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Toxicology Flashcards

1
Q

Father of toxicology

A

Paracelsus

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2
Q

Father of Modern toxicology

A

Mathieu Orfila

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3
Q

Classification of poisons (CINCAM)

A

Corrosives
Strong acids (organic/inorganic)
Strong alkalis
Irritants
Inorganic (metallic/non-metallic)
Organic (plant/animal)
Mechanical
Neurotoxic
Cerebral (stimulant/depressants)
Spinal (stimulant/depressant)
Organ affecting
Cardiotoxic
Hepatotoxic
Nephrotoxic
Asphyxiants
Others /miscellaneous
Hydrocarbons
Agrochemical
Domestic

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4
Q

Types of nature of poisoning

A

Accidental
Suicidal
Homicidal

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5
Q

Types of poisoning

A

Fulminant
Acute
Subacute
Chronic
Secondary (Minamata Bay Disaster)

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6
Q

Stupefying poisons

A

Stun or put victim in state of little or no sensibility.
For kidnapping,rape,robbery

Datura
Cannabis
Chloral hydrate

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7
Q

Ordeal poison

A

To prove or disprove the innocence or guilt of a suspect.
Given to suspect accused of crime

Calabar beans
Ordeal tree
Cerbera tanghin
Croton seeds

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8
Q

Toxalbumin

A

Resemble bacterial toxin in action
Inhibits protein synthesis
Inactivate ribosomes
Antigenic in nature
Produce antibody
Agglutinate and lyse the RBCs
Similar to viperine snake venom

Ricin (castor)
Crotin (croton)
Abrin (ratti)

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9
Q

Coma cocktail

A

To poisoned comatose patient
Three substance combination
Dextrose + Naloxone + Thiamine
In any hypoglycemic agent poisoning

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10
Q

Characteristic odours of poisons

A

Garlic
Fishy
Kerosene like
Phenolic smell
Burnt rope
Bitter almond
Sweet pungent

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11
Q

Signs and symptoms of acute poisoning

A

Abdominal pain
Vomiting
Diarrhoea
Haematemesis
Constipation
Jaundice
Paralysis
Tremors
Convulsion
Seizures
Peripheral neuropathy
Oliguria
Haematuria
Coma

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12
Q

Affects of poison on skin

A

Alopecia
Blister
Bullae
Dry
Hot skin
Formification

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13
Q

Affects of poisons on CNS

A

Ataxia
Muscle fasciculations
Muscular rigidity
Paraesthesia
Peripheral neuropathy
Coma

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14
Q

Condition + accumulation of poison in hair

A

Chronic heavy metal poisoning
Arsenic

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15
Q

Removal of unabsorbed poison from the body

A

Emesis
Gastric lavage
Catharsis
Whole bowel irritation
Endoscopic/surgical removal

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16
Q

Characteristics of non-Over the counter drugs

A

Cant be purchased without prescription.
Labelled with Rx
Schedule H drug warning
Red vertical line on left side of container.

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17
Q

Removal of absorbed poison

A

Urine alkalinisation
Urine acidification
Dialysis
Haemoperfusion
Exchange perfusion
Purging
Diaphoretics
Antidotes
Symptomatic treatment
Follow up

18
Q

Copper poisoning

A

Metallic copper is non - poisonous
Copper sulphate (astringent, emetic, irritant)
Copper subacetate/ verdigris (bluish green)
Cupric acetoarsenite (emerald green)
Cupric arsenite (Scheele’s green)

19
Q

MOA in copper Poisoning

A

Act on sulphydril group
Inhibit G6PD + glutathion reductase

20
Q

Symptoms of acute copper sulphate poisoning

A

Metallic taste
Throat constriction (sense)
Mouth - burning pain
Nausea
Increased salivation
Vomiting (repeated + voilent)
Vomitus - bluish / greenish blue
Purging ( repeated)
Abdomen - Colicky pain
Tenesmus
Renal failure
Hemolysis ( jaundice, Hb uria, myoglbinuria)

21
Q

Autopsy features in acute copper poisoning

A

Yellow skin (jaundice)
Greenish gastric mucosa (congested + swollen + eroded)
Liver - soft
Kidney - PCT degenration

22
Q

Management of Acute copper poisoning

A

Stomach wash (vomit)
Castor oil (purgative)
Chelation ( cuprimine / EDTA / BAL)
Fluid + electrolyte

23
Q

Chronic copper poisoning

A

Vineyard sprayer’s Lung
Wilson’s disease
Chalcosis (Cu in tissues)
Metal Fume Fever (Brass founder’s ague

24
Q

Postmortem appearance in chronic copper poisoning

A

Yellow skin
Greenish blue froth (mouth + nose)
Rectal perforation
Liver
Enlarged
Soft
Greasy
Fatty infiltration
Fatty degenration
Centrilobular necrosis
Kidney
Congested
PCT degeneration
Copper deposition

25
Arsenic posoning
Metallic non- poisonous Water insoluble Oxidise on heating form arsenic trioxide (poisonous) Arsenic trioxide Arsenic disulphides (Realgar) Arsenic trisulphide Copper arsenite (scheele's green) Copper arsetoarsenite( paris green) Arsenic trichloride Arsine gas Fatal Dose - 200-300mg (trioxide) Fatal period - 1-2 days
26
MOA in arsenic poisoning
Attach sulphydryl grp Inhibit pyruvate dehydrogenase (No oxidative phosphorylation) (Reduced cellular ATP) (Apoptosis)
27
Clinical features of acute arsenic poisoning
Metallic taste Increased salivation Garlicy breath Dysphagia Irritation / burning pain (Throat) Colicky abdominal pain Thirst Vomiting ( dark brown) Purging (rice watery stools + bloody) Anus - pain, tenesmus, irritation CVS (arrhythmia, cardiomyopathy, subendocardial haemorrhage) Renal - painful micturition CNS Liver - fatty degeneration
28
Investigations in acute arsenic poisoning
ECG QT prolongation ST depression T wave flattening
29
Postmortem findings in acute arsenic poisoning
Sunken eyes Cyanosis Longer + early rigor Delayed putrefaction (antibac. arsenic) Organs - congested enlarged Lungs - subpleural ecchymoses Brain Edematous Patchy necrosis Haemorrhagic encephalitis Congested meninges Heart Subendocardial haemorrhage Stomach Erosion Ulceration Congested Inflammation Red velvety apperance Lines of redness (walls) Mucosa Swollen edema Bright red Desquamated
30
Management of acute arsenic poisoning
Gastric lavage (warm water / milk) Antidotes Dimercaprol i.m. gluteal region Sodium thiosulphate Penicillamine Sodium thiosulphate Continued Nasogastric secretion (re-secreted in GIT ) Cathertics Castor oil MgSO4 Whole bowel irrigation
31
MOA of chronic arsenic poisoning
Chronic Repeatative inhalation Chronic repeatative ingestion (occupational)
32
Clinical features of chronic arsenic poisoning
1st stage (gastrointestinal) Oedema (eye lid + ankles) Loss of appetite Weight loss Vomiting Colicky pain Constipation / diarrhoea Black line - Gums White silver fur - Tongue 2nd stage (dermatological) Rain drop pigmentation Hyperkeratosis Aldrich - Mee's line (white nail plate) Alopecia Nasal septum - perforated Liver - enlarged, cirrhotic Kidneys - damaged Voice - Hoarse + Husky 3rd stage (neurological) CNS Polyneuritis Hyperaesthesia (skin) Encephalopathy Muscle tenderness. + Cramps Arthralgia Impotence Bone marrow suppression Aplastic + Megaloblastic anaemia 4th stage (neuromuscular) Neuropathy (resemble GBS) Cardiac failure (cause of death)
33
Treatment of chronic arsenic poisoning
British anti -Lewisite Vit B1 injection (peripheral neuritis)
34
Mercury poisoning
Bright silvery Not absorbed from GIT Deadning (fingerprints) Sindoor Attach Sulphydryl grp Highest concentration in kidneys
35
Acute mercury poisoning
Methyl mercury deposits in hair 250 times Fatal Dose - 1-2g
36
Clinical features of acute mercury poisoning
1st phase Hot burning pain Throat constriction (sense) Dysphagia /Dyspnoea Epigastric pain Abdominal pain afterwards Vomit Purging (liquid bloody faeces) Mouth + tongue - corroded + swollen 2nd phase Glossitis Gingivitis Teeth loosening Jaw necrosis Renal tubular necrosis Membranous colitis (dysentery) Resembles Kawasaki disease
37
Management of mercuric chloride poisoning
Chelating agent (BAL + DMSA) Gastric lavage (5% sodium formaldehyde sulphoxylate) Penicillamine DMPS Fluids
38
Postmortem findings in acute merucury poisoning
White + swollen Mucous membrane GIT (haemorrhagic necrosis) Heart ( subendocardial haemorrhages) Liver (fatty changes) Kindney (PCT necrosis) Deposition in cortex
39
MOA of Lead poisoning
Inhibits Ala - dehydratase Coproporphyrinogen -III oxidase Ferrochelatase Sulphydryl group
40
Acute lead poisoning
FD - 20g lead acetate 40g lead carbonate FP - 2-3 days Symptoms Metallic taste Vomit / nausea Thirst Paraesthesia Cerebellar ataxia Renal damage Cause of death is hypovolaemic shock due to gastroenteritis.
41
Management of acute lead poisoning
Gastric lavage Mg / Na sulphate (form lead sulphate) Convulsions Diazepam Phenytoin Phenobarbitol Peritoneal / haemodialysis
42
Clinical features of chronic lead poisoning (Plumbism) (FLARE)
Facial pallor (earliest sign) (vasospasm) Lead / Burtonian line Lead palsy (peripheral neuropathy) Wrist drop Foot drop Due to action on ant. Horn cells (spinal cord) and interference in phosphocreatinine metabolism. Lead encephalopathy Inactivates monoamine oxidase(SH) Lead osteopathy Deposition promoted by Ca + Vit D Anaemia + basophilic stippling Abdominal colic Retinal stippling (glistening grey lead particles)

Foriensic Medicine (10 decks)

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