Learning Objectives• By the end of the lecture student should be
able to • Classify poison ( accord mode of action)• Neurotics action and• Classification • Heroin, ways of administration • Stages • Sign/ symptoms / post mortem findings• Treatment• complications
According to mode of actionAccording to mode of action
1- Corrosives
2- Irritants
3- Neurotics
4- Cardiac
5- Aphyxiants
6- Miscellaneous
CINCAM
•Neurotics:Neurotics: Act on nervous system.
Symptoms,Symptoms, Headache, drowsiness, giddiness,
delirium, stupor, coma, convulsions or paralysis.Post-mortem findings,Post-mortem findings, are not markedly visible to naked eyes.
Cerebral PoisonsCerebral Poisons
a. Somniferous (sleep inducers)b. Inebriants (drunkenness)c. Deliriants (hallucinogens)
Somniferous poisonsSomniferous poisonsincludes Opium and its alkaloids.InebriantsInebriants includes,
A. AlcoholB. AnaestheticsC. Sedatives & Hypnotics D. FuelsE. Insecticides
DeleriantsDeleriants These includes Dhatura, Bellodona,
Hyoscymus, Cannabis Indica, and Cocaine.
B. SpinalSpinal poisons are those which act on spinal cord, eg. Nux-Vomica
C. PeripheralPeripheral are those which acts on peripheral nerves, eg. Crurae
SOMNIFEROUS POISONS (OPIOIDS)
They are known as somniferous or narcotics because they i. Reduce pain ii. Induce sleep
Important poisons
i. OPIUM
ii. Heroin (Brown sugar) Synthetic derivatives of opium (Diaccetyl morphine)They are strong analgesic and narcotics but cause severe addiction.
Excitement
Narcosis
OPIUM AND MORPHINE
OPIUM (AFIM):- It is dried juice obtained by incision of unripe capsule of white popy (Papaver somniferum)
• There are two groups of alkaloids i. Phenanthrene ii. Isoquinoline
Phenathrene group
Isoquinoline group
(They are mild analgesic but no narcotic effect)
i. Morphine about 10%
ii. Codeine about 0.5%
iii. Thebaine about 0.3%
iv. Dionin
v. Heroin (Diaccetyl Morphine)
Papaverine about 1%
Narcotine about 6%
• Ripe and dry capsule of popy contain very little opium.
• Poppy seeds (khaskhas) are creamish in colour and contain no opium.
• They are used as food and oil for cooking.• The alkaloids of opium are used in medicine are
i. Morphineii. Codeine
iii. Apomorphine: It is used as emetics
They act as narcotics and sedatives
Diagnosis of morphine
• Marquis Test:– Conc Sulphuric acid 3ml– Formaline 3 drops– Suspected mixtureObserve color changeIt changes from black to purplish blue Result:+ve morphine
• Question: Question: How Is Heroin Used?How Is Heroin Used?• Answer: Answer: Heroin is usually• injected,• sniffed/snorted, or• smoked• InjectedInjected , a heroin abuser may inject up to four times a
day. • I/V injection: onset of euphoria (7 to 8 seconds),• I/M intramuscular injection : onset of euphoria (5 to 8
minutes).
Sniffed or smokedSniffed or smoked, peak effects are usually felt within 10 to 15 minutes.
• Smoking and sniffing heroin do not produce a "rush" as quickly or as intensely as intravenous injection, NIDA researchers have confirmed that all three forms of heroin administration are addictive.
A. STAGE OF EXCITEMENT: Absent if amount taken in large amount.
i. Sense of well beingii. Laughter, hallucination.iii. Increase in H.Rateiv. Convulsions in children may occur
B. STAGE OF STUPOR:-
C. The stage of excitement is followed by i. Headache, Giddiness, diminished sensibility.ii. Strong tendency to sleep awareness only by painful stimuli.iii. The pupils are contracted, lips cyanosediv. Pulse & respiration normal.
C. STAGE OF NACROSIS: i. Deep comaii. Muscle relaxediii. Pupils contracted & no reaction to light iv. BP is lowv. Skin is cold, profuse perspiration &
temperature is low less than 35oC
CAUSE OF DEATH
i. In fatal termination cyanosisii. Fine froth escape for month. iii. Breathing is sighning & irregular (2-4/m)iv. Coma deepens & death results from asphyxia
due to respiratory paralysis.
FATAL DOSE
Morphine 200 mg opium 2gm10 ml of tincture of opium.In children 1 – 3 drops of tincture of opium.
Morphino-mania / Morphinism
• Cause : regular use• Maladjusted personality.– Disphoria (away from reality)– Delusion of grandiosity– Disoriented– Porn personality– Sexually pervert– Disturbed interpersonal relationship.– Short tempered and lethargic
DIAGNOSITC POINT:i. Breath smells of opium
pointed pupils with no reaction to
light.i. Moist perspiring skinii. Low temp < 35oCiii. Cyanosis, froth at month & nose.
D / D:i. CVAii. Metabolic conditions
a. Uraemic comab. Keto accidosis, diabetic coma
iii. Alcohol poisoningiv. Organophosphorous compounds
Abstinence Syndrome
• Withdrawal Effects:• Onset 6 – 8 hours• S/s– Sweating, rhinorrhea, lacrimation.– Dilated pupil– Irritability, abdominal cramps, restless– Muscle cramps, weight loss.
TREATMENT: In early stages the patient should be kept awake by walk.
1. Emetics – ineffective – due to depression of vomiting centre.
2. Stomach wash a. with tepid water.
b. with KMNO4 : 1: 5000 strength till the washed water with original pink colourc. Some KMNO4 should left in stomach to oxidize alkaloids that is secreted in stomach after absorption.d. In the absence of KMNO4, wash stomach with
i. Tea or tannic acidii. Mixture of powder Charcoal & water.
IMPORTANT: Gastric lavage
should be done if the drug is taken by Hypo dermic or S / C injection as alkaloid is re-secreted into stomach after
absorption.
TREATMENT: SPECIFIC:
i.i. Nalorphine I/VNalorphine I/Vii. (Specific antidote to opium alkaloid &
morphine 5 – 10 mg I / V after every 15 minutes till pupil begin to dilate & responce become normal & pt is aroused Maximum dose 40 mg.
NaloxoneNaloxone (pure antagonist) 0.4 – 0.8mg I/m or I/V to be
repeated every 10 to 15 minutes Maximum dose 10 mg.
i. Antibiotic in case of prolonged coma.ii. Artificial respirationiii. Keep the body warm.iv. Symptomatic treatment
P/M APPEARANCE
i. Externalii. InternalExternal : i. Smell of opiumii. Face nail or bluish black. iii. P/M lavidity is black.iv. Froth at nose & mouth moderate in amount.
INTERNALLY:i. Stomach may contain lumps of opiumii. Trachea, bronchi are covered with froth &
lungs are oedematous. Blood is dark. Blood, bile & brain should also be preserved.
M / L ASPECTS: Mostly suicidal easily availability & painless.Homicidal rare due to bad smell and taste mostly use in infanticide .Accidental poisoning due to over dosage.
• SummerySummery• By the end of the lecture student should be
able to • Classify poison ( accord mode of action)• Neurotics action and• Classification • Heroin, ways of administration • Stages of addiction • Sign/ symptoms / post mortem findings• Treatment• complications
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