Toxicology Flashcards
Classification of poison?
CINCAM
Eschar is formed in acid / alkali?
Acid
Limit lateral spread
Coagulative necrosis is seen with…..
Acid
Alkali -liquefactive
Acid/ alkali which one is more dangerous?
Alkali
Cause deeper damage
2 types of acids? Examples of each?
Organic : carbolic, acetic, oxalic,formic
Inorg: sulphuric, nitric, hydrochloric.
Give examples of alkali
Ammonia
Sod/ pot hydroxide
Sod/ pot carbonate
The 4 things u shouldn’t do in a corrosive poisoning case?
Emesis
Gastric lavage
Charcoal
Neutralize
Properties of alkali vs acid
Xanthoporetic action.
Carbonisation
Hygroscopic property.
What are the Common features of corrosive consumption other than odynophagia, intense thirst, vomithing, (6)?
Abdominal pain
Chemical peritonitis
Resp distress.
Autopsy finding in sulphuric acid poisoning?
Black necrotic tongue
Black necrotic stomach mucosa
Gastric perforation
Chalky white teeth
Autopsy findings in nitric acid poisoning?
Yellowish discoloration of skin, teeth, stomach mucousa, brownish stomach mucosa
What is vitriolage? Commonly used corrosive for this? What all u can see while examining the victim?
Intentionally throwing corrosive for the disfigurement of a person.
Sulphuric
Nitric
Marking nut juice
Chemical burns, ulceration, contractures.
No blister, singeing of hair
How you can manage vitriolage??
Topical irrigation with water and ns
Apply Mgo paste
Eye= olive oil
Carbolic acid is also k/as…….
It has a…… Property.how cresol, lysol and dettol related to this acid.how this acid is produced?
Phenol.
Antiseptic
They are phenol derivatives
Phenol crystal on exposure to air forms pheenol liquid
Presentation of an acute phenol poisoning(carbolism) case??
Burning pain - tingling& numbness - anaesthesia.
Decrease emesis
Leathery stomach mucosa.
Blood= 1.pyrocatechol
2.hydroquinone
CNS:CNS depression, convulsion, constriction of pupil.
URINE: Olive green urine.
Kidney :oligouria, renal failure.
What is Phenolic marasmus??
Chronic phenol poisoning
How we clinically diagnose phenol poisoning?
Phenolic odour, dark urine
( gastric lavage possible due to lathery stomach mucosa)
Autopsy feature of phenol?
Resistant to putrefaction.
What kind of acid is hydrofluoric acid? And what effect does it have?
Inorganic acid
Local+ systemic effect
Causes : liquefactive necrosis.
Toxicity of hydrofluoric acid is due to?
Fluoride ion.
Which cause
LIQUEFACTIVE NECROSIS: affect skin/ deeper tissue/ bones.excruciating burning pain disproportionate to amount of exposure.
2. INSOLUBLE SALT with calcium, magnesium leads to
Hypocalcemia, hypomagnesemia, & hyperkalemia
How to manage a condition of hydrofluoric acid toxicity?
*Immediate icu admission.
*Continuous ecg monitoring
* Topical decontamination e water
*Calcium gluconate 2.5% topical, *injection of calcium gluconate.
*Correct electrolyte level
To whom hydrofluoric acid toxicity occur more?
Glass etching.
Oxalic acid is an……. Acidic. Also known as…………..! It visually resembles…….it was used for………
Organic
Acid of suga
Magnesium sulphate.
Ink/ rust removal
Source of oxalic acid?
Veg such as almond, corn,spinach,
Ladies finger
What happens if Oxalic acid comes in systemic circulation?
Calcium oxalate hypocalcemia
Crystals features of
Oxaluria tetany.
Needle/ evelope
Shaped cast.
Comes out of Urine.
Block tubule & renal
Failure.
How u treat oxalic acid poisoning?
GL e calcium lactate solution.
Antidote : calcium gluconate.
Hemodialysis.
Rx of renal toxicity.
Boiled lobster appearance is seen?
Boric acid
Erythemic skin.
Peeling of skin
Skin is completely swollen.
Most common acute heavy metal poisoning?
Arsenic
Mc chronic heavy metal poisoning?
Lead
3 forms of Arsenic?
Elemental
Org
Inorganic(toxic)
Example for inorganic arsenic
Salt is there
* Arsenic trioxide which is colourless tasteless and order less and most toxic salt of arsenic.
*Sheele’s green
*Paris green.
Gas form arsine
Garlic odour
Most toxic form
Types of Arsenic poisoning
*Fulminant which is massive intake (3g)
Acute large dose
Chronic small dose for a long period
Fatal dose in acute Arsenic poisoning
100-200 mg
Two forms of acute Arsenic poisoning
Gastroenteric form
Which include: profuse diarrhoea
Hemorrhagic gastritis
Narcotic form
Which include: affect CNS
Neurological manifestations.
Differentiate acute Arsenic poisoning from cholera
Acute Arsenic poisoning
Throat pain vomiting loose stools.
tenesmus present .
On Autopsy : red velvety stomach mucosa.
Cholera
Ls- v- tp.
No tenes
Chronic arsenic poisoning is K/as
Arsenicosis
Contamination of groundwater e arsenic?
Hydroarsenicism
Clinical features of chronic arsenic poisoning?
Skin2
Nail hair
Blood vessel
Nerve
Bm
What is torokku arsenic ds?
Inhalation / drinking (contaminated e arsenic).
Lung ca
Skin ca
Bowen ds
Black foot ds
Taiwan ( endemic ds )
Drinking
Peripheral vasospasm
Ischemia
Peripheral gang
Most reliable sample used? Other samples?
Urine
Blood,hair, nail, bone.
Tests for arsenic poisonig
Obsolete - marsh, reinsch.
Latest- neutron activation analysis
Atomic absorption
Spectrometry.
Medicolegal imp
Accidental.
Homicidal
(Retard putrefaction
Decomposed bodies, ash)
Aphrodisiac.
Chelating agent for arsenic
BAL, DMSA.
Chronic poisoning by mercury is known as
Hydrargyrism
Uses of Mercury
Photography
Fingerprinting
Thermometer
Dental amalgam
Sea food
Hat making
Glass bowling
Order of toxicity of Mercury
Organic >mercuric >mercurous> element form
Mercuria lentis?
Toxicity due to vapour
Anterior lens capsule
On slit lamp: malt brown reflex
Normal vision.
Diseases caused by organic Mercury
1.minamata ds
Contaminated fish
Lipid soluble
Cross blood brain barrier
CNS symptoms
Ataxia, tremor convulsion
2. Hunter russel syndrome
Ds caused by inorganic Mercury
Erethism
Pink ds
Clinical features of erethism
Neuro psychiatric manifestations
Tremors
Writing- speech- ataxia- concussio mercurialis.
Hatters/ glass bowlers/ dandbury shakes.
Emotional instability
Emotional outburst
Most common in hat industry
Mad hatter syndrome.
What is pink disease
Mercurous poisoning.
Hypersensitivity reaction in children
Painful peripheries
Feeling of skin
Pruritis
Puffy
Calomel/ acrodynia/ swift fear/selters
Ds
Chelating agent= BAL, DMSA.
Why cadmium causes bone weakening bones softening & bone deformity
Because cadmium replaces Calcium from Bone
Which poisoning couses itai itai disease or ouch ouch disease
Cd
Clinical features of cadmium poisoning
Multiple pathological fractures
Severe bone pain
This is an homicidal poison which is known as poisoner’s poison.
This cause butterfly Rash dermatitis,
Behaviour change, alopecia, madarosis, aldrich mees line &
Peripheral sensory motor neuropathy
Thallium ( th acetate& sulfate )
Lead is used in
Paint, pipe, pottery, petrol, pencil, bullet
Most toxic form of lead
Tetra ethyl lead
Organic form
Lipid soluble
Inorganic forms of lead?
Lead carbonate
Acetate
Tetroxide
Sulfide.
Which are the 2 anaemias sceen in lead poisoning
Normocytic normochromic.( bone marrow suppression )
Micro.hypochro(decreased hb production dt inhibition of ALA dehydratase, ferrochelates. )
What is the manifestation of pbs?
Burtonian/ Burton’s line.
Blue colour deposit in gingivodental jun.
Upper teeth
1 w exposure.
Dental caries- bact h2s+pb =pbs.
Importance of 5- pyramidine nucleotidase
It is required for removal of ribosomal particle from reticulocyte for formation of RBC.
It’s inhibition causes basophilic stippling.
Manifestations in Bone
Bone line
RadioDens opacity in metaphysis of long bone.
Most common in children’s
Due to deposition of calcium
