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Poison
A substance, natural
or synthetic, that
causes damage to
living tissues and has
an injurious or fatal
effect on the body
Poison
All substances
known to human are
poisons, and only
the dose
determines the
effect
Toxicology
Toxicum:
Poison (Latin)
Toxikom:
Logia:
S i
Science
(L
(Latin)
ti )
Accidental poisoning
exposure to a
poison resulting in
symptoms by an
accidental action
e.g. common in
children or at work
place
12/23/2011
Deliberate poisoning
Occupational poisoning
occurs in context of
employment
Environmental poisoning
Forensic toxicology
exposure resulting
f
from
the
th presence
of a chemical in
air, food or water
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Scope of Toxicology
How to Kill?
How Much in
Environment?
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How to
Remedy?
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How to Kill?
Toxicology (categories)
Acute Toxicity
Chronic Toxicity
Sub-lethal Effects
Behavioral, Ecological, Physiological, Genetic,
Reproductive, Developmental
Trans-generational Effects
Molecular/Biochemical Modes of Action
Resistance, GMOs (genetically modified organisms)
Toxicology (effects)
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mutation(s)
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inhalation
intraperitoneal
oral
mucous membrane
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sub-cutaneous
topical
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Ecosystems
Soil, Water or Air
Seasonal Fluctuations
O
Occupational
ti
l
Workplace Exposures
Epidemiological
Geographic and Industry-wide Patterns
Residential
eg. Lead, Asbestos, Food Residue
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How to Remedy?
Dangerous Drug Rules
Clinical
Antidotes, Pharmaceuticals
Hazardous Waste
Bury, Burn, Export
Industrial Ecology
Policy
and
Risk
Acceptable Levels
Environmental Justice
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Rule 2
Rule 8
Rule 13
Rule 14
Rule 17
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If the
th d
drugs are tto b
be obtained
bt i d b
by post,
t th
they
shall be sent by registered post.
In case of real emergency the drugs may be
supplied on oral message, provided the
licensee is satisfied about the genuineness of the
order & medical practitioner furnishes or assures
to provide written signed order within 24 hours.
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1.
2.
3.
4.
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Medicinal hemp
.. 3 ounces.
Medicinal opium .. 3 ounces.
O i
Opium
alkaloid
lk l id derivative
d i i
(excluding prepared opium) ..... 60 grains.
Coca derivative
.. 60 grains.
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maintenance of record of
dangerous drugs in separate registers
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Toxicology (history)
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Toxicology (history)
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Paracelsus, Philippus
Theophrastus Aureolus
Bombastus von Hohenheim,
the "father of chemistry and
the reformer of materia
medica," the "Luther of
Medicine," the "godfather of
modern chemotherapy," the
founder of medicinal
chemistry, the founder of
modern toxicology
(1493-1591) born in
Switzerland employed as
military surgeon
1- Corrosives
Mineral acids
Organic acids
HCl, H2SO4
oxalic acid, carbolic acid
V
Vegetable
t bl acids
id
HCN
Strong alkalies
2- Irritants
A- Inorganic
Metallic
Non metallic
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B- Organic
Vegetable
Animal
C Metallic
CM t lli
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A- Cerebral
3- Neurotropics
A- Cerebral
i- Somniferous:
ii-Inebriants:
alcohol, anaesthetics
sedatives, hypnotics
fuels
insecticides
iii-Deliriants:
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B- Spinal:
C- Peripheral:
nux vomica
curare
4- Cardiac:
5 Asphyxiants:
56- Miscellaneous:
analgesic + antipyretic:
antihistamines:
tranquilizers:
anti depressants:
stimulants:
hallucinogens:
aspirin, paracetamol
avil
largectal, reserpine
tricyclic compounds
amphetamines
L.S.D
Corrosives
Irritants
Neuroleptics
Cardiac
Asphyxiants
Miscellaneous
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Keith Simpsons
1234
45678-
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Medico legal
Classification
Analgesics:
aspirin, paracetamol
Hypnotics:
chloral aldehyde, barbiturates
Sedatives & Tranquillizers: diazepam, largectal
Anti depressants: tofranil
Anti-depressants:
Narcotics:
opium alkaloid
Stimulants:
amphetamine, cocaine
Abortificient:
purgatives
Industrial gases & Volatile products: SO2, petrolium
Classification
Suicidal:
barbiturates, wheat pills etc
Homicidal: aconite, arsenic etc
Accidental: love
l
philter,
hilt h
household
h ld products
d t etc
Stupefying: dhatura, cannabis indica etc
Abortificient: madar, ergot etc
products
9- Corrosives
10- Irritants
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Duties of a doctor
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ii- vomitus
iv- blood
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In Living
Blood
Urine
Gastric Lavage
Vomitus
Left over food
Drinks/tea/water
In Dead
Stomach along with contents
Small intestine with contents
Pieces of liver, Spleen & Kidney
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Stomach Separated
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In Case of Poisoning
Local
Remote
Specific action
Opium alkaloid, digitalis
Local + Remote:
General action:
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Non-specific action
Corrosives by shock
As in oxalic acid
Effects more than one system
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Recall
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34567-
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Dose
larger dose acts rapidly & severe are the effects but
sometimes vomiting reduces effects e.g. CuSO4
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Toxicity Rating
a- Physio-chemical composition
6. Supertoxic
5 50 mg/kg
5-50
5 Extremely toxic
5.
50-500 mg/kg
4. Very toxic
3. Moderately toxic
5-15 gm/kg
2. Slightly toxic
1. Practically non-toxic
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Recall
Recall
Poison
Toxicology
Manner of poisoning
Forensic toxicology
History
Toxicology
Classification of poisons
Categories
Effects
Damage caused
Exposure types
Exposure routes
General classification
Keith Simpsons classification
Medico legal classification
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Boney-M
b- Chemical composition
(Rasputin)
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Rasputin
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(1859-1915)
c- Mechanical composition
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3- Condition of stomach
d- PH
concentrated acid + alkali gives more toxic effect
than diluted one
e- Stability of compound
e
paraldehyde sedative + hypnotic
CNS
depression
arsenic with H2O settles down at bottom so mix
with milk, coffee of same specific gravity
exposure to light + air
decomposes to
acetaldehyde
if stomach is full
S/S delay
fatty food
S/S delay
in phosphorus poisoning
rapid
snake venom harmless by mouth
carbonated beverages the rate of intestinal
absorption by in gastric emptying
all poisons absorbed from small intestine detoxify in
liver by portal circulation positive point of oral route
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Recall
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At home
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At home
At home
(Oral exposures)
(Ocular exposures)
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At home
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At home
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General Management
Assessment of Patient
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Whether it is an emergency
ABCD of resuscitation
1- Level of consciousness
unconscious state
uncooperative and hostile
absence of specific signs & symptoms
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Reeds classification
Assessment of Patient
Group 0
Arousable
Group 1
Group 2
Group 3
Group 4
2- Respiratory status
After clear airway has been established, by means of arterial
puncture & measurement of blood pH, pCO2 & plasma
bicarbonate
Simple method would be to measure respiratory minute
volume by Wrights spirometer. If its less than 4 litres/min,
respiratory insufficiency is present
3- Cardiac status
By recording & monitoring the pulse, blood pressure &
urinary output
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Hypotension
Amphetamines
Cocaine
Antihypertensive
drugs
Antipsychotics
Nicotine
Diuretics
Phencyclidine
Ethyl alcohol
Sympathomimetic
drugs
Opiates
Sedatives &
Hypnotics
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Bradycardia
Alcohol
Aconite
Dhatura
Digitalis
Salicylates
Opiates
Nicotine
Organophosphates
Sympathomimetic
drugs
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Assessment of Patient
Barbiturates
4- Body Temperature
Carbolic acid
Cantharidin
Ethylene glycol
Oxalic acid
Petroleum derivatives
Salicylates
Sulphonamides
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Hyperthermia
Miosis
Mydriasis
Nystagmus
Analgesic drugs
Amphetamines
Barbiturates
Alcohol (constricted
Alcohol
Barbiturates
Anticholinergics
Carbon monoxide
Antihistamines
CNS depressants
Cocaine
Opiates
in coma)
Benzodiazepines
Amphetamines
Barbiturates
Caffeine
Antihistamines
Carbamazepine
Phenothiazines
Carbamates
Carbon
monoxide
Phencyclidine
Salicylates
Carbolic acid
(Phenol)
Cocaine
Pheytoin
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Mydriasis
Parasympathomimetics
Cyanide
M th l d
Methyl
dopa
Dh t
Dhatura
Nicotine
Ephedrine
Opiates
Organophosphates
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Recommended
Vasopressors
Drug
Dose
(microgm/kg/min)
Dopamine
2-20
Epinephrine
1-4
Isoproteronol
0.5-4
Metaraminol
8-15
Norepinephrine
2-8
Phenylephrine
5-20
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Control of Convulsions
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Decontamination
Emesis
emesis
(vomiting)
gastric wash
(stomach lavage)
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Gastric lavage
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Gastric lavage
(stomach wash)
Type of tube:
morbidity
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Gastric lavage
KMNO4 ((1:5000))
Tannic acid
Iodinated water
Gastric lavage
(lavage fluid)
1- Warm water
2- Saline (0.9% or 0.45%)
3- Oxidizing silutions
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(contraindications)
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Gastric lavage
Gastric lavage
(complications)
1- Aspiration pneumonia
2- Laryngospasm
Tube
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Activated charcoal
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Activated Charcoal
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Medical Applications
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Activated charcoal
(medicinal charcoal)
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Special Measures
Forced Diuresis
forced diuresis
haemodialysis
haemoperfusion
plasma exchange
exchange transfusion
hyperbaric oxygen
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Haemodialysis
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Haemodialysable poisons
Etyhl alcohol
Methaqualone
Arsenic
Ethylene glycol
Methyl alcohol
Barbiturates
Isoniazid
Methyl drops
Bromides
Isopropyl alcohol
Phenytoin
Camphor
Lithium
Salicylates
Copper
Meprobamate
Theophylline
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Hemoperfusion
Amphetamines
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Plasma Exchange
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Exchange Transfusion
Hyperbaric Oxygen
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Antodote
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Role of Antidotes
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dehydrogenase)
4- Receptor site competition Some antidotes displace
the poison from specific receptor sites, thus
antagonizing the effects. e.g. naloxone which
antagonizes the effects of opiates at opiod receptor
sites
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Chelating Agents
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Chelating Agents
EDTA
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Chelating Agents
Genuine antidotes
lead
poisoning
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Agent
Indication
Glucose
Hypoglycemia
Haloperidol
p
Psychotic states
Heparin
Hypercoagulability
Lignocaine
Ventricular arrhythmias
Mannitol
Furosemide
Oxygen
Hypoxia
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By postmortem examination
1- External Examination
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By postmortem examination
2- Internal Examination
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3- Chemical Analysis
(saturated saline)
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Thanks !
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