General Toxicology

Toxicology - Branch of science that deals with

poisons with reference to their sources, properties,
mode of action, fatal dose, fatal period, symptoms
& signs which they produce, method of their
detection, treatment & autopsy findings

Poison
Drug

Legally, difference between poison & drug is:
Intent with which it is taken
ACTS

The Poison Act (1919):

It deals with:

- Import of poisonous substances.
- License authority for poisonous substances.
- Restriction in the sale of such substances.


Drugs & Cosmetics Act (1940)

It deals with:

O Import, manufacture, distribution & sale
of drugs
O Functioning of Central Drug Laboratory
O License authority
The Drugs & Magical Remedies Act 1954

ensures ethical standards are maintained when
drug are advertised by the manufacturer.
It prohibits advertisement for:
Abortion.
Prevention of conception.
Maintenance & improvement of capacity to
indulge in sexual desire.
Treatment for menstrual disorders.
Diagnosis, treatment & cure of venereal diseases.

Drugs & Cosmetic Rules Schedules
C: Biological & special products.
E: List of poisonous substance under ayurvedic,
siddha & unani system
F: Vaccines & sera
G: Hormone preparations
H: Drugs to be sold only on the prescription of
RMP.
J: List of diseases like appendicitis, cancer etc for
the cure & prevention of which no drug should be
advertised.
L: Antibiotics, antihistamines & chemotherapeutic
agents.


The Narcotic Drugs & Psychotropic
Substances Act (1985):

Amended 1988

Convention against Illicit Traffic in Narcotic
Drugs & Psychotropic Substances 1988 -
Vienna

Manner of Poisoning
Human
Suicidal
Homicidal
Accidental
Stupefying
Abortifacient
Arrow Poisons
Infanticidal
Misc.


Cattle

Abrus precatorius
Oleander
Aconite

CLASSIFICATION OF POISONS
According to S/S

Corrosives

Irritants

Systemic


Corrosives
Strong
Acids

H
2
SO
4, ,

HCl,
HNO
3
Carbolic
Strong
Alkalis

Hydrates
&
carbonates of
Na, K, NH
3
Metallic
Salts

Zn Cl
2
FeCl
2
Irritants
a. Agricultural

b. Inorganic
Metallic Pb, Cu, Hg, Ar
Non Metallic I
2
, Br
3
, PO
4

Mechanical hair, powdered glass

c. Organic Vegetable, Animal
Systemic
CNS CVS RS Misc
CNS
Cerebral
Spinal -

Strychnine
Gelsemium

Peripheral -

Curare
Conium
Somniferous

Inebriant
Deliriant
b. CVS Aconite, Tobacco
c. RS CO, CO
2
, H
2
S
d. Misc. - Food poisoning

According to site

1. Local
2. Remote
3. Local & remote

Factors modifying action of poison
1) Dose

2) Form of poison

3) Route of administration

4) Condition of body
Dose:
Quantity
Vary
Exceptions:
a) Idiosyncrasy
b) Allergy
c) Tolerance
d) Synergism & cumulative
Form of poison
a) Physical state

b) Chemical composition

c) Mechanical composition
Route of administration
a) Inhalation > Parenteral > Oral

b) Stomach contents

c) Sleep, Narcosis, Trauma


Condition of body
a) Age

b) State of health

c) Sleep
Fate of poison
- Local
- Absorption
- Elimination

Poisoning: Acute & Chronic
Diagnosis of poisoning
History

Papers

Clinical findings

Suddenness of onset

Several persons suffering etc
Poisoning in Living Poisoning in Dead
- Acute poisoning - History
- Chronic poisoning - Papers
- PM Examination: External & Internal
- Chemical analysis
- Experiment on animals
- Moral & circumferential evidence
Treatment of poisoning
A) Removal of unabsorbed poison

B) Use of ANTIDOTE for absorbed poison

C) Elimination of absorbed poison

D) General treatment- Symptomatic
A) Removal of unabsorbed poison

Treatment depends upon Route of Entry
e.g. Inhalation- fresh air, artificial respiration

Injection- tourniquet, incision & suction

Contact- washing

Ingestion- emesis, stomach wash

(Syn. Stomach wash ; Stomach pump ;
Gastric Irrigation)
"It is the process of cleaning out the
contents of the stomach"
GASTRIC LAVAGE
DEFINITION :-
INDICATIONS :-
1.Mainly useful within 3 hrs.
- Salicylates
- Phenothiazines.
- Tricyclic anti-depressants
- Antihistamines.
2. Gastric concretions.
3. Delayed gastric emptying.
4. Sustained release preparations.
5. Morphine / Barbiturates given parentrally :- resecreted by stomach.
6. Hyperthermia Climatic
Drug induced
Uptil
12-18 hrs.
Iced Solution
APPARATUS
Ewalds Tube
Boas Tube
Ryle's Tube - Lavacuator
Ordinary Rubber Tube
(Soft, Non Collapsable)

Length - 1.5 Metres (150 Cms)
Diameter - 1 Cm

( Infant - Children 10-12 F Catheter )
Stomach Tube
Round end
Perforated
Lateral openings
To pump stomach
contents
(Wooden)
1 end pointed,
Hole in middle to pass tube
POSITION OF PATIENT
Lies on left side / prone.
Head hanging over the edge (Stretcher / bed / table)
Face down supported by an assistant (mouth at
lower level than larynx)
Elevated foot end.

PROCEDURE
+ Remove any artificial dentures.
+ Patient If Conscious - Explain procedure.
- Obtain informed consent.
Unconscious - put in cuffed
(9-10 mm) endo-tracheal
tube-balloon the cuff.
(prevent aspiration)
+ Lubricate end of tube

+ Depress tongue
Pass tube (Gradually, Gently, Without force)

Pharynx



Oesophogus
Stomach
Uptil 50 cms mark on tube ADULTS
25 cms using 10-12 F INFANT + CHILDREN
Catheter / Ryle's tube.
(If No mark on tube :- distance equal to that between
bridge of Nose and Xiphisternum)
PROCEDURE
downwards
through
CHECK PASSAGE OF TUBE INTO STOMACH.
Keep free end of tube
just below water surface
air from stomach
expelled in 2-3
expirations
air from lungs causes
'bubbling' at each
expiration.
Push air into tube
auscultate
epigastric region
Gurgling sound
Tube in Air passage
Tube in Stomach
gag / cough reflex - nt.
gag / cough reflex + nt.
X-ray can detect position of tube

E

Hold the funnel high above patient's head.
Pass 1/4th Litre(250 ml) of warm water 35C.
When funnel empty - compress tube below the funnel
between finger and thumb.
Lower the funnel of tube below level of stomach.
Release thumb-finger pressure from rubber tubing.
Siphon Action
Contents of stomach emptied
TO IRRIGATE
Preserve Contents.
(Chemical Analysis)
Pour further Litre of solution (as above )
CHECK COMPLETION
If bleeding abandon the process.
Clear + odourless fluid
No Interaction between
Antidote + Poison
PourSmall Quantity of
Cathartic / Antidote
/Activated Charcoal
(1 gm/kg body weight)
In opium poisoning
or it's derivatives
KMno
4
Same pink colour as
the solution put in
Antidote + Poison
No Interaction between

LAVAGE WHAT / WHEN

MECHANICAL - Activated Charcoal
- Multi dose Activated Charcoal






CHEMICAL - Water with KMnO4 1:5000





- Common salt in water - Silver nitrate.
- Albumen - Mercuric chloride
- Dialysed Iron - Arsenic
- Copper Sulphate - Phosphorous
CONTRAINDICATIONS
RELATIVE
(With proper precautions)
ABSOLUTE
All corrosive poisoning
SOFTENS MUCOSA
Except : Carbolic acid
Comatose patient
THICKENS MUCOSA
Petroleum Distillates (Kerosene)
Pass cuffed
endotracheal tube
balloon the cuff
Volatile poison
Upper alimentary disease
e.g.: esophageal varices.
Severe hypothermia.
Haemorrhagic diastasis.
Advanced pregnancy.
Recent surgery
COMPLICATIONS
Laryngeal spasm.
Aspiration - pneumonitis.
Perforation of Stomach.
Sinus Bradycardia.
B) Antidotes for absorbed poison:
- Def

- Classification
1) Mechanical or Physical
2) Chemical
3) Physiological or Pharmacological
4) Universal

Chelating Agents
C) Elimination of absorbed poison
1) Catharsis:
a. Ionic /Saline: Mg citrate, Mg Sulphate, Na sulphate

b. Saccharides : Sorbitol
C.I.- Corrosives, diarrhoea, electrolyte imbalance, paralytic
ileus

2) Whole bowel irrigation:
a. PEG-ELS
b. PEG-3350


3) Forced diuresis
Indications
Forced alkaline diuresis

- Haemodialysis
- Haemoperfusion
- Peritoneal dialysis
- Haemofiltration
- Plasmapheresis
D) General treatment:
- Respiratory depression
- Shock
- Nutrition
- Infection
- General nursing-COMA

Duties of RMP in a case of Suspected
Poisoning
A) Duties towards Patient

B) Duties towards Relatives

C) Duties towards State
Duties towards Patient

Early diagnosis
Prompt treatment
Preliminary record
Homicidal
Psychotherapy
Duties towards Relatives

Interview:
- Information about the case
- Information about patient- condition,
diagnosis, prognosis
- If food poisoning- inform accordingly
Duties towards State : RMP

1) Private practice: inform Police only homicidal
2) In Govt.service:inform all cases of poisoning
3) If death occurs: inform Police in all cases whether
private or Govt.
4) Collection of suspicious material-vomitus, lavage(1
st

sample etc)
5) If food poisoning inform
6) Dying declaration
7) No death certificate
8) Insist on Medicolegal Postmortem-viscera preservation
9) Maintenance of record