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Learning Objectives

By the end of the lecture student should be able to Classify poison ( accord mode of action) Neurotics action and Classification Heroin, ways of administration Stages Sign/ symptoms / post mortem findings Treatment complications

Neurotics
CNS Poisons

According to mode of action


1- Corrosives
2- Irritants

3- Neurotics
4- Cardiac

CINCAM

5- Aphyxiants
6- Miscellaneous

Neurotics: Act on nervous system. Symptoms, Headache, drowsiness, giddiness, delirium, stupor, coma, convulsions or paralysis. Post-mortem findings, are not markedly visible to naked eyes.

Cerebral Poisons a. Somniferous (sleep inducers) b. Inebriants (drunkenness) c. Deliriants (hallucinogens)

Somniferous poisons includes Opium and its alkaloids. Inebriants includes, A. Alcohol B. Anaesthetics C. Sedatives & Hypnotics D. Fuels E. Insecticides Deleriants These includes Dhatura, Bellodona, Hyoscymus, Cannabis Indica, and Cocaine.

B. Spinal poisons are those which act on spinal cord, eg. Nux-Vomica
C. Peripheral are those which acts on peripheral nerves, eg. Crurae

SOMNIFEROUS POISONS (OPIOIDS)


They are known as somniferous or narcotics because they i. Reduce pain ii. Induce sleep Important poisons Excitement i. OPIUM Narcosis ii. Heroin (Brown sugar) Synthetic derivatives of opium (Diaccetyl morphine) They are strong analgesic and narcotics but cause severe addiction.

Analgesic

iii. Pethidine (Meperidine)


Euphoria

(Addiction is very high and treatment is difficult.

OPIUM AND MORPHINE


OPIUM (AFIM):- It is dried juice obtained by incision of unripe capsule of white popy (Papaver somniferum) There are two groups of alkaloids i. Phenanthrene ii. Isoquinoline

i.

Morphine about 10%

ii. Codeine about 0.5%

Phenathrene group

iii. Thebaine about 0.3%


iv. Dionin v. Heroin (Diaccetyl Morphine)

Isoquinoline group

Papaverine about 1% Narcotine about 6%

(They are mild analgesic but no narcotic effect)

Ripe and dry capsule of popy contain very little opium. Poppy seeds (khaskhas) are creamish in colour and contain no opium. They are used as food and oil for cooking. The alkaloids of opium are used in medicine are i. Morphine They act as narcotics and ii. Codeine
sedatives

iii. Apomorphine: It is used as emetics

Diagnosis of morphine
Marquis Test:
Conc Sulphuric acid 3ml Formaline 3 drops Suspected mixture Observe color change It changes from black to purplish blue Result: +ve morphine

Question: How Is Heroin Used? Answer: Heroin is usually injected, sniffed/snorted, or smoked Injected , a heroin abuser may inject up to four times a day. I/V injection: onset of euphoria (7 to 8 seconds), I/M intramuscular injection : onset of euphoria (5 to 8 minutes).

Sniffed or smoked, peak effects are usually felt within


10 to 15 minutes. Smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.

SIGNS & SYMPTOMS


Acute poisoning CNS i. Excitement There are three stages.

ii.

Stupor

iii.

Narcosis

A. STAGE OF EXCITEMENT: Absent if amount taken in large amount. i. Sense of well being ii. Laughter, hallucination. iii. Increase in H.Rate iv. Convulsions in children may occur

B. STAGE OF STUPOR:C. The stage of excitement is followed by i. Headache, Giddiness, diminished sensibility. ii. Strong tendency to sleep awareness only by painful stimuli. iii. The pupils are contracted, lips cyanosed iv. Pulse & respiration normal.

C. i. ii. iii. iv. v.

STAGE OF NACROSIS: Deep coma Muscle relaxed Pupils contracted & no reaction to light BP is low Skin is cold, profuse perspiration & temperature is low less than 35oC

CAUSE OF DEATH
i. ii. iii. iv. In fatal termination cyanosis Fine froth escape for month. Breathing is sighning & irregular (2-4/m) Coma deepens & death results from asphyxia due to respiratory paralysis.

FATAL DOSE
Morphine 200 mg opium 2gm 10 ml of tincture of opium. In children 1 3 drops of tincture of opium.

Morphino-mania / Morphinism
Cause : regular use Maladjusted personality.
Disphoria (away from reality) Delusion of grandiosity Disoriented Porn personality Sexually pervert Disturbed interpersonal relationship. Short tempered and lethargic

DIAGNOSITC POINT: i. Breath smells of opium

pointed pupils with no reaction to light. i. ii. iii. Moist perspiring skin Low temp < 35oC Cyanosis, froth at month & nose.

D / D: i. CVA ii. Metabolic conditions a. Uraemic coma b. Keto accidosis, diabetic coma iii. Alcohol poisoning iv. Organophosphorous compounds

Abstinence Syndrome
Withdrawal Effects: Onset 6 8 hours S/s
Sweating, rhinorrhea, lacrimation. Dilated pupil Irritability, abdominal cramps, restless Muscle cramps, weight loss.

TREATMENT: In early stages the patient should be kept awake by walk. 1. Emetics ineffective due to depression of vomiting centre. 2. Stomach wash a. with tepid water. b. with KMNO4 : 1: 5000 strength till

the washed water with original pink colour c. Some KMNO4 should left in stomach to oxidize alkaloids that is secreted in stomach after absorption. d. In the absence of KMNO4, wash stomach with

i. Tea or tannic acid ii. Mixture of powder Charcoal & water. IMPORTANT: Gastric lavage should be done if the drug is taken by Hypo dermic or S / C injection as alkaloid is re-secreted into stomach after absorption.

TREATMENT: SPECIFIC:

i. Nalorphine I/V
ii. (Specific antidote to opium alkaloid & morphine 5 10 mg I / V after every 15 minutes till pupil begin to dilate & responce become normal & pt is aroused Maximum dose 40 mg.

Naloxone (pure antagonist) 0.4 0.8mg I/m or I/V


to be repeated every 10 to 15 minutes Maximum dose 10 mg. i. Antibiotic in case of prolonged coma. ii. Artificial respiration iii. Keep the body warm. iv. Symptomatic treatment

P/M APPEARANCE
i. External ii. Internal External : i. Smell of opium ii. Face nail or bluish black. iii. P/M lavidity is black. iv. Froth at nose & mouth moderate in amount.

INTERNALLY: i. Stomach may contain lumps of opium ii. Trachea, bronchi are covered with froth & lungs are oedematous. Blood is dark. Blood, bile & brain should also be preserved. M / L ASPECTS: Mostly suicidal easily availability & painless. Homicidal rare due to bad smell and taste mostly use in infanticide . Accidental poisoning due to over dosage.

Complications

Summery
By the end of the lecture student should be able to Classify poison ( accord mode of action) Neurotics action and Classification Heroin, ways of administration Stages of addiction Sign/ symptoms / post mortem findings Treatment complications

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