toxicology 3
TRANSCRIPT
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.