AGAD TANTRA, Dr. SATISH SHINDADKAR [web based ebook reader .txt] 📗

children death may be immediate.

            This chemical used mainly in car battery acid, certain detergents, some Fertilizers, leather industries etc.

            It is significant componant of air pollution & results in the production of ‘acid rain’.

            It is a colourless to slightly yellow liquid, soluble in water.

Signs & symptoms :

            Eye - Skin - nose-throat irritation, Broncthitis, conjunctivitis, emphysema, mouth ulcer, Eye-skin burns, Dermatitis, choking, cough (with or without blood), discoloured teeth, haematemesis, gastrointestinal burns, vision loss etc.

Route of exposure.

 Symptoms

 Treatment

Inhalation

Burning sensation, cough, breathing difficulties,  shortness of breath, soar throat

Fresh air rest, half upright position. artificial respiration if needed.

 Skin

Redness, serious skin

burns, pain, blisters

Remove contaminated

cloths, Rinse

skin with plenty of water

 Eyes

Redness, pain, severe

deep burns.

rinse with plenty of water, remove contact lenses if possible.

 Ingestion

Abdominal pain,

burning sensation,

shock.

Rinse mouth,

Do not induce

vomitting,  Demulscents

can be given orally.

If H2So4, was swallowed, immediately give water or milk.  If symptoms like vomitting, convulsions, or decreased alertness are present avoid water or milk.

            If the person breathed in air containing H2So4, immediately  move to fresh air.

P.M. appearances - [ In all types of corrosives]

            It depends on quantitiy, strength & time taken to die -

1)         In short time death -

            - Corrosion & destruction of upper GIT

            - Gastric perforation.

            - Peritonitis

            - May be destruction of abdominal & thorasic viscera.

2)         In late deaths

            -  Signs of repair

            -  Scarring.

            -  Healed trickle marks.

Specific in H2SO4

            All organs coming in contact with acid are black (carbonisation)

            Perforation of stomach.

Medicolegal aspects ( In all types of corrosives)

-           Rarely used for suicide, homicides abortifacients.

-           Accidental poisoning may occur in children & in laboratory.

-           They are commonly used for throwing on body i.e. vitriolage.

***

Hydrochloric acid (HCl)

Classification - Corrosive mineral acid poison.
Fatal dose – 15-20 ml.
Fatal period – 1 – 2 Days.

HCl is colourless to slightly yellowish gas, highly corrosive, has irritating odour.

            It is used in photographic, textile, food-processing, rubber industries etc.

Complication           -           discoloured teeth, burned skin,  cause permanant blindness & cataract, Infection at the site of burnt skin.  Ingestion may lead to oesophageal stricture.

P.M. appearances :

            Same as in corrosives except perforation of stomach is uncommon.

Medicolegal importance - Same as in corrosives.

Signs & symptoms :

            Exposure may occur by inhalation, ingestion or eye - skin contact.

 

  Route of exposure

 Symptoms

 Treatment

 Inhalation

bluish colour to lips & fingernails, chest tightness,Choking, coughing (with or without blood) shortness of breath, dizziness, low B.P., Rapid Pulse, weakness.

 same as H2So4

 Skin

 Burns, dermatitis, ulcers of the skin.

 same as H2So4

 Eye

 loss of vision.

 

Ingestion

Abdominal - chest - throat- mouth - severe pain, breathing difficulty, fever, Rapid drop in blood pressure, bloody vomiting.

 same as H2So4

Nitric Acide (HNo3)

Classification - Corrosive mineral acid poison.
Fatal dose – 10-15 ml.
Fatal period – 12-24 hrs. In children death may occur within few minutes.

It is commonly known as ‘red spirit of nitrate’, Aqua fortis.

It is colourless, liquid with choking smell.  It is a powerful oxidising agent & dissolves all metals except gold & platinum.

 Route of exposure

 Sympotms

 First aid

 Inhalation & eye

irritation of eyes,

lacrimation, photophobia, burning sensation in throat,  cough, dyspnoea.

Fresh air rest, Half upright position.  Artificial respiration         if needed

  Skin

 Lips, tongue, teeth & skin are white initially & later yellow due to xanthoproteic reaction.

 Remove contaminated cloths Rinse skin with plenty of water

Ingestion

Abdominal distention,

vomitting, oliguria,

albuminuria

  Rinse mouth,  Do not induce vomitting, give  plenty of water to drink.  Also demulscents can be given orally.

P. M. appearances :

            Same as in all corrosives.

            Except perforation of the stomach is less common.

            All tissues which come in contact with the acid are yellow.

Medicolegal importance -

            Same as in corrosives.

***

Hydrocyanic acid (HCN)

Classification - Corrosive vegetable acid poison.

Fatal dose - 60 mg of HCN, 200 mg of KCN

Fatal period -

Death is immediate.

Sometimes may be delayed by 2-10 min.

Other cyanides e.g. Potassium cyanide (KCN) also have same action like HCN.  HCN is present in some fruits like plum,peach, bitter almonds.

            Cyanides are also used in chemical laboratories, gold plating, fertilizer industry for fumigation of ships etc.

Mechanism of action : Cyanides act as protoplasmic poison by inhibiting the enzyme cytochrome oxidase, thus reducing oxygen utilisation in the cells resulting in cytotoxic hypoxia.       

            Since the tissue respiration stops, death is immediate.

            Death is by bulbar paralysis.

Signs & Symptoms :

            Poisoning results on ingestion, inhalation & absorption through abraded skin.  With large doses, sudden death can occur.

            With low doses, giddiness, nausea, headache, confusion, dysponea, cynosis, fine froath at nose and mouth, convulsions and dilated pupils.

            Sometimes clenched teeth is seen. Breath smells as bitter almonds.

            Inhalation of HCN vapours results in feeling of constriction in chest & throat, dizziness, vertigo, insensibility & death.

Treatment :

            Treatment has to be immediate.  In low dose consumption - emetics & gastric lavage should be given.  After that symptomatic treatment should be given.  Sodium thiosulphate given i.v. combines with cyanides to form sodium thiocynate which can be excreted by kidney.

-           Nitrites to convert Hb to methemoglobine.

-           In case of inhalation - artificial respiration & symptomatic treatment should be given.

P.M. appearance :

Cyanosis, Froath at nose & mouth, Slight corrosion, Pink post mortem lividity, features of asphyxia, Smell of bitter almonds from stomach contents & body tissue

Medicolegal importance :

Commonly used for suicide, Rarely used for homicide & as cattle poison.  Accidental poisoning is common in laboratories. Usually terrorists keep cyanide Capsules & cummit suicide when caught.

***

Oxalic acid ( C2H2O4)

Classification - Corrosive organic acid poison

Fatal dose - 15-20 gms.

Fatal period - 1-2 hrs.

            They are white, shining crystals with burning sour taste.

Mech. of action :

            -           Corrosive action.

            -           Utilization of serum calcium to form calcium oxalate.

Signs and symptoms :

            With large doses sudden death can result (Narcotic effect)

            -           Sour taste, burning pain in upper GIT & vomitting (coffee coloured), diarrhoea, pain at anus.

            -           Tingling & numbness, twitchings of face & extremities, generalised convulsions, finally collapse.

            Acute renal failure may occur.  Oxaluria Characterised by oliguria, albuminuria, haematuria & presence of calcium oxalate crystals in urine.

              Prolonged contact of oxalic acid with skin may produce cyanosis & even gangrene.

Treatment -

Gastric lavage with lime water, warm water should not be used. Calcium salts can be used as alkali ( as an antidote) 

Parathyroid extract 100 units I.M. is useful.

            Symptomatic treatment.

P.M. appearances -

-           Severity of corrosive action depends upon concentration of oxalic acid ingested.

-           No staining of viscera.

-           The stomach is congested, softened & contains brown material.

-           Stomach & all other viscera show cloudy areas due to deposition of calcium oxalate.

-           All internal viscera are congested.

-           Renal tabules are loaded with Calcium oxalate crystals.

Medicolegal importance :  Poisoning is rare

***

Carbolic acid  (C6H5OH.)

Classification - Corrosive organic acid poison.

Fatal dose - 10-15 gm. or 30 ml of pure acid.

Fatal period - 3-4 hrs.

            It is also called as phenol, phenic acid & phenyl alcohol.  It is an organic compound & white crystaline solid at room temperature.

Mechanism of action :

-           Corrosion, necrosis & Gangrene of the local area.

-           Action on CNS & Kidney.

Signs & Symptoms :

            Phenol & its vapours are corrosive to the eye, skin & respiratory tract.  Repeated or prolonged skin contact with phenol may cause dermatitis, or even 2nd & 3rd degree burns.  Inhalation of phenol vapours may cause lung oedema.           It may cause harmful effects on CNS & heart resulting dysrhythmia, seizures, & coma.  Long term or repeated exposure may have harmful effects on liver & kidney.

Treatment :

            Induction of vomitting,        Gastric lavage with castor oil in water,

            Demulscents, Rest symptomatic treatment.

Antidote :      magnesium oxide (MgO),

magnesium sulphate ( MgSO4)

P.M. appearances :

-           There is greyish white staining of viscera.

-           Mucous membrane of upper GIT is congested & detached.

-           Appearance of stomach is known as leather bottle appearance.

-           There is strong characteristic phenolic smell.

-           Other internal viscera are congested.

Medicolegal importance -

-           Commonly used for suicide.

-           Used for homicide by mixing with alcohol

-           It is used as abortifacient.

-           Accidental poisoning is common.

-           Viscera should be preserved in saturated salt solution.

***

Formic acid ( HCOOH)

Classification - Corrosive acid poison.

Fatal dose - approx 30 gm.

Fatal period - uncertain.

It is also called methanoic acid, carboxylic acid.  It occurs naturally in venom of bee & ant stings.  Its major use is as preservative.

Signs & symptoms :

  Route of exposure

 Symptoms

 Treatment.

  Inhalation

 Burning sensation, cough, Laboured breathing, Shortness of breath, sore throat, unconciousness.

 Fresh air rest, half upright position. Artificial respiration & oxygenation if required

Skin

 Serious skin burns pain, blisters, nercrosis may occur

Remove contaminated

cloths.  Rinse skin

with plenty of water

Treatment of burns.

 Eyes

Redness, pain, blurrred vision, severe deep burns

 Rinse with plenthy of water remove contact lenses if possible.

  Ingestion

Abdominal cramps, burning sensation, vomitting, diarrhoea, soar throat, ulceration, haemmorrhage, perforation metabolic acidosis & haemolysis.

 Do not induce vomitting.  Rinse mouth.  Gastric lavage is contra indicated.  Demulscents should be used.

Chronic exposure

 Kidney damage, skin allergy

 

Alkalies

These alkalies act as corrosives when concentrated & as irritant when dilute.   These are soluble in water, ethanol & methanol, Absorb Co2 and moisture from air.  They are used in many industries.

Classification :  Corrosive alkali poison

 

Alkalies

 Fatal dose

 Ammonium hydroxide (NH4OH)

 30 gm

 Potassium hydroxide (KOH)

 5 gm

 Sodium hydroxide (NaOH)

 5 gm

 Ammonium carbonate [(NH4)2 CO3]

 30 gm

 Potassium carbonate K2CO3

 15 gm

 Sodium Carbonate Na2CO3

 30 gm

 Fatal period

 about 4 hrs

Mechanism of action : Absorption of water.

            Formation of soaps & proteinates with fats & proteins.  So they dissolve proteins & saponify fats - cause liqifaction necrosis & so deeper chemical burns.

Route of exposure

 Symptoms

 Treatment

Inhalation

 Burning Section, Cough, Difficulty in breathing, Shortness of breath, Sore throat, Symptoms may be delayed, Redness, Severe skin burns, Pain and blisters

 

Fresh air rest,

Half upright position,

Artificial respiration.

 Skin and Eyes

 Redness, Pain, blurred vision, severe deep burns

 Remove contaminated cloths, rinse with plenty of water, remove contact lenses if possible

 Ingestion

 Burning pain, soapy feel and taste, Nausea, vomiting, Tongue and lip becomes dark brown & abraded, Dysphagia, oliguria, Alkaline urine.

 

Dilution with water, Demulcents,

Do not induce vomiting

P.M. appearances -

            Mucous membranes & viscera - swollen & slimy stomach - congested & may be brown or black, stomach containts are coffee coloured due to alkalie hematin - perforation of stomach is not common.

Medicolegal importance -

Poisoning is uncommon.

Rarely suicidal

Sometimes accidental - usually in laboratory used for vitriolage.

 

6) क्षोभक विष  (Irritants)

Phosphorous

Classification -Irritant inorganic non-metal poison

स्थावर खनिज विष
Fatal dose - 100 to 150 mg.
Fatal period - Variable

There are 2 forms.

1)         White or yellow         -           highly poisonous.

2)         Red or violet  -           non-poisonous.

Mechanism of action :

In acute poisoning :

Liver damage results in carbohydrate and fat metabolism disturbance.

In chronic poisoning : There is excessive bone formation at the epiphyseal end leading to necrosis and sequestration.

Signs and symptons :

1)         Acute Poisoning.

            There are 4 stages.

Stage I.           First latent period of 1-6 hrs.

Stage II.          GIT and CNS menifestations, garliky smell and taste, burning sensation in upper GIT, dehydration, Headache, insomnia, deafness, impared vision, tremors, convulsions, paralysis and coma.

Stage III.         Second latent period of 2-3 days.

Stage IV         Liver failure and CNS menifestations.

2)         Chronic Poisoning :

            It is normaly due to exposure of fumes in people working in industry where phosphorus is used.

            Weakness, pain in abdomen, jaundice, bronchitis, joint pain, tooth ache, Phossy jaw Can be seen.

Treatment :

Acute Poisoning -

-           Demulscents are contraindicated

-           Gastric lavage

-           Glucose and i.v. fluids

-           Vit K., B- complex and C

Antidote         -           0.1 %  CuS04 solution.

                                    0.1 % KMnO4 solution.

Chronic poisoning.

            -           Preventive measures should be advised

            -           symptomatic treatment.

P.M. findings :

In short time deaths -

            Skin is yellow and shows subcutaneous haemmorrhages, inflammations, errosion and perforation of upper GIT.

            Stomach contents are luminous and garliky degeneration in liver and kidney.  Entarged liver.

In delayed deaths :

            Jaundice, bleeding from orifices and internal organs, dehydration, liver degeneration, liver is small, leathery and yellow.

Medicolegal importance :

            - It is used for suicide, homicide and in criminal abortion.

***

Iodine

Classification - Irritant inorganic non-metal poison. स्थावर खनिज विष

Fatal dose - approx 2 gms.

Fatal period - 24 hrs. Immidiate death in case of anaphylaxis.

It is solid, bluish-black crystals emitting violet vapours.

Mechanism of action :

            Irritation. It precipitates proteins.

Signs and Symptoms :

Acute poisoning -

There  may be sudden death due to anaphylaxis in sensative people.

-           Burning pain in upper GIT.

-           Vomitting sometimes diarrhoea.

-           Uraemia

-           Shock.

Chronic poisoning (IODISM)

            It results due to excessive consumption of drugs containing iodine.

            Headache, running nose, conjuntivitis, bronchorrhoea, salivation, parotitis, nausea, vomitting, diarrhoea, myxoedema, wasting of testes, erythematous patches and ulcers on the skin.

Treatment -  Use of emetics, Gastric lavage.

            antidote - Starch solution