Rishikul State P.G.

Ayurvedic college & Hosiptal

Haridwar (Uttarakhand) DEPARTMENT OF TOXICOLOGY AND MEDICAL JURISPRUDENCE

Topic: -

Carbolic acid, Strimulunts, Hallucinogcns LSD Sedatives and Hypnotics Barbiturutes

Submitted By Kavita Rana B.A.M.S (2nd Batch - 2010

Submitted to-: Dr. Ravi Srivasthav Dr. Ramesh Tewari )prof Dr. Manoj Adlakha Dr. Aswni Kumar

Phenol C6H5OH

 Carbolic acid is hydroxybenzene obtained from coal tar oil by synthesis. It consists of colorless, prismatic needle like crystals which on standing becomes pinkish with a peculiar phenolic odour. Even though it does not turn blue litmus red and has no acid reaction, it is called an acid because it forms carbolates (Salts) when acted upon by strong bases.

 Fatal dose Fatal period

hours

20 drops or 30 grains. : Average : 3-4 3 60

Minimum minutes Maximum

hours

 Carbolic acid poisoning is known as carbolism. It has following two actions (a) Local Action (on skin and alimentary tract) (b) Remote Action (after absorption)

1.

2.

Carbolic acid produces burning sensation, tingling and numbness when applied over the skin. When swallowed it produces hot burning pain extending from mouth to the stomach, followed by tingling sensation and anaesthesia. Swallowing and speech are painful and difficult. The lips, mouth and tongue are corroded. Occasional vomiting of frothy mucus with a strong smell of carbolic acid may be present.

1. 2. 3. 4. 5. 6.

Cold, clammy and pale skin. Weak and thready pulse. Contracted and pinpoint pupils. Strong smell of carbolic acid from breath. Supression of urine or oliguria. Carboluria- When exposed to air, the metabolic products of carbolic acid(i.e. hydroquinone and pyrocatechol) are oxidised resulting in dark smoky green colour of the urine. This symptom is known as carboluria which serves as the warning of the toxic properties of the carbolic acid.

Death result from paralysis of respiratory or cardiac centre.

Treatment
1. 2. 3. 4. 5. 6. 7. Gastric lavage with lukewarm water containing animal charcoal, olive oil, magnesium or sodium sulphate or 10% glycerine in water till the returning fluid loses phenolic odour. Liquid paraffin, olive oil, vegetable oil may be left in the stomach after washing. Demulcents like white of egg or milk may be given. Intravenous saline with sodium bicarbonate should be administered to render the urine alkaline. Oxygen inhalation and artificial respiration, if needed. Castor oil or olive oil is applied preferably in the form of spray to the burns (caused by carbolic acid after washing with 10% ethyl alcohol, soap solution and water. Rest of the treatment is symptomatic.

 It is a popular suicidal agent due to its easy availability as it is commonly used as antiseptic, disinfectant and surface anaesthetic etc. It is rarely used for homicide due to its detectable odour and taste. It may be used to procure abortion. Accidental poisoning may occur

 Dark brown excoriations may be seen on the angles of the mouth and chin. Ash grey patches of corrosion are seen on the lips and mouth. The mucous membrane of the stomach and duodenum are brown, leathery with sub mucosal haemorrhagic spots and prominent rugae. Smell of carbolic acid is perceptible on opening the stomach. Kidneys are enlarged, highly congested and show signs of acute haemorrhagic nephritis. Lungs are congested and oedematous. Brain is congested. The blood is dark, semifluid and partially coagulated.

 Introduction
Antihistamines drugs are used in allergic disorders, cold & parkinsons disease etc. They antagonise the action of histamine. They also have anticholinergic, antiadrenaline and anti-serotonin effects.

 Death in antihistaminic poisoning occurs from respiratory failure.

 Initial depression followed by excitation of the central nervous system. Dryness of mouth Nausea Vomiting Headache Blurred vision Urinary retention Fixed dilated pupils Disorientation Ataxia Hallucinations Stupor Coma

Fatal Dose Fatal period

: :

1 Gram 3 to 18 hours

 Stomach wash with warm water and sodium bicarbonate. Diazwpam for convulsions 0.2-0.5 mg/kg body weight I.V slowly followed by repeated doses as required. (maximum dose of 100 mg/day) Oxygen inhalation and artificial respiration, if required. Rest of the treatment is symptomatic.

1. Postmortem Appearances same as of asphyxia. 2. Medicolegal aspects Poisoning is mostly accidental from overdosage.

 Introduction
Cocaine is an alkaloid deliriant derived from the dried leaves of the plant Erythroxylum coca. It is odourless, colourless, crystalline substance with bitter taste and slightly soluble in water but freely soluble in alcohol. It is often available with pan sellers.

 Smoking Chewing Snorting (application to nasal mucous membrane) Intravenous Injectio

 (a) INTERNAL : It first acts as a stimulant and then depresses the central nervous system. LOCAL : It blanches mucous membranes, dilates the pupil and paralyses the sensory nerve terminals.

 Local Tingling sensation and feeling of numbness at the site of application. Face Flushed Skin Pallor GIT Dysphagia Nausea Vomiting Bitter taste Dryness of mouth & throat CNS Sense of happiness & well being excitement

CVS RS

Ocular Temperature General

Restlessness Talkativeness Hallucinations Tremors Convulsions Coma Tachycardia Myocardial ischaemia Dyspnoea Cyanosis Pupils dilated Sudden rise with a rigor Increased libido (sexual desire)

 After an hour, stage of excitement is followed by stage of depression which in characterised by profuse sweating, feeble respiration and collapse, ending in death from respiratory or cardiac failure. Fatal dose : 1 gm orally Fatal period : About 2 hours

 If swallowed, stomach wash should be done with potassium permanganate or tannic acid solution. If injected, torniquet should be applied above the part of injection to delay its absorption. If applied locally to nose etc., it should be washed out with normal saline or lukewarm water. Excitement should be controlled by diazepam. Oxygen inhalation and artificial respiration, if required. Amyl Nitrite, an antidote is given by inhalation. Rest of the treatment in symptomatic.

 Brain, spinal cord & other internal organs are congested. General asphyxial signs (Cyanosis, frothing at the mouth and nostrils etc.) Pupils are found dilated. Cardiac dilatation.

1. Cocaine is common drug of addiction in young individuals. 2. Its is rarely used for homicide or suicide. 3. Accidental cases may occur from urethral, vesical and rectal injection. 4. It is believed to increase the duration of sexual act by depressing the sensory nerves of glans penis. 5. It is rapidly detoxified by the liver and thus it is difficult to detect it in the viscera.

 Hallucinogens are the drugs which produce abnormal effects on the mind such as distortion of time. Space, sound, colour and other sensations. They are also known as psychedelics.

 Introduction LSD is the most ptent and widely used hallucinogenic drug having marellous effect even in minute doses. It is synthesized from rye ergot. It is generally taken by youngsters in a spirit of adventure to enter a world of fantasy or to escape from the realities of life.

 It acts mainly on the central nervous system and interferes with the filtering mechanisms of the mind resulting in altered perception, thinking and mood.

Emotional swings Hallucinations Suspiciousness Bizarre behavior Synaesthesia Nausea and vomiting Widely dilated pupils Insomnia Tremors Vertigo Headache

Psychotic reactions Sudden recurrences (flash backs ) of the adverse effect especially bad trips. Permanent damage to brain cells. Fatal dose : Uncertain Fatal period : not known

Limit stimulation Tranquilizers or barbiturates Psychotherapy Symptomatic measures

1. It is habit forming and produces psychological dependency. 2. Panic attacks, depression and paranoid reactions have been seen. 3. Suicide, homicide and accidental deaths by misadventure are common.

 Sedatives are drugs that sudue excitement and produce a calming effect on the central nervous system while hypnotics are the drugs which induce and maintain sleep.

Introduction:
Barbiturates are commonly used as sedatives, hypnotics, anaesthetics, anticonvulsants and tranquilizer etc. They occur as white, crystalline, odourless powder and are bitter in taste.

 Barbiturates are classified into following four groups depending upon their duration of action: 1. Long Action (Duration 8 to 16 hours) Phenobarbitone (Luminal) Sodium barbitone (veronal) Diallybarbituric acid (Dial) Sodium pento barbitone (Soluble Luminal) 2. Intermediate (Duration 4 to 6 hours) Butobarbitone (Soneryl) Soium pentobarbitone (Nembutal) Amylobarbitone (Amytal)

3. Short acting (Duration 3 to 6 hours0 Hexabarbitone Sodium quinal barbitone (Soneryl) Secobarbital (Seconal) Cyclobarbitone (Phanodorm) 4. Ultra short acting (for duration of anaesthesia) Brevital (Methohexobarbitone) Pentothal (Thiopentone sodium)

 Barbiturates are hypnotic and depress the central nervous system. The effect of barbiturates varies from mere tranquillity to coma depending upon the dose. Death may be due to respiratory failure or ventricular fibrillation in early stages and bronchopneumonia or pulmonary oedema in later stages.

 Central Nervous
System

Headache
confusion Disorientation Excitement Delirum Hallucinations Ataxia Loss of reflexes Pupils constricted but reacting to light. Stupor progressing to coma

 Cardio-vascular System

.Renal . Others skin

Hypotension Bradycardia Cyanosis Low Cardiac output Scanty and dark uirne Urine incontinence Blisters are found on the Hypothermia Loss of muscle tone

 Fatal dose average

Barbiturates 1. Long acting per 100 ml 2. Medium acting 100 ml 3. Short acting 100 ml

1-4 gms
Lethal blood level 10 mg

Fatal dose 3-4 gms

2-3 gms
1-2 gms

7 mg per
3 mg per

* Fatal period

1-2 day

. Patient remains in coma for 24-48 hours before death which may even last for several days.

1. Stomach wash with warm water using potassium permanganate and animal charcoal. 2. Solution of magnesium sulphate should be left in the stomach for purgation and to minimise intestinal absorption. 3. Body warmth should be maintained. 4. Mechanical ventilation with O2 (artificial respiration)should be given. 5. 2.5 mg of metaraminol (Aramine ) I.V. to combat shock. 6. Diuresis : I.V. Sodium bicabonate. (2-3 ampoules) in one litre of 5% dextrose at the rate of 30 ml/kg/hr. 7. Dialysis and exchange transfusion, if needed. 8. Antibiotics and symptomatic treatment

1. External -

Asphyxial findings Cyanosis Barbiturate blisters Froth in mouth & nostrils Congested face

 Mucosa of alimentary canal is congested. Kidneys show degenerative changes in convoluted tubules. Lungs are congested and oedematous. Subendocardial hemorrhages may be seen in heart. White particles may be seen in stomach with eroded gastric mucosa. Other organs are also found congested.

 Mostly deaths from barbiturates are either suicidal or accidental. Homicidal death from barbiturates is rare. Addiction may occur due to excessive use of barbiturates.