Irritants

(Metallic Poisons)

ARSENIC
Arsenic itself is not poisonous, only its compounds
are poisonous.
Arsenic Trioxide,
Arsenic Acid
Arsenic Sulphide
Arsine
Arsenic Trichloride are poisonous.
Arseniuretted hydrogen is a colorless gas with
GARLIC LIKE non irritating odor.
Direct poison to Hb producing hemolysis,
haemoglobinuria and RF.
Death is instantaneous.
Most common form of Arsenic used is Arsenic
trioxide known as white Arsenic, which is available in
crystalline powder & solid mass forms.

Mechanism of Action
Arsenic interferes with cellular respiration
by combining with SH groups of
mitochondrial enzymes.
Uncoupling
mitochondrial
oxidative
phosphorylation,
interferes
with
Glycolysis.
Target
is
VASCULAR
ENDOTHELIUM,
causing increased permeability, tissue
edema and hemorrhage Especially in the
INTESTINAL CANAL.
Local : Irritation of mucus membranes.
Delayed: Depression of CNS.

CLINICAL PICTURE
FULMINANT TYPE
Massive doses 3-5gms rapidly cause
death in 1-3 hrs from shock.
Capillaries are markedly dilated,
resulting in fall of blood pressure.
Direct action on heart muscle.
GASTROENTERIC TYPE
Resembles bacterial food poisoning.
Natural disease like Gastroenteritis.

CLINICAL PICTURE Gastro

enteric Type
GIT constriction in throat, burning
and colicky pain in esophagus,
stomach, bowel
Intense thirst & projectile vomiting.
Purging after vomiting, tenesmus ,
pain, irritation about anus.
Stools frequently & involuntarily,
dark colored, stinking & bloody, later
becomes colorless, odorless, watery
resembling rice water stools of
cholera.

Differential diagnosis of Acute Arsenic poisoning

1. Pain in

1.

throat
2. Purging
3. Vomitus
4. Stools

2.
3.
4.

5. Voice
6. Conjunctiv
a

5.
6.

Arsenic
poisoning
Present
before
vomiting
Follows vomiting
Consists of mucous
bile and blood
High
colored,
discharged
with
straining
and
tenesmus
Not affected
Inflamed

Cholera
1. Present
after
vomiting
2. Precedes
vomiting

3. Watery
4. Rice
water
and
involuntary
5. Peculiar
rough

and

6. Not inflamed

CLINICAL PICTURE
Loss of hair, skin eruptions.
Fatty liver, oliguria, uremia, pain
during micturition, urine contains
protein, RBC.
VT, VF.
CNS: Tremors, convulsions, coma,
paralysis, vertigo.
Narcotic form: Formication, tenderness
of muscles, delirium, coma, death.
FD: 0.1-0.2gms, FP:1-2 D.

Treatment
Stomach wash Stomach wash should be done
with freshly prepared solution of ferric oxide in
table spoonful doses suspended in water
1% sodium thiosulphate in water is helpful.
Butter & greasy substances prevent absorption.
British Anti Lewisite in decreasing doses for 7-10
days.
Oral Penicillamine 100 mg/kg body wt in four
divided doses is given in 24 hrs for 4-8 days after
initial 12-48 hrs of B.A.L. therapy
EDTA; DMSA, DMPS.
Demulcents, castor oil.
Glucose-saline with NaHCo3.
Hemodialysis/ Exchange transfusion.

PM APPEARANCES
Rigor mortis lasts longer
Dehydration

Shrunken
body,
sunken eye balls.
Stomach
lesions

Swollen,
edematous, congestion especially in
pyloric region.
Sub
mucosal,
sub
peritoneal
hemorrhages.
Inflammation is marked at Greater
Curvature, Post. part, Cardiac end of
stomach.

PM APPEARANCES
In Putrefaction Yellow streaks in sub
peritoneal layer of stomach & intestines
due to Arsenic sulphide.
Liver, Kidney, Spleen congestion,
enlarged, cloudy swelling, fatty change.
Lungs

Congestion,
Sub
Pleural
ecchymoses.
Kidney - Glomerular nephritis, ATN.
Brain edematous, patchy necrosis,
congested meninges.
Sub endocardial petechial hemorrhages
are common.

PM APPEARANCES

Sub
endocardial
petechial
hemorrhages are also seen in
Mercury, Phosphorus, Heat stroke,
Acute infections.
Death
due
to
acute
Arsenic
poisoning:
Arsenic in blood in
excess of 1 mg%.
X- rays shows Arsenic in GIT.

CHRONIC POISONING

Repeated small doses like in well water.

Stage I GIT Symptoms
Stage II Cutaneous Manifestations
RAIN
DROP
type
pigmentation
of
skin,
HYPERKERATOSIS of palms and soles
Bands of opacity in fingernails ALDRICH MEES
lines.
Cirrhosis of liver, chronic nephritis, cardiac
failure,
Stage III - Bone marrow suppression.
Stage IV - Neuropathy
CNS - Paresthesia,,
Teratogenic resulting in Lung & Skin cancer

PM APPEARANCES
Stomach

Gastritis,
patchy
inflammatory
redness,
patchy
hemorrhagic gastritis.
Small intestine Dilated, reddened,
thick mucosa.
Fatty liver, Jaundice,
Kidneys ATN,
Postmortem imbibitions of Arsenic:
From stomach into neighboring viscera,
contamination from surrounding earth.
Keratin tissues have good affinity to
Arsenic.

ORGANIC ARSENICAL
COMPOUNDS
NAA, FAAS useful for Arsenic estimations in
bones and keratin tissues.
Excreted mainly by kidneys, as methylated
arsenic.
Excreted in to stomach and intestines even
when given by other routes like iv/im(opium)
Arsenophagists Person taking Arsenic daily,
acquire tolerance up to 0.3gm., as an
aphrodisiac.
Chemical Tests for Arsenic Detection
A. Reinschs Test
B. Marshs Test
C. Gutzeit Test

POPULAR AS HOMICIDAL
POISON
Advantages:
Cheap, easy availability.
No color, smell, taste.
Small dose enough to cause death,
clinical
picture
is
similar
to
CHOLERA.
Disadvantages:
Can be found in putrefied bodies,
bones, keratin tissues for years.
Delays Putrefaction.