PRINCIPLES OF

TREATMENT

Removal of the patient from source of

poison
Removal of the unabsorbed poison
Diluting the poison and delaying its
absorption
Elimination of the absorbed poison
Use of specific antidote
Symptomatic treatment (RS, CVS)

WHITE PHOSPHORUS

Features: Whitish/yellowish, luminescent, inflammable, insoluble (so bile/fat

is necessary)
Common use: Industries, fireworks, rat poison
Action: Protoplasmic poison, causes fatty liver with necrosis, necrosis of
kidney etc.
Signs and symptoms of ACUTE POISONING:
It is inflammable so when held in the hand, may cause burns -> slow healing, painful ulcers
When ingested -> burning pain in the pharynx, intense thirst, [after 1-6 hrs] vomiting and

diarrhoea (garlic smell, dark red, luminescent), abdominal pain, [after 1-2 days] symptoms
subside for 2-3 days (period of apparent well-being).
Late symptoms: Signs of liver (jaundice, increased bleeding everywhere) and kidney
damage (scanty, dark urine containing blood, albumin and bile salt), restlessness,
convulsions, psychosis.

Treatment:
For external lesions -> wrap with wet cloth, apply ointment
For ingested poison
emetics / stomach wash with 0.1% CuSO4
Non-fatty purgatives
Vitamins and IV glucose for liver protection
Restriction of fatty diet
Absolute rest and constant watch for some days
Symptomatic treatment

CHRONIC PHOSPHORUS POISONING

Cause: Inhalation of vapours in
factories or consumption of
contaminated sea-fish
Signs and symptoms:
GI tract disturbances, liver (cirrhosis,

jaundice, ascitis, spider naevi) damage,

muscular cramps, necrosis of mandible with
sequestration and discharge of foul-smelling
pus by sinus PHOSSY JAW.

Treatment:
Avoid further exposure/intake
Maintain oral hygriene
Supportive treatment for liver; nourishing

ARSENIC

Sources: White arsenic (As2O3) used as general tonic, Industrial arsine

(AsH3), colouring agents- Scheeles/Paris green.
Arsine causes haemolysis (leads to anemia) and damages liver (jaundice) and
kidneys (oliguria with RBC casts, uremia). Treated by dimercaptopropyl ethyl
ether.
White arsenic: available as amorphous powder, signs and symptoms of ACUTE
POISONING:
With a very high dose, vomiting, diarrhoea, abdominal pain followed by collapse and death.
With average fatal dose, metallic taste, dryness, burning sensation, difficulty in swallowing.
Severe abdominal pain, vomiting and diarrhoea (rice water stools). Dehydration causes low BP,

oliguria and exhaustion.

There is albuminuria, muscular weakness, depression of myocardium (EKG changes), [with
organic compounds] degeneration of optic nerve and focal brain degeneration.
Long standing effects: bone marrow aplasia with basophilic stippling, immature RBCs and WBCs
and development of white streaks at the growing parts of the nails (Mees lines).
Cause of death may be circulatory collapse, electrolyte loss, hepatic failure or toxic
encephalopathy.

Treatment:
UNABSORBED POISON: Stomach wash with lukewarm water, then with freshly prepared ferric

oxide (ferric chloride + magnesium oxide) else use dialysed iron or emesis + purgative like
magnesium sulphate.
ABSORBED POISON: Antidote of choice is BAL or dimercaprol.

CHRONIC ARSENIC POISONING

Cause: Industrial/agricultural (insecticides) exposure,
contamination
Signs and symptoms:
Non-specific initially (fatigue, malaise, lack of concentration, arthralgia, GI

disturbances)
Then more specific-> muscular weakness, change in keratin tissue, abnormal
pigmentation (initially brown milk rose complexion around neck, shoulders,
temples, trunk; then dark pigmentation of palms and soles with thickening). No
pigmentation of mucus memb.
Hyperkeratosis + epithelioma of palms and soles
Possible symptoms: ulceration of nasal mucosa, alopecia, liver damage, kidney
damage, bone marrow aplasia + Mees line

Death may occur due to same reasons + infection dehydrat

Treatment:
Avoid further exposure/intake
BAL/penicillamine
Supportive treatment; nourishing food

CHEMICAL TESTS FOR ARSENIC: Marshs test, Reinschs test.

These are very sensitive tests that can detect arsenic from hair, nails, bone,

teeth years after death. If the body is burnt, the ash/soil from the cremation
ground may also show arsenic long after cremation.

COPPER

Pure metallic copper is not poisonous but

soluble copper (from utensils, CuSO4,
subacetate, copper chloride) is.
Signs and symptoms:
Nausea, vomiting with GREENISH BLUE VOMIT which

turns deep blue if treated with ammonia, diarrhoea,

abdominal pain.
Liver (jaundice, haemolysis, anemia) and kidney
damage (oliguria, haematuria), paralysis, respiratory
distress, coma.

SPECIFIC ANTIDOTE: 1% potassium

ferrocyanide

MERCURY

Source: Mercuric chloride (corrosive sublimate), mercuric cyanide,

mercuric oxide and sulphate.
Remember: Mercuric sulphide (vermilion) and mercurOUS chloride
(calomel, purgative) are non-toxic.
P/K: Absorbed orally/inhaled/topically by sebaceous glands. Gets
deposited in all tissues especially BRAIN (when inhaled), liver, kidneys
(PCT, LoH, DCT), spleen, bones.
Signs and symptoms of ACUTE POISONING:
When swallowed: Irritation, burning sensation, metallic taste, difficulty in swallowing,

constriction in throat, painful abdomen.

Vomitus contains mucous, blood and shreds of gastric mucosa. The mucosa of the
mouth, tongue and gums appears greyish white and necrosed.
Renal damage: oliguria, albuminuria, haematuria, OEDEMA
Generalised symptoms: loss of appetite, headache, tremor, ataxia, deafness,
emotional instability, loss of memory.
Death may occur due to renal failure/cardiac dep/hepatitis/starvation.

Treatment: Proteinaceous substance eg. egg albumin, gelatin, milk

along with other demulcents (protect stomach). For absorbed part, BAL
or penicillamine.
Postmortem findings: submucosal haemorrhage, necrosis of everything.

CHRONIC MERCURY POISONING

Signs and symptoms:
Falconis syndrome (kidney dysfunction)
Constant metallic taste, gingivitis, glossitis, loosening of

teeth with blue line in the gum.

Mercuriolentis (deposition in LENS CAPSULE)
Acrodynia (redness, swelling, desquamation of palms, soles,
fingers and toes)
Decreased metabolism of catecholamine causing profuse
sweating, tachycardia, hypertension, pheochromocytoma
Mercurial erethism (insomnia, anxiety, irritability, emotional
instability) with tremor of hands (Hatters shake).
Picture of pyramidal tract lesion (unsteady gait,
exaggerated reflex)
Personality change

Treatment: dimercaptosulfonicacid (DMSA) or

EDTA or penicillamine; Vitamin C, Sulphur-rich diet

POTASSIUM

Exogenous (high dose therapy, poisoning with

KI/KMnO4) or endogenous (kidney failure) causes.
Signs and symptoms:
Exogenous poisons -> severe irritation of GI tract locally,

haemolysis, liver+kidney damage, urinary bladder and

retinal damage.
With KMnO4 -> severe gastroenteritis, glossitis, respiratory
distress when used ORALLY / ulceration + necrosis & perforation
when used INTRA-VAGINALLY.

Endogenous -> tingling, numbness, weakness with paralysis

of fingers and toes, confusion, bradycardia, elevated T

waves, circulatory collapse

Treatment: Calcium chloride / calcium gluconate