.Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

 Activated charcoal in repeated doses.
 Injection-Fab-fragment - i.v. (Digoxin specific antibody fragment)

d.Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance

• Slight inflammation of gastric mucosa

• Fragments of leaves may be found in GI Tract.

Medico legal Importance:- Accidental due to therapeutic dose.

 29

OLEANDER POPISONING

(NERIUM ODORUM, WHITE KANER)

Definition:- It is a type of cerebro- cardiac poison

Properties:- All parts of the plant are poisonous. It is containing several cardiac glycosides.

Active principle:- Nerin, Oleandrin.

Action:- It is cerebro-cardiac depressant poison. The glycosides act directly on the Heart muscle. It
stimulates & than depresses the myocardium, smooth muscles, spinal cord & CNS.

Fatal Dose: -

15- 20 gm. Root,

5-15 gm. Leaves.

Fatal Period: - 20-36 hours

Clinical Features:-

A. Specific Symptoms:

• profuse frothy salivation

• Respiratory irregularities, pupil dilated
• Muscular twitching &titanic spasm, lock jaw, coma.
• Cardio respiratory failure death.

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 30

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way:
 Maintenance of breathing:
 Maintenance of circulation
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
 Disability management
( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - by- Stomach washes with Tannic acid solution

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

C.Admiistration of Antidotes: to Neutralization or counteract the action of poison. - Given –

Atropine Sulphate for Bradycardia to increase heart rate and
Cardio respiratory stimulant drugs.

d.Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance:-
• Congestion in mucous membrane of stomach, duodenum & internal organs-
Liver, lungs, kidney
Medico legal Importance
 Suicidal,
 Abortifacient
 Homicidal-
 Cattle poison
 31

OLEANDER POISONIG

(CERBERATHEVETIA, YELLOW KANER)

Definition:- It is a type of cerebro- cardiac poison.

Properties:-
All parts of plant are poisonous. The globular fruit of the plant contain a single triangular brown Nut.
Each Nut contains 5 seeds. The seeds are more poisonous

Active principle:- Thevetin, Thevotoxin, Cerberin

Action:-
It is cerebro-cardiac depressant poison.
The glycosides act directly on the Heart muscle. It stimulates & than depresses the myocardium,
smooth muscles, spinal cord & CNS.

Fatal Dose:

8- 10 seeds in crushed form

15- 20 gm. Root
5- 10 gm. leaves.

Fatal Period: - 2- 3 hours.

Clinical Features:-

A. Specific Symptoms:

• Vomiting, diarrhea,
• Burning & dryness in mouth with tingling sensation.
• pupil dilated
• Convulsion, heart block, collapse

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:
 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 32

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
 Disability management
( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: -by- Stomach washes with Tannic acid solution

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c.Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

Atropine Sulphate for Bradycardia to increase heart rate and Cardiorespiratory stimulant
drugs

d.Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance
• Congestion in mucous membrane of stomach, duodenum.
• Congestion of internal organs- Liver, lungs, kidney
• Sub endo cordial hemorrhage in the heart.

Medico legal Importance

• Suicidal
• Abortifacient
• Homicidal- Cattle poison.
 33

NICOTIN--POISONING

(TOBACCO, TAMBAKU)

Definition:- It is a type of cerebro- cardiac poison

Properties & Origin

• Tobacco is the leaf of the Nicotiana Tabacum plant.
• The dried leaves (Tambaku) are chewed or used in the form of smoke or snuff.
• All parts of the plant poisonous accept the ripe seeds.
• Nicotine is colorless, volatile, bitter liquid used extensively in agricultural as fertilizers,
fumigants & insecticide spray.

Active principle: Nicotine& Anabasine

Action:-It is cerebro-cardiac depressant poison. It first stimulates then depresses& later paralyses
autonomic ganglia, myocardium, smooth muscles, CNS. It also acts on somatic Neuro muscular junction
& peripheral nerves.

Fatal Dose:-

50- 100 mg of nicotine

10- 15 gm. Crude tobacco.

Fatal Period: 5- 15 minutes

Clinical Features:-

A. Specific Symptoms:

• Nausea, Vomiting, Burning sensation in stomach& hyper salivation,

• Bradycardia, hypotension, Cardiac arrhythmias,
• Sweating, Agitation, convulsion, coma
• Death occurs due to respiratory failure.

B. General Symptoms: the symptoms of all systems of body:

 Gastro intestinal Tract:

 Respiratory Tract:
 Central Nervous System
 Cardiovascular System
 Excretory System
 34

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way:
 Maintenance of breathing: Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid:
 Disability management
( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a.Removal of unabsorbed poison: - by- Stomach wash with warm water containing charcoal,
tannic acid or potassium permanganate.

b.Removal of absorbed poison or metabolic products: by Diuretic , Purgative and Diaphoretic

c.Administration of Antidotes: to Neutralization or counteract the action of poison. - Given –

 Mecamylamine (inversine) orally.
 Cardio respiratory stimulant drugs

d.Symptomatic Treatment & maintenance of patients’ general condition.

Postmortem Appearance:-
 Brownish froth at mouth & nostril.
• Hemorrhagic congestion of GI tract.
• Stomach may contain fragments of leaves with smell of tobacco.

Medico legal Importance:-

Accidental commonly due to ingestions, excessive smoking .
 35

CARBON MONOXIDEGAS POISONING (CO)

Definition:-It is a type of Asphyxiant poison.

Properties & Origin:-

• It is colorless, tasteless, odorless, non-irritating gas. It cannot be perceived by sense

• It is formed by burning of carbon at high temperature or limited supply of oxygen.
• It has great affinity with hemoglobin & it forms a stable compound known as carboxy-
hemoglobin (COHb).
• Carboxy- hemoglobin reduces oxygen content of blood & act as chemical Asphyxiant.

Action: - Carbon Monoxide reduces oxygen carrying capacity of blood & Act as Asphyxiant. Produce
respiratory embarrassment.

Fatal Dose Fatal Period: -depends on saturation of COHb in blood.

Above 60-70% saturation of Carxyhaemoglobin (COHb) in blood may produce painless death.

Clinical Features:-

A. Specific Symptoms:

 Development of symptoms depends on saturation of Carboxy- hemoglobin (COHb) in blood.

 10-50% Concentration- headache, nausea, breathlessness, dizziness, mental confusion, weakness,
ataxia, faintness, defective sight& hearing (imbalance of body).
 50-60% saturation- loss of power of movement, respiratory irregularities, convulsion, syncope,
coma, pupil dilated, skin pinkish & reddish with rash& blister.
 60-70 %- deep coma, weak, rapid pulse, painless death due to deprivation of oxygen
 70-80%- or Above-Rapid death

MANAGEMENT:-
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists
 Maintenance of air way:- Clear & establish air way by positioning, suctioning or
insertion of oro-pharyngeal airway or endotracheal intubation.

 Maintenance of breathing: Provide breathing by artificial respiration and oxygen

inhalation to improve concentration of Oxygen in Blood and Relieve hypoxia, maintain
tissue respiration.
 Maintenance of circulation: for better circulation fluid therapy is given to combat fluid
loss, prevent shock and maintain Bloodpressor, Nutrition and Electrolyte balance.
( Fluid Therapy:- intra-venous infusions are given like – Dextrose, Fructose, ,Glucose ,
Normal Saline, Ringer Lactate, with multi-vitamins
 36

 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid : These are
lifesaving emergency drugs given to provide strength and enhance function of vital
organs (Brain, Heart, Lungs) in life threatening condition and to prevent shock.
--Emergency Drugs- Injections- Adrenalin, Amphetamine, Nikethamide, Bemegride,
Picrotoxine, Cardiazole, Restimuline, Theophylline).
--Corticosteroids—Injection- Hydro-Cortisone, Dexamethasone, Betamethasone,
Prednisolone.
 Disability management ( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by

 Removal patient from source into fresh air

 Oxygen inhalation & Artificial respiration

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

c. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –
 Injection-Cytochrome i.v.,
 Injection- Corticosteroid i.v.
 20% Mannitol 50ml for cerebral edema.
 Cardio respiratory stimulant drugs
 Fluid Therapy is given.
 Blood transfusion
 Strong Antibiotics.

• Symptomatic Treatment & maintenance of patients’ general condition

Postmortem Appearance:-

• Skin & mucous membrane shows cherry red colour.

• Color of Lips, finger, bright cherry red
• Irregular patches of bright red color are found over anterior surface of body (post
mortem stains)are cherry red in color
• Blood is bright red & fluidy
• Internal organs bright red due to formation of carboxy hemoglobin
• Lungs edematous
• Petechial hemorrhage in brain & Meninges
• Presence of Carboxy- hemoglobin (COHb) in blood & serum.

Medico-legal Importance:-Accidental, Suicidal, Automatism poisoning

 37

CARBON DI OXIDEGAS POISONING (CO2)

Definition:-It is a type of Asphyxiant poison

Properties:- This gas is produced by respiration, combustion, fermentation & decomposition of

organic matter. (Burning of charcoal, Explosion of coal mines)

Action: - Carbon di oxide produces lack of oxygen in the tissues. Act as Asphyxiant Produce
respiratory embarrassment.

Fatal Dose& Fatal Period: - -Depends on saturation of CO2 gas. In blood. Above 70% saturation of
CO2 in blood produce death.

Clinical Features:- Symptom depends on the degree of concentration of gas & saturation of the blood
by gas

A. Specific Symptoms:

 10-50% Concentration- headache, nausea, breathlessness, dizziness, mental confusion,

weakness, ataxia, faintness, defective sight& hearing (imbalance of body).
 50-60% saturation- loss of power of movement, respiratory irregularities, convulsion,
syncope, coma, pupil dilated, skin pinkish & reddish with rash& blister.
 60-70 %- deep coma, weak, rapid pulse, painless death due to deprivation of oxygen
 70-80%- or Above-Rapid death.
 Commonly death occurs in a closed room during winter season with burning lamp(Lampha

MANAGEMENT:- Management of the poisoning case is very important part in any

poisoning case to save the life of the patient and restoration of health.
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT:

It consists:-
 Maintenance of air way
 Maintenance of breathing:
 Maintenance of circulation:
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid
 Disability management
(Neurogenic states asses level of consciousness)
 38

B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: -

 Remove the person from source into fresh air.

 Oxygen inhalation & artificial Respiration.

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic

c. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –
 Injection-Cytochrome i.v.,
 20% Mannitol 50ml for cerebral edema.
 Cardio respiratory stimulant
 Corticosteroids
 Fluid Therapy is given.
 Blood transfusion

d. Symptomatic Treatment & maintenance of patients’ general condition It is line of

treatment which is given according to symptoms and need of the patient to early
recovery and restoration of the health with proper nursing care, (Moth, bowel, Bladder,
skin care), Monitor and maintain vital parameters, Rest, reassurance and Psychotherapy
is given to the patient.

Postmortem Appearance:-
• face pale, livid & swollen,
• tongue protruded & grasped by teeth,
• Pupil dilated, froth in nostril & mouth.

Medico legal Importance

• Accidental.
• Suicidal [in western country (France) common method of suicide to
inhale
 39

STUDY OF
AGRICULTURE POISONS
 40

Agriculture poisons

Definition:- Agro-chemicals or agriculture poisons are natural (Biological) or chemical

agents known as fertilizers and pesticides used for the management of ecosystem in
agricultural sector. They are used to improve crops and control the population of
agricultural pest (Insects) and weeds and promote plant growth.

Pesticides or Firtilizers: Pesticides are the agro chemicals used in agriculture to promote
crops against insects, fungi, weeds. They also supply nutrients to the soil and plants which is
essential to the growth of plant and crops.

The term pesticides includes all of following- Insecticides, Rodenticides, Herbicides,

Bactericides, Fungicides and antimicrobial. They are also toxic to human being they may
produce adverse health effect – like – cancer, effect on reproductive, immune and nervous
system.

Natural fertilizers or Agrochemicals:- Natural fertilizers are the organic material that contains
vital plants nutrients ( It is mixture of nitrates or manure (khad) such as nitrogen, phosphorus
and potassium, cow slurry, dung (gobar) leed,(compost) , Blood meal, bone meal, worm
casting. used to make soil more fertile

Chemical Agriculture poisons are categorized by their chemical structure and their
specific Use.

A. Insecticides
B. Fungicides
C. Rodenticides
D. Herbicides etc.

A. INSECTICIDES:-
Organic phosphates & Organo chlorines e.g.-
 (HETP) -Hexa ethyl tetra phosphate),
 (TEPP)- Tetra ethyl pyro phosphate),
 Melathion, Sulphotep,
 Parathions, Methyl parathion,
 Diazinon (Tik-20)
 Endrin, D.D.T.

B. FUMIGANTS- Alluminiumphosphide (Celphos, sulphas, Alphos)

C. RODENTICIDES- Zinc phosphate, Thallium phosphate.
 41

C. HERBICIDES- Paraquate, Bromoxynil

Commonest types of Pesticide substances used for poisoning are following-

 Organo phosphates
 Chlorinated Hydro carbons ( Organo chlorine)
 Aluminium Phosphide
 Carbamates and Pyrethroides
 Microbial and Insect growth regulator

Organo Phosphorous Poisoning

Definition: - Organo-phosphorus poisons are Irritant poisons.
 42

Physical Property: - Organo phosphorus poisons are ester of phosphoric acid used as
Insecticide & pesticide.

They form two series of compounds:-

Alkyl Phosphates compounds
 HETP (Hexa ethyl tetra phosphate),
 TEPP (Tetraethyl pyro phosphate),
 Melathion, sulphotepp.

Aryl Phosphates comoounds

Parathion,
Methyl-Parathion,
Diazinon (Tik-20)

Action: -Organic Phosphates binds to the Acetyl cholinesterase Enzyme, and inhibits
action of enzymes so in absence of cholinesterase enzyme Acetylcholine Transmitter is not
utilize by the body systems so transfer of impulse prevented at myo neural junction,
synapses of ganglion & in all parts of body
Death may occur due to failure of respiratory centers & paralysis of respiratory muscles.

(Acetylcholine Transmitter used in presence of Acetyl cholinesterase enzyme }

Fatal Dose: -60 m.g.to 1 gm. orally.
50—80 mg. i.m. i.v.

Fatal Period:
30 minutes to 3 hrs. (Within 24 hours}

Clinical Features:-

A. Specific Symptoms:
 Cramps, Salivation, Bradycardia, Hypotension, Blurred Vision.
 Pinpoint Pupil with red
colourLacrymation or Tearing.
 Frothing in nostrils &mouth.

B. General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract: - Nausea, vomiting, diarrhea, burning sensation in mouth, throat,
esophagus, stomach and abdomen, pain in abdomen, difficulty in swallowing,
hematemesis, Melina.

 Respiratory Tract: - difficulty in breathing, suffocation, impaired respiration, hoarseness

of voice, Cyanosis, respiratory failure, skin cold and clammy.

 Central Nervous System :- Headache, vertigo, pale anxious face, Digginess, drowsiness,
insensibility, weakness, restlessness, agitation, cramps, numbness and tingling sensation,
excitement, depression, speech altered, staggering gait, convulsion, impaired memory,
 43

delirium, hallucination, pupil dilated/constricted, impaired vision & hearing, collapse,

shock, unconsciousness, coma.

 Cardiovascular System:--Pulse rapid/feeble/slow, tachycardia, bradycardia, Arrhythmia,

heart block, heart failure.

 Excretory System:- Albuminuria, hematuria, burning micturition, oliguria, Oxaluria,

Carbolurea, anuria, renal failure, edema, anasarca.

MANAGEMENT:- Management of the poisoning case is very important part in any

poisoning case to save the life of the patient and restoration of health.
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT: The main aim of general management is to help the
patient to stay alive by given attention to vital parameters (Pulse, B.P. Respiration,
Temperature) to stabilization of poisoning case. It consists
 Maintenance of air way:- Clear & establish air way by positioning, suctioning or
insertion of oro-pharyngeal airway or endotracheal intubation.
 Maintenance of breathing: Provide breathing by artificial respiration and oxygen
inhalation to improve concentration of Oxygen in Blood and Relieve hypoxia, maintain
tissue respiration.
 Maintenance of circulation: for better circulation fluid therapy is given to combat fluid
loss, prevent shock and maintain Bloodpressor, Nutrition and Electrolyte balance.
( Fluid Therapy:- intra-venous infusions are given like – Dextrose, Fructose, ,Glucose ,
Normal Saline, Ringer Lactate, with multi-vitamins
 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid : These are
lifesaving emergency drugs given to provide strength and enhance function of vital
organs (Brain, Heart, Lungs) in life threatening condition and to prevent shock.
--Emergency Drugs- Injections- Adrenalin, Amphetamine, Nikethamide, Bemegride,
Picrotoxine, Cardiazole, Restimuline, Theophylline).
--Corticosteroids—Injection- Hydro-Cortisone, Dexamethasone, Betamethasone,
Prednisolone.
 Disability management ( neurogenic states asses level of consciousness)

B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by -- Stomach wash with potassium permanganate,

Solution or 5% Sodium Bicarbonate solution
 44

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic
 Diuretics: - Water, Salt, Sugar, Fluids, Tea, Coffee, Sodium & Potassium bicarbonate
solution.
 Purgatives: - Castor oil, Sodium sulphate, Sodium tartrate, Lectulose, Methyl cellulose,
Liquid paraffin.
 Diaphoretics: - Pilocarpin drug , Hot water, Tea, Milk, blanket.

c. Administration of Antidotes: to Neutralization or counteract the action of poison. -

Given –
 Injection:- Di acetyl monoxim- sulphate ( DAM )
 Injection- pralidoxime iodide, Pralidoxime chloride.
 Injection- Atropine sulphate

d. Symptomatic Treatment & maintenance of patients’ general condition It is line of

treatment which is given according to symptoms and need of the patient to early recovery
and restoration of the health with proper nursing care, (Moth, bowel, Bladder, skin care),
Monitor and maintain vital parameters, Rest, reassurance and Psychotherapy is given to
the patient.

Postmortem Appearance
 Blood stained froth at the mouth & nose
 Mucosa of the stomach congested with sub mucosal Petechial hemorrhage
 Other all internal organs are congested

Medico legal Importance

 Suicidal,
 Accidental during spray

TEST: - Urine of the person gives strong yellow color with sodium hydroxide.
 45

Aluminum Phosphide poisoning

(CELPHOS, SULPHAS)

DEFINITION: - It is a type of agriculture Irritant (fumigant) poison.

PHYSICAL PROPERTY-

 It is solid, white color fumigant, It has garlicky odor

 Used as pesticide, insecticide & Rodenticides
 It is also used as grain preservative. It liberates Phosphine gas (PH 3) & left nontoxic
aluminum phosphite residue in grain.
 It is available as white tablet of Celphos, Alphos, quickphos & phosphotex
 1 tab liberate 1 gm Phosphine

ACTION:-
 Phosphine gas inhibits cytochrome oxidase respiratory enzyme & produce cytotoxic
effect (cellular hypoxia).

Fatal Dose: -
3- 9 gm. 1-3 tab

Fatal Period: - 1 – 3 hour (within 12 hr. to 36 hrs.)

CLINICAL FEATURES :-

A. Specific Symptoms:

 Dyspnea, respiratory distress, tightness in chest & retrosternal pain

 Respiratory failure, pulmonary edema, hypotension, arrhythmias,
 Acute CHF, shock, pericarditis, myocarditis.

B. General Symptoms: the symptoms of all systems of body;

 Gastro intestinal Tract: - Nausea, vomiting, diarrhea, burning sensation in mouth, throat,
esophagus, stomach and abdomen, pain in abdomen, difficulty in swallowing,
hematemesis, Melina.

 Respiratory Tract: - difficulty in breathing, suffocation, impaired respiration, hoarseness

of voice, Cyanosis, respiratory failure, skin cold and clammy.

 Central Nervous System :- Headache, vertigo, pale anxious face, Digginess, drowsiness,
insensibility, weakness, restlessness, agitation, cramps, numbness and tingling sensation,
excitement, depression, speech altered, staggering gait, convulsion, impaired memory,
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delirium, hallucination, pupil dilated/constricted, impaired vision & hearing, collapse,

shock, unconsciousness, coma.

 Cardiovascular System:--Pulse rapid/feeble/slow, tachycardia, bradycardia, Arrhythmia,

heart block, heart failure.

 Excretory System:- Albuminuria, hematuria, burning micturition, oliguria, Oxaluria,

Carbolurea, anuria, renal failure, edema, anasarca.

MANAGEMENT:- Management of the poisoning case is very important part in any

poisoning case to save the life of the patient and restoration of health.
In general, management of poison is based on following principles:

A.GENERAL LINE OF MANAGEMENT: The main aim of general management is to help the
patient to stay alive by given attention to vital parameters (Pulse, B.P. Respiration,
Temperature) to stabilization of poisoning case. It consists

 Maintenance of air way:- Clear & establish air way by positioning, suctioning or
insertion of oro-pharyngeal airway or endotracheal intubation.

 Maintenance of breathing: Provide breathing by artificial respiration and oxygen

inhalation to improve concentration of Oxygen in Blood and Relieve hypoxia, maintain
tissue respiration.

 Maintenance of circulation: for better circulation fluid therapy is given to combat fluid
loss, prevent shock and maintain Bloodpressor, Nutrition and Electrolyte balance.
( Fluid Therapy:- intra-venous infusions are given like – Dextrose, Fructose, ,Glucose ,
Normal Saline, Ringer Lactate, with multi-vitamins

 Cardio- Respiratory stimulant drugs (Emergency drugs) and Corticosteroid : These are
lifesaving emergency drugs given to provide strength and enhance function of vital
organs (Brain, Heart, Lungs) in life threatening condition and to prevent shock.
--Emergency Drugs- Injections- Adrenalin, Amphetamine, Nikethamide, Bemegride,
Picrotoxine, Cardiazole, Restimuline, Theophylline).
 Corticosteroids—Injection- Hydro-Cortisone, Dexamethasone, Betamethasone,
Prednisolone.
 Disability management ( neurogenic states asses level of consciousness)
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B. MAIN OBJECTIVE OF TREATMENT

a. Removal of unabsorbed poison: - by -- Gastric Lavage with potassium permanganate

solution (KMnO4)

b. Removal of absorbed poison or metabolic products: by Diuretic , Purgative and

Diaphoretic
 Diuretics: - Water, Salt, Sugar, Fluids, Tea, Coffee, Sodium & Potassium bicarbonate
solution.
 Purgatives: - Castor oil, Sodium sulphate, Sodium tartrate, Lectulose, Methyl cellulose,
Liquid paraffin.
 Diaphoretics: - Pilocarpin drug, Hot water, Tea, Milk, blanket.

c. Administration of Antidotes:
 Activated charcoal orally to adsorb Phosphine gas (PH3)
 Liquid paraffin for excretion of Celphos & Phosphine gas from gut

d. Symptomatic Treatment & maintenance of patients’ general condition –

It is line of treatment which is given according to symptoms and need of the patient to
early recovery and restoration of the health with proper nursing care, (Moth, bowel,
Bladder, skin care), Monitor and maintain vital parameters, Rest, reassurance and
Psychotherapy is given to the patient.

POSTMORTEM APPEARANCE:-
o Garlic like odor in mouth, nostril & in gastric content
o Blood stained froth in mouth & nostril
o Mucous membrane of esophagus, stomach & duodenum congested.

MEDICO-LEGAL- IMPORTANCE:-

 Suicidal,
 Homicidal in case of Dowry death in Rural.
 Occasionally – accidental.
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