• Paracetamol

Introduction
• Antipyretic
• Analgesic
• effect on gastric mucosa
Mechanism of action
• Metaboliszed by cytochrome p450
• N acetyl benzoquinone imine
• Nomally its desptroyed by glutathione
• Hepatic necrosis
• Binds with proteins
Fatal dose
• 20 tablets
• 20 to 30 grams hepatotoxic

IV formulation of acetaminophen 
Fetal period
• 3 to 5 days
Symptoms
• Stage 1 24 hours
• Anorexia diaphoresis malaise drowsiness

• Stage 2 after 24 hours

• Apparent recovery
• Right upper quadrant pain
• Lfts are elvated so is PT bilirubin AST GST
• Stage 3
• Hepatic necrosis sets in
• Coagulation defect
• Jaundice
• Encephalopathy
• Renal failure
• Death due to hepatic failure with coma
• Stage 4
• If pt survives complete resolution of liver damage
• Chronic poisoning is uncommon
Risk factors

• Alcholism
• Aids
• Tb on therapy
• In children
Medicolegal
• Toxicity is most common
• Accidental
• Suicidal
• Homicidal rare
Antidote
• N acetyl cysteine
Treatment
• Gastric lavage
• Activated charcoal
• Anti emets
• Hypooglycemia dextrose solution
• Vitamin k
• Fresh frozen plasma
• Mannitol
• H2antagonist
PM findings
• Presence of remains of tablet in stomach
• Presence If skin rashes
• Yellow and enlarged liver
• Jaundice
• Petechial haemmorages
• Gi bleeding
• Hepatic necrosis
• Renal tubular necrosis
• Cerbral edema
Tobacco
Nicotine
• Prepared from the leaves of nicotiana tobaccum
Active priciple
• Nicotine
• Nornicotinr
• Anabasine
• Anabatine
Sources
• Nicotine is a natural toxic substance found in tobacco products. It’s
also the chemical that makes tobacco products addictive. Nicotine is
found in cigarettes, cigars, e-cigarettes, chewing tobacco, snuff, pipe
tobacco, tobacco plants, some insecticides (
How is someone exposed to the effects of
nicotine?
How is someone exposed to the effects of nicotine?
Nicotine can enter the body through:

Absorption through your skin, if nicotine is in liquid form and spilled on the skin
or touched.
Inhalation into your lungs, from smoked products and electronic cigarettes.
• Ingestion and absorption through the mucous membrane of your mouth
(from tobacco chew products or liquid nicotine) or through the intestines
(after accidental swallowing of e-cigarette refill products or drinking liquid
nicotine).
Mode of action
• Binds to acetylcholine receptors
• Alerting pattern at eeg
• Tremors convulsion
• First cause stimulation then depression of cns
• Death possible due to collapse of respiratory system
Rising trends
• Today, nicotine poisoning has become a growing concern because of
new nicotine products on the market, particularly 
electronic cigarettes (e-cigarettes) and pure liquid nicotine. The
concentration of nicotine in liquid products is higher than most
other tobacco products
Fatal dose
Can a person overdose on nicotine from smoking alone?
• It’s unlikely; however, it’s not impossible. There’s been one case report
where two brothers In lahore presented to cmh who smoked 17 and 18
pipes of tobacco in a row and were fatally poisoned.
• 1 cigrate contains 1g of tobbaco
• 15 to 60 grams of tobbaco is fatal
• Leading causes of nicotine poisoning are smokeless tobacco products
(chew and snuff) and liquid nicotine that’s used in e-cigarettes. The
nicotine is more concentrated in liquid nicotine. Chewing and snorting
tobacco releases more nicotine into the body than smoking.
What are the signs and symptoms of nicotine
poisoning?
Early phase symptoms after ingestion include:

Nausea and vomiting. Vomiting occurs in more than 50% of people with symptoms.
Increased salivation.
Abdominal pain.
Pale skin color.
Sweating.
Increased blood pressure.
Increased heart rate.
Rapid, heavy breathing (hyperpnea).
Muscle twitching.
Seizures.
• Late phase symptoms include:
• Diarrhea.
• Low blood pressure (hypotension) and slow heart rate (bradycardia).
• Abnormal heart rhythms.
• Shock.
• Coma.
• Muscle weakness/paralysis.
• Shallow breathing, difficulty breathing, respiratory failure
• How does nicotine poisoning cause death?
• Death typically happens due to paralysis of the muscles that control
your breathing, fluid buildup in your airways and heart and blood
vessel failure (cardiovascular collapse).
Treatment

Benzodiazepines to control seizures.

Intravenous fluids (IV) fluids to treat low blood pressure.
Antidepressants
Atropine to treat slow heart rate.
Ventilator to help deliver oxygen if there’s respiratory failure.
Post mortem findings
Characteristic order in git
Brownish froth in mouth
Congestion of liver
Medicolegal
• Poisoning mostly in chewing and ingesting
• Used for infanticide
• Homicidal or suicidal
How to prevent nicotine poisoning
• Stop smoking. Alone