Inorganic Irritants: Metallic Poisons 455

Differential Diagnosis 4. Muscle

5. Skin
1. Acute poisoning resembles cholera
6. Nails.
2. Alcoholic neuritis
3. Guillain-Barre syndrome.
Medicolegal Importance
10,11
Management 1. Homicidal poison – in past it is considered as ideal homi-
cidal poison. The arsenic is administered in chronic way
Acute poisoning
to a person and the clinical features is manifested for
• Gastric lavage
natural disease
• Administer activated charcoal
2. Used as cattle poison13
• Aggressive fluid resuscitation and cardiovascular support
3. Accidental poisoning: due to
remains the mainstay of initial management.
• Used in indigenous medicine – chronic poisoning
• Chelation – BAL, Succimer (DMSA), or DMPS. Every
• Well water (tube well water) 7
50 mg BAL binds 30 mg of arsenic.
• Adulteration with alcohol drink
• Exchange transfusion
• Mistaken for medicine
• Continuous venovenous hemodiafiltration.
• Arsenophagist – some people take arsenic daily as an
aphrodisiac and are habituated for arsenic.
Disadvantage of BAL
• Have to give as an intramuscular injection Mercury
• Unpredictable bioavailability.
Synonyms: Quick silver. Para
BAL is Contraindicated in:
Features
Patients with glucose-6-phosphate dehydrogenase deficiency
because BAL may cause hemolysis. • Only metal, which is liquid at room temperature
• Metallic mercury is having bright silvery luster and is
Chemical Test for Arsenic Detection volatile at room temperature. The fumes are odourless
and invisible (Fig. 36.7).
1. Reinsch’s test
• It is 13.5 denser than water
2. Marsh’s test
• Metallic mercury is not poisonous if taken by mouth, as
3. Gutzeit test.
it is not absorbed. However, if vapours are inhaled, may
Fatal dose: Arsenious oxide – 180 mg
exert toxic effects.
Fatal period: 12 to 48 hours.
• Mercury exists in three forms:14
1. Elemental mercury – Hgo – vapours are toxic
Autopsy Findings
2. Inorganic mercury
• Rigor mortis last for longer duration 3. Organic mercury.
• Jaundice • Inorganic salts are of two types as:
• GIT – mucosa is congested and edematous. The mucosa 4. Mercuric (bivalent Hg++) – more poisonous
may be reddened or show hemorrhagic gastroenteritis. 5. Mercurous (monovalent Hg+) – less poisonous.
The focal hemorrhages give rise to flea bitten appear-
ance and this appearance is considered as characteristic. Toxic Compounds
The mucosal appearance is described as red velvet like12
Toxicology

• Subendocardial hemorrhages in heart with fatty degen- Inorganic compounds are mentioned in Table 36.6.
eration
• Liver – fatty degeneration. Organic Compounds

B
Organic compounds of mercury are more toxic than inor-
Preserved for Chemical Analysis ganic compounds and are:
Section 

1. Routine viscera 1. Ethyl mercury

2. Long bone – femur 2. Methyl mercury
3. Scalp hairs 3. Mercurochrome.