AGAD TANTRA - Dr. SATISH SHINDADKAR (best ebook reader for chromebook TXT) 📗

and sodium thiosulphate.

P.M. appearances -

            -           Inflammations of upper GIT,

            -           stomach contents are blue and emit smell of iodine.

            -           Degeneration of heart, liver and kidney.

Medicolegal importance

            -           It is used for vitriolage.

            -           It is sometimes used for suicide and homicide.

सोमल  (Arsenic )  (As)

 Classification Irritant inorganic metallic poison.

स्थावर खनिज विष, धातूविष (सुश्रुत)

Fatal dose     100-200 mg.

Fatal period   12 ते 48 तास सामान्यत: , परंतु, अतिमात्रेत सेवनाने 2-3 तासात देखील मृत्यू.

औषधी मात्रा     1  to 4 mg (र.त.)

कल्प    शंखविषोदय, चण्डेश्वर

Arsenic occurs in many minerals, usually in conjunction with sulphur & metals & also as a pure elemental crystal.

            Arsenic is a metalloid means its visual appearances are like a metal but it is a pure conductor of electricity.

            Arsenic is extremely poisonous.  Arsenic & its compounds are used in the production of pesticides, herbicides, treated wood products & insecticides.

            Use of arsenic in consumer products in Europe & United States is banned from 2004, but it is heavily used in other countries.

            During  18th to 20th centurey a number of arsenic compounds have been used as medicines, including arsphenamine & arsenic trioxide.

            Arsphenamine was indicated for syphilis & trypanosomiasis, but has been replaced by modern antibiotics.

            Arsenic trioxide has been used in a variety of ways over past 500 yrs, but most commonly in the treatment of cancer.

शुद्ध सोमल हे जीर्ण श्वास, कुष्ठ, विषमज्वर, श्लीपद, संधिवात, फिरंग, अग्निमांद्य, जीर्णपाण्डू, प्रतमक, श्वास, राजयक्ष्मा, हृत्शूल, अतीसार, इत्यादी व्याधींमध्ये विविध योगांद्वारे उपयोगात आणले जाते.

तसेच क्षारसदृश चिकित्सेसाठी बाह्य लेपनार्थ उपयोग केला जातो.

Mechanism of action :

-           Trivalent compounds interfere with the cell metabolism & oxidation by combining with sulphydryl enzymes.

-           Pentavalent compounds uncouple the mitochondrial phosphorylation.

-           It causes dialation of capillaries.

Toxic signs & symptoms -

1)         Acute poisoning -

            Symptoms may include, diarrhoea, severe projectile vomitting hematuria, cramp in muscles, stomach pain, convulsions, intense thirst, shock, coma & death.

            Inhalation of arsenic vapours causes cough, pulmonary oedema, ulceration of cornea, conjunctivitis etc.

            If consumed in large dose death may arrive within 3 hrs due to shock.

2)         Sub acute poisoning -

            In this type inflammation of nerves & paralysis are seen.  Also symptoms related to gastro intestinal system & respiratory system are seen.

3)         Chronic poisoning - It is seen in following conditions.

i)          Recovery from acute poisoning.

ii)         Repeated consumption in low dose.

iii)        Therapeutic use of arsenic for long time.

iv)        Drinking arsenic contaminated well water over long period.

v)         Occupational exposure.

            There are 4 stages -

I)          State of nutritional & gastrointestinal disturbances :

            Weakness, weight loss, loss of appetite, abdominal pain, constipation, red & soft gums, increased temperature, Vit A deficiency etc.

II)         Stage of Catarrhal changes :

            Increased secretion from respiratory tract, hoarseness of voice, congested eyes, photophobia etc.

III)        Stage of skin reashes :

-           Brown, pin point pigmentation of skin known as Rain drop appearance.

-           Chronic ingestion causes vasodialation, the milk and roses complexion.

-           Nails become brittle & have linear pigmentation.

-           Hair becomes dry, pigmented & may fall off.

-           Sometimes herpes zoster.

IV)       Stage of CNS disturbances:

            Head ache, tingling & numbness, muscle pain, bone marrow depression, nuritis, muscle atrophy & muscle paralysis.

Differential Diagnosis -

1)         Gastroenteritis.

2)         Chronic alcoholism.

3)         Bacterial food poisoning - The menifestations of vomitting & diarrhoea are delayed by 6-36 hrs in bacterial food poisoning while they occur within 15-30 min in arsenic poisoning.

4)         Cholera - Difference between arsenic poisoning & cholera are -

NO.

 Arsenic poisoning

  Cholera

1

 History of poisoning

 History of epidemic

 2

 Vomitting followed by diarrhoea

 Diarrhoea followed by vomitting.

 3

 Pain in throat

 Nil.

 4

Vomitus initially contains stomach contents, then blood & is later watery.

 

Watery throughout

 5

 Pain & irritation at anus.

  Nil.

 6

Diarrhoea initially contains fecal matter, later blood & is  finally         watery.

 

rice-watery throughout.

 7

Eyes congested

  Nil.

 8

 Voice hoarse

 Normal

 9

 X-Ray Abdominal finding shows opaque shadow.

  Nil.

 10

 Chemical analysis shows traces of arsenic

 Microscopic finding shows presence of v- cholerae bacteria.

चिकित्सा :

आयुर्वेदिक :  शतपुटी अभ्रक भस्म हे प्रमुख प्रतिविष मानले जाते.  त्याचा योग्य मात्रेत वापर करावा.

आधुनिक :  Treatment of acute poisoning :

-           Use of emetic drugs, gastric lavage & other symptomatic treatment should be used  according to neccessity.

-           Use of antidotes.

a)   Physical antidote     -     Demulcents.

b)   Chemical antidote : Freshly prepared hydrated ferric oxide (ferric chloride+alkali) combines with arsenic & form a harmless ferric arsenic salt.

c)   Physiological antidotes -  Inj. BAL 3 mg/kg body wt.

Treatment of chronic poisoning :

-           Avoid the regular contact of arsenic,  Inj. BAL.

-           Vit B- complex, Give sodium thiosulphate i.v.

P.M. Findings :        Dehydration, jaundice.

-           Stomach appearance is known as red- velvety appearance.   There are large erosions, multiple ulcerations & sub mucous  petechial haemorrhages.

-           haemorrhages on endocardium, larynx, tranchea, lungs & abdominal organs.  There is degeneration of liver, heart, kidney.

Medicolegal importance -

-           Since tasteless and odourless it is commonly used for homicide, suicide, as abortifacient and as cattle poison.

-           It is eliminated through urine, feaces, skin, saliva, bronchial secretions & milk.

-           There are tests available to dignose poisoning by measuring arsenic in blood, urine, hair and finger nails.

            The urine test is most reliable test and needs to be done within 24-48 hrs for an acute analysis.

            Test on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months.

-           It leads to tolerence & addiction.  It retards decomposition.

-           It is deposited in liver, kidney, intestine, spleen, lungs, brain, spinal cord, muscles, bones, hairs & nails.

नाग - शिसे (Lead-Pb)

 Classification - Irritant inorganic metal poison. स्थावर धातू विष

Fatal dose - uncertain 0.5 -20 gm. approx.

Fatal period - uncertain. 2-3 days to some months

            It is a grey coloured, heavy but soft metal. It has metallic property.

Toxic compounds :

i)          Lead monoxide -      Litharge PbO

ii)         Lead Sulphide -       PbS

iii)        Lead tetraoxide - Pb3SO4

Mechanism of action :

i)          It inhibits sulphydryl group of enzymes.

ii)         The chronic symptoms are mainly due to fixation of lead in brain and peripheral nervous system.

iii)        Spasm of capillaries.

Sign and symptoms  :

            Lead poisoning can cause through mouth, nostrills and skin.

            Poisoning through nostrils is 10 times more toxic than oral route.

Acute Poisoning :

            It is very rare.  Toxic sympoms are same as other metal poisoning.  Only instead  of diarrhoea there is constipation (common symptom), stools are black with foul smelling.

Sub acute poisoning :

            It results from consumption of repeated doses of soluble salts of lead.

            -  Blue line on the gums ,Pale face ,Decreased secretions ,Sweet-astringent-metallic taste in mouth, burning of throat, vomitting, colicky pain ,constipation,oliguria, albuminuria, presence of lead in urine. red-coloured urine, Drowsiness, insomnia, headache, muscular cramps, convulsions, paralysis etc.

Chronic poisoning -

             - Hypochromic anaemia with punctate basophilia.

            - RBC deformities.

            - Abdominal pain and constipation.

            - Hypertension, atherosclerotic changes.

            - nephritis, delerium.

            - paralysis.

            - Encephalopathy.

            - Retinal stipling and optic atrophy.

            - facial pallor.

            - Blue line on gums ( Burtonian line)

            - May cause sterility, abortion, death of foetus, menstrual disturbances.

            - weakness, anorexia, foulbreath, dyspepsia, irritability, pain in joint, hair fall etc.

Treatment.

            - Use of emetics

            - Gastric lavage

            - Calcium gluconate, vit D and vit. C.

Antidote :

            Physical         -           Demulscents.

            Chemical       -           Na2So4, MgSo4

            Pharmacological - Calcium edetate, Inj. BAL.

P.M. appearances :

            - Gastric mucosa is congested, sometimes eroded.

            - Black stool

            - Features of gastroenteritis.

Medicolegal importance -

            - Poisoning is mainly accidental and usually chronic.

            - Suicidal and homicidal poisoning is very rare.

            - Sometimes used as cattle poison and to produce abortion.

***

पारद Hg

Classification - Irritant inorganic metal poison. स्थावर धातू विष

Fatal dose - about 1 gm of corrosive sublimates.

Fatal period - variable - few hrs to 3-5 days

            Mercury is a liquid metal, heavy in all liquid drugs and heavier than water by 13 1/2 time.

            Pure form of mercury is insoluble in stomach hence non poisonous when taken by mouth.  Its vapours are absorbed by nasal route and toxic effect is produced.

            If fine powder form of mercury by oral route or rubbed on skin it may be absorbed.

            Common poisonous compounds of mercury are

            HgCl2, Hg2Cl2, Hg (CN)2, HgO, HgS      etc.

Mechanism of action :

            Mercury depresses cellular enzymatic mechanism by combining with sulphydryl group.

Route of exposure

 Symptoms

 Treatment

Acute

Inhalation

of vapours

Salivation, stomatitis, vomitting

diarrhoea, cough, dyspnoea,

conjunctivitis, corneal

ulceration, nerphrotoxicity.

 

- use of emetics.

- Gastric lavage

- IV fluids.

  Ingestion

 Metalic taste, burning sansation, feeling of constriction in throat and upper GIT, burning and pain at GIT, nausea, vomitting diarrhoea, pain at anus, convulsions, collapse, death

- haemodialysis.

i) Physical antidote

-  demulscents.

ii) Chemical antidote

8 % soln. of

sodium formaldehyde

sulphoxylate

with 5 %

Sodium  bicabonate.

 

iii)Pharmocological

antidote.

- BAL

- Penicillamine.

 

Other symptomatic

treatment.

If death is

delyaed

Salivation,

inflammation of gums, foul breath, loosening of teeth; nephrotoxicity

 

  Chronic

Exposure

Excessive salivation, metallic

taste, GIT disturbances, gums (blue line) inflammation, ulceration and necrosis.

Pink disease (Pink cheeks,nose

hands - feet)

- uraemia, nephritis.

- Murcurial lentis (brownish

discolouration of eyes)

Murcurial tremors,

- Erethism (mental illness)

- Skin erruptions.

 

In chronic

poisoning.

Stop further

exposure.

P.M. appearances :

            -  Mouth and tongue became brownish white.

            - Oesophagus and stomach shows inflammation, congestion, coagulation, corrosion.

            - Cecum and large intestine shows inflammation, ulcers and necrotic changes.

Medicolegal importance :

1.         Poisoning is mostly accidental.

2.         Suicidal and homicidal poisoning rare.

3.         Sometimes used for criminal abortion.

4.         Bones, teeth, hairs and nails are preserved as additional viscera.

***

मोरचूद Copper Sulphate (CuSO4)

Classification - Irritant inorganic metal poison. स्थावर धातू विष

Fatal dose - The lowest dose of CuSO4 that had a toxic impact on human is 11 mg/kg wt and fatal dose is about 15-30 gm.

Emetic dose - 0.3 to 6 gm.

Fatal period - 1 - 3 days

औषधी मात्रा - १/८ ते १/४ गुंजा ( १५ ते ३० मी.ग्राम)

कल्प - नीलकंठ रस, तुत्थ हरीतकी

 

Copper Sulphate forms bright blue crystals (CuSO4, 5H2O).  It is commonly known as Blue vitriol or blue stone.  It is used chiefly for agricultural purpose as a pesticide & in leather industry.  It has a nauseous & metallic taste.  It is freely soluble in water.

Mechanism of action :

-           It acts on sulphydryl group of enzymes.

-           It precipitates proteins.

-           CuSO4 is a powerful oxidising agent which is corrosive to mucous membranes.

-           Cellular damage & cell death may result from excess accumulation of copper.

विषाक्तता लक्षणे :         

            The usual routes by which humans can receive toxic exposure to CuSo4 are through eye, or skin contact as well as by inhaling poweders and dusts.

            Skin contact may result in itching & eczema.

            Eye contact with CuSo4 can cause conjuctivitis, inflammation, ulceration & clouding of the cornea.

Acute toxicity symptoms :

Gastro intestinal effects :

             Nausea, vomiting & crampy abdominal pain.    Vomiting usually occurs within 15 min. of ingestion.   Vomitus is greenish blue.

            Hamorrhagic gastroenteritis with mucosal erosions, metallic taste, burning epigastric sensation & diarrhoea may occur.

            In several cases haematemesis & malena occur.

Cardiovascular effect :

In several cases cardiovascular collapses, hypotension & tachy cardia may occur within a few hours of poisoning.

            Several methaemoglobinamia can result in cardiac dysrhythmia & hypoxia which could contribute signficantly to cardiovascular collapse.

Hepatic effect :

            Jaudice appears after 24-48 hours in more sever poisoning.   It may be associated with tender hepatomegaly.

            Level of bilirubin is directly proportional to the severity of poisoning.

Renal Effect :

            It is observed usually after 48 hours Acute renal failure developed in 20-40 % of patients.  Oliguria, anuria, albuminuria, haemoglobinuria, haematuria are seen.

CNS effects : Coma or seizure.

Chronic toxicity symptoms :

            Green or purple line on gums.  nausea, giddiness, head ache, vomitting, diarrhoea, abdominal colic, Conjuctivitis, corneal ulceration, laryngitis, bronchitis renal failure, anaemia, neuritis, muscle atrophy dermititis, body secretions are greenish, bronze diabetes & wilson’s disease.

Differential diagnosis :

 Poisoning due to other heavy metals like lead, mercury, arsenic etc.

चिकित्सा :

आयुर्वेदिक -  500 mg BD, पर्पटाद्यारीष्ट  20ml BD, एरंड स्नेहाने विरेचन

आधुनिक :

-           As CuSO4 is itself emetic agent there is no use of emetic drugs.

-           Gastric lavage with 1 % potassium ferro cyanide solution.

-           Use of diuretics & purgatives.

-           IV fluids as per required.

-           Proper use of antidotes.

            1)         Demulscents.

            2)         Potassium ferro cyanide.

            3)         BAL, EDTA, N- Penicillamine.

PM findings :

-           Signs of jaundice.

-           Oesophagus & stomach are congested.

-           haemorrhages & ulceration of intestine & colon.

            In chronic poisoning degeneration of liver & kidney is seen.

Medicolegal importance :

-           The poisoning is mostly accidental.

-           Occasionaly used for cattle poisoning.

-           It is rearely used for homicide & suicide.

***

यशद (Zn)

Irritant inorganic metal poison.

            Zinc is a bluish white lustrous metal.  The toxic efects of zinc are confined mainly to the use of following three salts of metal -

1)         Sulphate        -           having irritant action.

2)         Chloride         -           having corrosive action.

3)         Phosphide    -          

Fatal dose    -

  Fatal period -

Zinc sulphate -15 gm.

2 hrs. - 5 days

 Zinc chloride- 400 mg.

 few hrs - several