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Inorganic Irritants: Metallic Poisons 453

Fig. 36.5: Arsenic triodide Fig. 36.6: Copper arsenite

• It also inhibits transformation of thiamine into acetyl


CoA and Succinyl –CoA resulting in thiamine deficiency.
• It replaces the phosphorus in the bones
• Arsenic is incorporated into hair, nails and skin.
• It causes increased permeability of small blood vessels
with inflammation and necrosis of intestinal mucosa thus
causing manifestation of hemorrhagic gastroenteritis. Table 36.3: Showing difference between arsenic
poisoning and cholera
Clinical Features Features Arsenic poisoning Cholera
Pain in throat Before vomiting After vomiting
Acute poisoning Conjunctiva Inflamed Not inflamed
A patient with acute arsenic consumption may present in Vomitus Contains mucus, It is watery or
1. Fulminant type: collapse and circulatory failure bile and streaks of whey like
blood
2. Gastroenteritis type
Purging Follows vomiting Usually precedes
3. Narcotic form
vomiting
• Metallic taste
• Garlicky odour Stools Rice watery in Rice water
early stages, later liquid,
• Nausea and vomiting
becomes bloody, involuntary jet
• Colicky abdominal pain discharged with
• Profuse diarrhea resembling rice water stool of chol- straining and
era. Difference between arsenic poisoning and chol- tenesmus
era is summarized in Table 36.3 Laboratory 1. Radio-opaque Vibrio cholera
• Circulatory failure examination shadow on X-ray detected on
Toxicology

• Intense thirst of abdomen in microscopic


• Oliguria arsenic trioxide examination
• Uremia poisoning
• Ventricular tachycardia 2. Coproporphyrin
• Headache in urine B
• Vertigo 3. Arsenic
Section 

detected in
• Tremors
chemical analysis
• Convulsions