Chronic Arsenic Poisoning

classification of poison
• C
• I
• N
• C
• A
• M
 Classification of irritants
• Inorganic-- 1-metallic 2- non metallic

• Organic-- 1-animal 2-vegetable

• Mechanical
acute vs chronic
 Chronic Arsenic Poisoning
Chronic arsenic poisoning results from:
• 1-Chronic repetitive inhalation of arsine gas
• 2-Chronic repetitive ingestion-- Persons
engaged in the occupation of:
-- Refining of ores
-- Manufacture
of weed killers, insecticides, paints, dyes and
cosmetics.
--Persons who ingest it as medicine for long
periods.
• 3-May follow the acute poisoning after recovery.
 S/S
• Long term arsenic toxicity leads to multi system
disease
• Chronic poisoning consists of the following stages:
• First stage of nutritional & gastrointestinal: The
following symptoms are produced in the first stage:
• Anorexia
• weight loss
• abdominal pain
• nauseas andVomiting
• diarrhea
 Second stage of catarrhal changes
• Mucous membrane is inflamed, resulting in
conjunctivitis, running eyes and nose, coughing,
hoarseness of voice and bronchial catarrh.
• p5. has S/s similar to ommon cold
 Third stage of skin rashes
• Irritation of skin resulting in vesicular eruption.
• Rain drop pigmentation-- patchy brownish
pigmentation of skin. D/D Addison’s disease.
• Palms and soles -- hyperkeratosis,
• Hair-- alopecia.
• Nails-- brittle. Mee`s line-- transverse white lines
appears on the nails of the fingers and toes.
They indicate period of arrested growth due to
interference with normal metabolism. Those who
have more than one exposure may show double
line.
 Fourth stage:
• peripheral neuropathy -- glove and stocking
type of anesthesia. tingling, numbness.
Decreased pain, temperature and touch
sensation
• Muscular atrophy of extensor muscles resulting
in wrist drop and foot drop.
• Unable to walk, distal reflexes are decreased.
(Knee jerk is lost)
• Ataxia
• Tenderness of muscle
• s/D alcoholic neuritis
• There may be evidence of liver damage,
kidney damage, and bone marrow
depression at some stage.
 Treatment
• Remove the patient from source of poison.
• B.A.L. is to be given 6 hourly for 2-3 days and
then once daily.
• Vitamin B complex injection for peripheral
neuritis.
• symptomatic
 PM appearnce
• Retard decomposition.
• Liver, kidney and heart--fatty degeneration
• GIT-- congestion.
 Medicolegal Aspects
• Homicidal poisoning -- It is an ideal homicidal
poisoning, can be mixed with sweets, bread, cooked
vegetable, drinks, milk, pan. Mass homicidal poisoning
simulates cholera.
• It is tasteless, odorless, easily available and small doses
are required for homicide. small doses given for a
prolonged period simulates gastroenteritis.
• Disadvantages are: 1- Can be detected even in the
charred bodies 2- delays putrefaction 3- Can be detected
in decomposed bodies 4- Can be found in bones, hair
even years after the poisoning.
 Medicolegal Aspects
• Abortificient -- used on abortion sticks as paste
or ointment.
• Cattle poison -- used as a cattle poison, is
mixed with water in the well.
• Suicidal purposes -- used for suicidal purposes.
• Accidental -- medicinal use for aphrodisiac or
tonic. When it is accidentally mixed with food or
drinks. When it is mistaken for baking powder or
soda. Children take paint or insecticide
containing arsenic.
 Medicolegal Aspects
• Arsenophagist– who habitually takes arsenic
as a tonic or aphrodisiac. They develop
tolerance.
Postmortem imbibitions of arsenic.

P.M. Imbibition Poisoning

Conc. Of Conc. Is more Conc. Is more
arsenic in the soil than in the body than
in the body in soil
Vital reaction in Absent Present
GIT
Changes in Absent Present such
stomach as red velvet
appearance.
Arsenic in hair Absent May or may not
and nails be present.