TOXICOLOGYPART-3

- DR.AKIF A.B

1) A case of poisoning was brought to the casualty, a gastric lavage was done, and the lavage turned black when it was heated after being treated with silver nitrate. The poisoning is most likely to have been due to which of the following?

A Tik-20

B Celfos

C Malathion

D Parathion

Ans. B Celfos

Aluminium phosphide-

AgNo3 filter paper is turned black by fumes of suspected gastric aspirate containing Phosphine, due to Aluminium Phosphide.

Gastric Lavage +Mixed with AgNO3

Heated Black color

CELPHOS-Aluminium phosphide

-3gm of celphos liberates 1 gm of phosphene which inhibits cytochrome oxidase and causes respiratory depression.

3gm celphos 1gm phosphene Inhibits CytochromeOxidase

Causes Respiratory depression

2.Q. Haemodialysis is mandatory in which poisoning?

A Copper sulphate poisoning

B Ethanol poisoning

C Amphetamine poisoning

D Organophosphorus poisoning

Ans. B Ethanol poisoning

HEMODIALYSIS IN POISONS

B = BarbituratesL = LithiumA = AlcoholS = SalicylatesT = Thiophylline/Thiocyanate

HEMODIALYSIS IS C.I in POISONS

K =KeroseneB = BenzodiaepineC =Chloroquine/CuSO4Hero =Heroin

3.Q. Widmark’s formula is used for measurement of blood levels of:

A Benzodiazepines

B Barbiturates

C Alcohol

D Tranquilizers

Ans. ALCOHOL

ETHANOL ESTIMATION

WIDMARK FORMULA

A = P C RWt. of alcohol Body wt.

Conc.of alcohol

Constant, Males=0.6

Females= 0.5

ETHANOL ESTIMATION-Best method for alcohol estimation = Gas chromatography

- Amitabh = Alcohol dehydrogenase

-K = Kozelka test

-B = Breath analysis test

-C = Cavett test

Based on Henry’s Law

4.Q. Which of the following beverages contains the maximum percentage of alcohol:

A Whisky

B Brandy

C Wine

D Rum

Ans. D Rum

Rum = 50-60% alcohol.

Whisky, Gin, Brandy = 40-45%.

Port, Sherry = 20%.

Wine = 10-15%.

Beers = 4-8%.

5.Q. In carbolic acid poisoning, pupils are:

A Constricted and pin-point

B Semi-dilated

C Dilated and not responding to light

D Irregularly shaped

Ans. Constricted and Pin- Point Pupil

PIN-POINT PUPILF = FormaldehydeB = Barbiturates.C =Carbolic AcidO = OrganophosphorusM = Opium

6.Q. Glass-blowers shakes’ are seen in poisoning due to:

A Lead

B Mercury

C Arsenic

D Copper

Ans. B Mercury

MERCURY-Donovan solution = Mercury + Arsenic

-MC mercuric salt causing poisoning is = HgCl2

Mu = Minimata Disease

Mmy = Mercuria Lentis

H = Hatter Shake

E = Erethism

A = Acrodynia

D = Danbury Tremors

- Blue-Black line on gums.

MINIMATA DISEASEMinimata disease, is a neurological syndrome caused by severe mercury poisoning.

Symptoms include ataxia, numbness in the hands and feet, general muscle weakness, narrowing of the field of vision and damage to

hearing and speech.

MINIMATA DISEASE

MERCURIA LENTIS

-deposition of brown pigment on anterior lens capsule without affecting visual acuity.

- Brown malt reflex.

HATTER SHAKETremor (Intentional, coarse, affecting arms, hands, tongue and later legs,

also called hatter's shake/glass blower's shake/danbury tremors)

ERETHISMErethism : Psychological disturbance characterised by shyness, timidness,

loss of memory, depression, insomnia.

PINK DISEASEAcrodynia (Pink disease, characterised by pain, paraesthesia, pinkish discolouration of hands and feets)

BLUE LINES ON GUMS1) Lead

2) Mercury

3) Iron

4) copper

7.Q. In chronic lead poisoning, there is increased urinary excretion of:

A Coproporphyrin

B Protoporphyrin

C Prophobilinogen

D Uroporphyrin

A) Coproporphyrin

Diagnosis Of Lead Poisoning

LAB PARAMETER VALUES REMARK1) Coproporphyrin in Urine

>150mcg/l Exposure to lead

2) Amino Levulinic Acid in Urine

>5mg/l Indicates lead absorption

3) Lead in blood >70mcg/100ml Clinical symptoms appears

4) Lead in urine >0.8mg/l Lead exposure and absorption

5) Basophilic stippling of RBCs

Punctate basophilia

8.Q. Hippus is seen in which poisoning:

A Abrus

B Aconite

C Alcohol

D Dhatura

Ans. B Aconite

Aconite- late stages Hippus is seen.

ACONITE-Mitha(sweet) Bish / Mitha zeher

-1st Symptom is : Numbness of tongue

-Roots are poisonous

-Queen of all poisons

- Hippus Reaction + : Alternate constriction and dilatation of pupil

Also seen with Barbiturates

VEGETABLE POISONS1) Abrus Precatorius/ Ratti

- Principle : Abrin = similar to Viper’s Venom

Extract from seeds….. Seeds are not poisonous, Only extracts are poisonous

- Used as Animal poison by needle…also k/a Sin Needle

2)Semecarpus Anacardum-Marking nuts/ bhilawan

-Active principle : Semecarpol

-Juice of seeds produces Artificial Bruise

-Washerman uses it to mark clothes.

9.Q.Antidote in Cyanide poisoning is:

A Sodium thiosulphate

B Silver nitrate

C Sodium calcium edenate

D Sodium bicarbonate

Ans. A Sodium thiosulphate

Cyanide/HCNQ- Amyl nitrite inhaled in handkerchief,

Sodium nitrite i.v. and through the same syringe

Sodium thiosulphate i.v., EDTA.

HYDROCYANIC ACID

-Also k/a Prussic Acid

-Derived from Linseed Plant

-Bitter almond smell

-Inhibits enzymes of respiratory chain : 1) Carbonic anhydrase 2) superoxide dismutase 3) Cytochrome oxidase 4) Succinate dehydrogenase

-Rx: Amyl Nitrite+

Vit. B12+

Na. Thiosulphate

Triple Antidote

Amyl nitrite + CN = Meth-Hb

Vit.B12 + CN = Cyanocobalamine

Na.thiosulphate +CN= Thiocyanate

10) Q. Haematuria occurs from the bite of the:

A Cobra

B Krait

C Sea snake

D Viper

Ans. D Viper

Non-poisonous snake- Semi-circular set of bite marks.

Poisonous snake- 1 or 2 deep fang-marks.

Swallow snake venom- harmless- as not absorbed by GIT.

Most common symptom of snake bite- ‘Fright’.

Cobra- Neurotoxic, Cholinesterases; pain & swelling, paralysis, Drooping eyelids(ptosis), larynx edema, coma, convulsions.

Krait- Neurotoxic, albuminuria, Cholinesterases; No pain & swelling, drowsiness is more, paralysis, etc, same as for cobra.

Viper- Hemolytic, Hburia, pain & swelling, Hburia, unconsciousness, abd. pain, No paralysis.

Sea-snakes- Myotoxic, myoglobinuria, pain

CANTHARIDES/SPANISH FLY/

BLISTER BEETLE- Causes Priapism

-found mainly in europian countries.