The Common Poison

Intoxication
Ethyl Alcohol(Ethanol)
1. It’s the most widely used drug in the world.
2. The most deaths cause by the chronic effects
of alcohol or others reasons (such as motor
vehicle accidents, craniocerebral injury,
congenital anomalies) being linked to alcohol.
3. Alcohol beverage contain 0.5~95% alcohol .
 4. Alcohol is rapidly absorbed from all the
mucosal surfaces of the gastrointestinal tract. Food
delays the absorption of alcohol, alcohol is
absorbed faster on an empty stomach.
5. Alcohol is soluble in water, it is present in the
body tissue in direct relation to the amount of
water content of the tissue or fluid.
6. Alcohol is metabolized in the liver. Over
90% of the ethanol ingested is oxidized to
carbon dioxide and water, and the remaining
5~8% is excreted as ethanol in the breath,
urine, and perspiration.
7. For nonalcoholics, the rate of elimination
from the blood varies between about
11~25mg/100ml/hour. Alcoholics are able to
eliminate alcohol at a faster rate.
8. The effects of ethanol is on the nervous system.
Symptoms: reduced inhibition of higher
nervous center decrease in attentiveness
confusion, staggering gait stupor, coma
death
9. Most deaths caused by acute alcohol
intoxication occur with blood alcohol levels of
400mg% or greater.
 Symptoms
There are three phases of intoxication
2. Stage of excitement
3. Stage of incoordination
4. Stage of coma
1.stage of excitement-
-feeling of well being and a certain slight
excitation.
-the action, speech and emotions are less
controlled due to lowering of inhibition normally
exercised by the higher centres of the brain.
- increase confidence and lack of self control
2. Stage of incoordination-
when the alcohol content of the blood attains a
level of 150-250 mg/100ml the sense of
perception and skilled movements are affected.
The increased loss of inhibitory action of the
higher centers causes an alteration of in the
conduct of individual.He may become carefree,
cheerful, ill-tempered, irritable, excitable,
quarrelsome, sleepy and so on.
-nausea and vomoting are common
3. Stage of coma
in this stage the motor and sensory cells are
deeply affected, speech becomes thick and
slurring, coordination is markedly affected,
causing the patient to become giddy, stagger and
possibly fall.the person passes into a stage of
coma with stertorous breating.
 Micturation syncope
• It is a condition which occurs usually after
heavy beer drinking
• When a person rises from bed in the middle
of night to pass urine, he loses
consciousness during the act of urination,
probably due to sudden upright posture.
 Munich beer heart
• It is a condition in which cardiac dilatation
and hypertrophy is seen due to excessive
and prolonged beer drinking.
• Fatal dose - 150-250 ml of absolute alcohol
consumed in one hour
• Fatal period 12 to 24 hours
•Corrosive Substances
Classification
1.Strong inorganic acid: sulfuric,
hydrochloric, nitric acid.
2.The most common organic acid:
phenol(carbolic acid), lysol, and cresol.
3.The strong alkalis: sodium and potassium
hydroxide, ammonia.
•The principal mechanism of injury by
this group of substances is the
destruction of tissue at sites of direct
contact.
•The different corrosive agents have
different actions on soft tissues
1. Strong acids act by dehydrating the
tissues, coagulating the proteins, and
converting haemoglobin to haematin.
 2.the soft, slippery slime is the
characteristic appearance by caustic
soda.
3. Carbolic acid tends to stiffen the
tissues and bleach them; Lysol is a
soapy solution of phenol and cresols.
 Sulphuric acid poisoning
• Pure sul acid is a heavy,odourless,colorless,
non-fuming,hygroscopic, oily liquid.
• Signs and symptoms
-the lips r usually swollen and excoriated
and brown and black streaks may be found
extending from the angles of the mouth to
the sides of the chin and sometimes to the
front of the neck due to flow of the acids.
• There is corrosion of mucous membrane of mouth
,throat and esophagus, immediate burning pain,
stridor, drooling, odynophagia.
• Epigastric pain soon spread all over the abdomen
and thorax.
• The nausea and vomiting occurs
• The vomit is brown or black, mucoid and strongly
acid
• Thirst is intense, but any attempt to drink cause
vomiting
• There may be edema of glottis which causes
asphyxia.
• Teeth are chalky white.
• Tonge becomes swollen, sodden and black.
• The abdomen becomes distended and very
tender
• The eyes r usually sunken and pupils
usually dilated
• Fatal dose- 10 to 15 ml
• Fatal period 12 to 24 hours
• Cause of death
circulatory failure, edema of glottis,
collapse due to perforation of stomach,
toxaemia
Arsenic poisoning
•arsenic compounds. arsenious oxide,
sodium and potassium arsenites, arsenic
sulphides and so on.
•The mechanism of poisoning
Arsenic compounds interfere with
cellular respiration by combining with the
sulphydryl groups of mitochondrial
enzymes, especially pyruvate oxidase and
certain phosphatases.
• Its particular target is vascular endothelium,
leading to increase permiability, tissue edema and
hemorrhage, especially in the intestinal
canal.Locally it causes irritation of the mucous
membranes and remotely depression of the
nervous system
• Arsenate causes its toxicity by uncoupling
mitochondrial oxidative phosphorylation.
• It interferes with glycolysis
•The form of poisoning
1. The fulminent type
massive doses < 3-5 gm> of arsenic when
rapidly absorbed causes death in 1 to 3
hours from shock and peripheral vascular
failure.all the capillaries are markedly
dilated, especially in the splanchnic area
with marked fall of blood pressure. Arsenic
also has direct action on heart muscle
• 2. The gastrointestinal form is a more common type of
arsenic poisoning.
• Symptoms usually appear half to one hour after
ingestion but may be delayed many hours especially
when it is taken with food
• Signs and symptoms of this type include
• Constriction in the throat and difficuilty in swallowing.
• vomiting, burning pain in the abdomen, cramps, and
diarrhea.
• Stool is dark colored and bloody at the begining
Carbon monoxide
•The sources of carbon monoxide: coal
gas, the exhaust fumes of internal
combustion engines, smoke from
conflagrations, and the fumes from
defective heating appliances (furnace,
stove, or water heater),explosion in
mines.
•Carbon monoxide has an affinity for
haemoglobin that is between 200~300
times greater than oxygen.
• It displaces oxygen from its combination
with haemoglobin and forms a relatively
stable compound known as
carboxyhaemoglobin.
• It reduces oxygen content of the blood, and
hence that of the tissues.
• It acts as a chemical asphyxiant and
produces death due to anaemic anoxia.
• HbCO saturation levels of blood relate
to the clinical symptom.
HbCO (%) The clinical symptoms
< 10% absent or mild
15%~30% fatigue, loss of attention,
headache
30%~50% confused to subject
faint on exertion
> 50% unconsciousness or death

•The specific cherry-pink colour of the

skin and blood
Organophosphorus pesticides
• They r esters of phosphoric acid and form
two series of compound
2. Alkyl phosphates-
tetron, dimefox,
malathion,trichlorfon etc
2. Aryl phosphates-
parathion,paraoxon, methyl parathion,
chlorthion etc
• It is absorbed by inhalation through the
skin, mucous membrane and the GI tract.
• It is metabolised in liver and excretion of
metabolites occurs through urine
•Common organic phosphates: parathion,
malathion, dichlorvos and so on

•All of these substances have a

parasympathomimetic effect and act as
cholinesterase inhibitors, acetylcholine
builds up neuromuscular junctions and
other neurotransmitter sites, resulting in
hyperexcitability of both voluntary and
involuntary muscle.
• The signs and symptoms include
headache, blurred vision, weakness,
nausea, sweating, salivation, convulsions,
loss of reflexes, and coma.

• Death results from bradycardia,

hypotension, and respiratory failure.

Cyanide
• Cyanide inhibits the action of
cytochrome oxidase, carbonic anhydrase
and other enzyme system.It blocks the
final step of oxidative phosphorilation and
prevents the formation of ATP and its use
as energy source.Cyanide acts by
reducing the oxygen carring capacity of
the blood and by combining the ferric
iron atom of intracellular cytochrome
oxidase, preventing the uptake of oxygen
for cellular respiration
• Cyanide gas is absorbed rapidly from
respiratory system and the acid and cyanide
salts from the stomach.Acid is also
absorbed from skin.absorbtion is delayed if
it is taken on a full stomach or with much
wine.
• It is mainly excreted in the urine, a small
amount excreted in the breath.
• The colours of the blood is bright red
due to excess oxyhaemoglobin.
• The signs and symptoms are manifested
collapse, rapid pulse, gasping respiration,
convulsions and death.