Toxicology

General Toxicology

Deals with general aspects of poisons

Toxicology

Branch of medical science which deals with scientific

study of poison with reference to their sources, their

properties, signs & symptoms produced , fatal dose,

fatal period , treatment, post mortem appearance,

quantitative and qualitative analysis of the poison

Toxicology

It is not a branch of Forensic Medicine

But due to legal implications (can be used to

commit suicides / homicidal purposes) it is
included in forensic medicine

Toxicology may not be medical only , it may be

plant toxicology, geological toxicology etc.
FATAL DOSE

It is the amount of poison which is sufficient to kill a

normal, healthy adult person

FATAL PERIOD

It is the time interval between intake of poison and

occurrence of death
BRANCHES OF TOXICOLOGY
1. General Toxicology: Deals with general aspects
of poisons

2. Special Toxicology: Deals with individual poisons

3. Analytical Toxicology: Deals with analysis of

poisons . Analysis may be
quantitative or qualitative analysis

1. Environmental Toxicology: Deals with poisons present in an

environment
1 General Toxicology: Deals with general aspects of poisons

2 Special Toxicology Deals with individual poisons

3 Analytical Toxicology Deals with analysis of poisons . Analysis may be

quantitative or qualitative analysis

4 Environmental Toxicology: Deals with poisons present in an environment

5. Industrial Toxicology: Deals with poisons e.g. asbestos,
silicose poisons

6. Agriculture Toxicology: Deals with poisons used in

agriculture e.g. insecticides,
herbicides or pesticide eg. DDT,
organophosphorus compounds etc.
8. Occupational Toxicology: Deals with poisons to which a person is
exposed during working in an environment
as a person working in factory related with
asbestose may have disease called
asbestosis

8. Vehicular Toxicology: Deals with poisons present in

vehicular exhaust

9. Forensic Toxicology : Deals with legal aspects of

toxicology

10. Non Medical Toxicology: e.g. geological toxicology, plant

toxicology
Quantitative Analysis
Means level of poison in urine, blood and various
organs

Qualitative Analysis
Means name of the poison which is used
Toxicology

POISON

Any substance having harmful effect on the body is

called poison

OR

Any substance capable of acting in harmful manner

on body is called poison
 Toxicology

Difference between Medicine and Poison

Medicine Poison
1 Used for cure of a disease Used to harm a person or
or prevention of a disease To cause injury to a person
2 Therapeutic dose is taken Toxic or lethal dose is taken
or given
3 Legal differences is intention with which a
substance is taken or given to someone
Classification of Poisons

1. Symptomatic classification

2. Ancient classification

3. Historical classification
Symptomatic Classification of Poisons
1. Corrosive Poisons:
Are poisons which when come in contact with
tissues cause extensive inflammation, deep
ulceration and bleeding.

2. Irritant Poisons:
Are substances which when come in contact with
the tissues cause slight inflammation, shallow
ulceration and may cause slight bleeding.
Differences

Corrosive Irritant

More ulceration Less ulceration

More bleeding Less bleeding

More inflammation Less inflammation

3. Neurotic Poisons:
Poisons acting on nervous systems

4. Cardiac Poisons:
Poisons acting on heart

5. Asphyxiant Poisons:
Causing asphyxia, disturbance of normal process
of respiration

6. Miscellaneous Poisons
1. Corrosives These are Strong acids and strong alkalis
i. Mineral acids H2SO4, HCl, HNO3 e.g.
ii. Organic acids e.g. oxalic acid, acetic acid, carbolic acid and
salicylic acid
iii. Vegetable acids e.g. Hydrocyanic acid
iv. Conc. Solution of Alkalies e.g. caustic soda (NaOH), caustic
potash (KoH), ammonia, Carbonate of Na & K i.e.
Sodium Carbonate &
Potassium carbonate
2. Irritant
i. Inorganic irritants e.g. metallic & non metallic
irritants
ii. Organic irritants vegetable and animal poisons
iii. Mechanical irritants e.g. powdered glass, dried
sponge
Metallic irritants e.g. arsenic, antimony, mercury,
lead, copper, manganese, barium etc.
Non Metallic irritants e.g. phosphorus, chlorine,
bromine, iodine
Organic irritants:
Vegetable irritants e.g. caster oil seeds, croton oil
seeds, abrus precatorus, ergot, capsicum, marking
nut, madar

Animal irritants e.g. snake bite, scorpion bite and

insects bite
3. Neurotics
a. Cerebral neurotics
b. Spinal neurotics
c. Peripheral neurotics

Cerebral neurotics:
i. Somniferous e.g. opium alkaloids like morphine,
heroin (diacetyl morphine)
ii. Inebriant e.g. Alcohol, anaesthetics, hypnotics
iii. Deleriants e.g. Dhatura, Blladona, Hyoscyamus,
Canabis indica (bhung, charus, gunja, mari juana,
hashish)
Spinal cord Poisons
e.g.(1) Nux vomica which stimulates the
spinal cord
(2) Gelsimium which depresses the spinal
cord

Peripheral neurotics
e.g. Curare, conium (poison given to Sucrat)
4. Cardiac Poisons

Degitalis, Oleander, Aconite, Tobacco

5. Asphyxiant Poisons

Coal gas, CO, CO2, sewer gas, war gas

6. Miscellaneous Poisons

a. Analgesics

b. Abortificiant

c. Anti histamines

d. Other drugs
Poison

LD 50
Is a dose that represents the concentration of
contents required to produce death in 50% of animals
that are exposed to it

ED 50
Is a dose of substance that is therapeutically effective
in 50% of subjects receiving it

Therapeutic Index:
It is LD50/ED50
Toxicity Rating
1. Nontoxic: Dose more than 15gm/kg body wt
2. Slightly Toxic: Dose more than 5 15gm/kg body wt
3. Moderately Toxic: Dose more than 500mg 5gm/kg
body wt
4. Very Toxic: Dose more than 50mg 500mgkg body
wt (one tea spoon full to 1 ounce)
5. Extremely Toxic: Dose more than 5 50 mg/kg body
wt (7 drops to one tea spoon full)
6. Super Toxic: Dose less than 5 mg/kg body wt (less
than 7 drops)
Ancient Classification of Poisons

1. Human Poisons

2. Animal Poisons
Human Poisons
Homicidal poisons e.g. Arsenic
Suicidal poisons e.g. Tranquilizers, Hypnotics
Accidental poisons e.g. administrated without any
intentions e.g. Kerosene oil is taken instead of water
Stupefying poisons e.g. Dhatura poison, it is also
called road poison
Used to cause dullness of the senses
Persons behave like a tamed animal
Exhibitional poisons e.g.
Poisons are taken to express the interior feelings

without any fear of death, may be used to

blackmail a person as large dose of poison is

required to kill a person e.g. CuSO4 & Diazepam

Homicidal Poison

Are commonly used to kill another person e.g.

Arsenic is an ideal homicidal poison as signs /
symptoms of poisoning resemble cholera.

Aconite , Thallium, Organo phosphorus, Insulin

etc.may be used to kill others
Human Poisons

Suicidal Poison

Potassium cyanide, Hydrocyanic acid, Opium, Barbiturates,

Insecticides, Tranquilizers, Coal gas ( in European countries )

may be used to commit suicide.

Accidental Poisons
It includes snake bite, scorpion bite, Kerosine oil etc.

Stupefying Poison
Causes dullness of senses
Victum offers no resistance
Examples are Dhatura , Canabis indica.
Exhibitional Poisons

Copper sulphate, Diazepam etc are used as large

dose is required to cause death , so are safe

Toxicology
Animal Poisons
Accidental Poison
Accidental poison: mixed accidentally in foder e.g.
madar
a. Without intention to kill
b. With intention to kill
Abrus precatorus, arsenic, yellow oleander, aconite,
nux vomica, parathion (organo phosphorus compounds)
etc to cause financial damage to enemies, as for
cultivation animals were used (oldest profession was
cultivation)
Toxicology

Occupational Classification:
1. Agricultural poisons e.g. insecticides, pesticides,
DDT, organo phosphorus compounds, parathion

2. Industrial poisons e.g. CCL4, Aniline, Methane,

Hydrocarbons, Silica, Asbestos

3. House hold poisons e.g. cosmetics,

detergents, soaps, sui gas, shoe polish etc.
Toxicology

Routs of Administration of Poisons:

1. Skin: Intact skin e.g. organophosphorus compounds
Broken skin e.g. wounds & injuries

2. Oral: Most commonly used route is ingestion

3. Inhalation: e.g. sewer gas, coal gas, CO, sui gas

4. Injections: Subcutaneous I/D, I/M, I/V, I/thecal

I/peritoneal, I/articular etc.

5. Natural orifices: Nose, ears, anus, vagina, urethra

Most Rapid Actions of Poison:

Inhalation is the fastest route of entry into the

body and then is intravenous route

Routes of Elimination of Poisons:
1. Urine Most common route is urine
2. Faeces
3. Respiration e.g. alcohol is present in expired air
4. Saliva
5. Milk
6. Bile
7. Sweat / perspiration
8. Mucous and serous secretions of body
Toxicology

Actions of Poisons:
1. a) Local:
Poisons comes in contact with tissues e.g. H2SO4
deep ulceration, bleeding and inflammation

1. b) General:
Actions occurs when the poisons are absorbed
Toxicology

2. a) Immediate Action:
Occurs immediately e.g. burning sensation in
phosphorus poisoning.

2. b) delayed action:
Occurs after some time i.e. half hour to fifteen
minutes for example in phosphorus poisoning
Toxicology

3. a) specific actions:
Where a specific organ or a specific system is
involved e.g. Arsanic affects the liver (Hepato toxic)
Hg= Para mainly affects kidney (Nephrotoxic)
CO specifically affects brain
3. b) Non specific actions:
Neuro genic shock after intake of H2SO4 (Due
severe pain)
 Toxicology

Factors affecting the action of poison

1) DOSE
It is the amount of substance taken at a time. It may be poison or drug
Therapeutic dose: Amount of drug taken at a time for treatment and
prevention of a disease
Toxic dose: Dose which produces signs and symptoms of toxicity is
called toxic dose. It will be greater than therapeutic dose
Toxicology

Lethal dose:
Minimum amount of a drug which is sufficient to
kill a healthy person.
LD 50 = Average fatal dose
Dose required to kill 50% of experimental animals

Minimum Lethal dose:

Amount of a substance required to kill 1% of
experimental animals
Lethal dose is amount required to kill 99% of
experimental animals
Toxicology

Exceptions to this rules are (more dose more effects)

a. Idiosyncracy e.g. Aspirin for child, iodine, cocaine,
morphine, milk, eggs etc. is an inborn
hypersensitivity of the body

a. Allergy: It is acquired hypersensitivity e.g. to

penicillin usually families are allergic to penicillin
group of drugs

b. Tolerance / Habit: In this condition you will have to

increase the dose to get desired effects e.g.
strychnine, tobacco, alcohol, arsenic etc.
Toxicology

d. Synergian = Potentiation
2+2>4 alcohol & Barbiturates
If two or more poisons are mixed their total effect is
much much more than of their individual effect

e. Cumulative effect: Some poisons get deposited into

the body if repeatedly small doses are taken
regularly it may cause signs / symptoms of toxicity
as they are being deposited in the body e.g. arsenic,
lead, Hg deposited in long bone
Toxicology

FORM OF POISONS:

i. Physical State

If physical state is gas it will cause much rapid

action then fluid and then solid
Toxicology

ii. Chemical Combination

If person takes dilute NaOH it will combine with

HCl present in the stomach NaCl + HOH so
NaOH is converted into a non toxic substance

Lead carbonate is non poisonous as it is not

soluble in H2O but soluble in HCl of stomach so
converted into water soluble form toxicity
Toxicology

iii. Mechanical Combination

e.g. Conc. H2SO is very toxic.

One drop of this conc. H2SO + water (one

glass/bucket) so its toxicity will be reduced by this

chemical communication
Toxicology

Route of Poison Intake:

a. Inhalation

b. I/V
Toxicology

Body Conditions:
i. Age:
Children can not tolerate the adults dose, both
extreme of ages are susceptible to toxic effect of
drugs

ii. Health:
Healthy may tolerate well than weak or diseased
person
Toxicology

iii. Sleep
Rate of metabolism is decreased during sleep so
effects of poisons will be less during sleep than
during awake state

iv. Intoxication:
When person is under effect of alcohol, effects will
be decreased due to intoxication and sleeping
tendency of body
Toxicology

Safety Index

Maximum therapeutic dose

Maximum toxic dose

Therapeutic Index = LD50/ED50

Toxicology

Fate of Poison in the Body

1. Excretion of poison may be excreted via vomiting or

faeces

2. Metabolism of poison: Liver is guardian of body

against poisons as metabolism occurs in liver, a
poison may get completely metabolized in the liver.
Toxicology

3. Adverse effects on the body: All signs / symptom of

poisoning may occur

4. Retention of poisons in the body e.g. arsenic. Acute

arsenic poisoning ch poisoning as some arsenic
is deposited in bones, hair.

5. All these occur at a time for a poison

Toxicology

Diagnosis of Poisons:

a. In the living in casuality department

b. In the dead
Toxicology

Diagnosis in the Living:

i. History taken from person, relative, friends,
colleagues or any person accompanying the in
toxicated person
ii. Sings & symptoms as in
a. Narcotics there is sleeping tendency
b. When stimulants are used e.g. Nux Vomica then
there will be convulsions
c. In nitric acid poison Color of vomiting will be
yellow
Toxicology

iii. Examination

a. General physical examination

b. Systemic examination

iv. Laboratory diagnosis: most important / valuable

point is lab diagnosis
Toxicology

v. Experiment on animal (all doubts should be resolved

in favour of the accoused) In old age poison was
taken and injected into animals and results were
observed. Not used now a days

vi. Miscellaneous
X-Ray
Biopsy e.g. small piece of an organ e.g. liver
Ultrasound hepatomeglay e.g. in alcoholic
intake initially & then it shrinks in cirrhosis
ECG for cardiac poison, oleander, tobacco etc
Toxicology

Diagnosis of Poisoning in Dead:

1. History (study police papers) on each page signs
and write seen and also write date e.g. FIR.

Study FIR Signs & Symptoms

Observed before death recorded by CMO if death
occurs in the hospital during treatment, get
treatment chart also
Toxicology
2. Post Mortem Examination
Internal
External
With clothes
Without clothes for any type of stain, remove
clothes one by one and examine the clothes
If it is not possible to remove clothes due to PM
Rigor mortis then cut clothes along the line of
stitching. See external orifices.Open all the three
cavities of body even if the cause of death lies in
one cavity
Toxicology

3. Chemical analysis:
The most important point. Your findings should be
in consistence with the lab findings

4. Experiment on animal

5. Miscellaneous
Legal Duties of Doctor in Poisoning
Cases
1. TREATMENT
Consent:
should be taken prior to the start of treatment as
treatment without consent in assualt
Age:
person should be above twelve years for medial treatment.
compos mentis : mentally fit condition (sane)
not intoxicated
(under the effect of alcohol)
consent should be taken from the pateint
if below twelve years then take consent of parent/guardian.
Legal Duties of Doctor in Poisoning
Cases

If intoxicated then consent of parents/guardian or any

accompanying person. If no body is available with
the patient then take consent from your colleague
e.g. M.S /Dy M.S or any other person. If no body is
available then move forward without consent and in
good faith start treatment.
2 Isolation, isolation is to avoid further poisoning (only
mother to be with the patient)
3 Proper treatment should be given
4 CONSULTATION it is legal duty to consult colleague
doctors/senior doctors/ specialist doctors
5 Preservation of the evidence:
1 Doctor must keep written record whenever there is
suspicion of legal action at a later date because
record is a witness whose memory never dies

Signs symptoms along with treatment given should be

recorded with date and time
especially if death occurs in a hospital

EVIDENCE TO BE PRESERVED IN NON FATAL CASES

Containers from which the poison was obtained and
containers in which poison was prepared
Urine (24hours specimen)
Vomitus and first two gastric levages (indicate ingestion of
poison but not necessarily poisoning)
 Facces/ stools
Body fat (obtained by biopsy)
Blood
Hair clipings
Cliping of finger and toe nails
EVIDENCE TO BE PRESERVED IN FATAL CASES
In addition to the above mentioned articles following should be
collected
The stomach with its contents
Liver (at least one half)
Kidneys (at least one)
Spleen
Blood (50-100ml) should completely fill the container
Bone 100mg (preferably shaft of femur)
Whole of spleen
Lung (at least one)
Brain (at least half, where required)
In medicolegal poisoning cases, physician must take care to
establish a legal chain of suctody in such a way that each
person having responsibility of handling the material can state
that it has not been scontaminated or changed
Information to police
Homocidal cases: All homocidal cases must be reported to
policee
suicidal cases:
if the person survives then no need to inform the police
If the person dies then information to police is must
Accidental cases:
if a single case of poisoning for example intake of kerosene oil
then information to police is not required
if large number of people are affected for example food
poisoning then information to police is must
Toxicology

4) Elimination of absorbed poison:

a) Forced diuresis:
the body is compelled to excrete more water via
kidneys and poison is excreted in urine so diuretics
are given to the patient. Also keep an eye on
electrolyte imbalance, avoid dehydration
Aspirin, Barbiturates, alcohol poison may be
treated in this way
b) Peritoneal dialysis
c) Haemodialysis (artificial kidney)
d) Barbiturates, alcohol, and salicylates are treated by
this
Toxicology
5) Symptomatic treatment:
Ensure iv line
Pain should be treated with analgesics
for respiratory distress oxygen inhalation is given
Convulsions to be treated by using CNS depressant
narcosis to be treated with stimulants e.g. Tea, coffee
6) Maintenance of general condition of the patient:
Clear air way should be ensured
Normal electrolytes balance to be maintained
Good nourshing diet
Psychotherapy for attempted suicide cases
Physiotherapy may be needed
Toxicology

Treatment of poisons:
1. Avoid further intake by removal from source of
poison
2. Removal of unabsorbed poison by a) gastric levage
b) by inducing vomiting
3. Removal of absorbed poison
4. Use of antidotes
a) chemical antidotes
b) universal antidotes
c) specific antidotes
Toxicology

Chealating Agents:
these are specific antidotes against heavy metals
they form stable compounds which are non toxic
Types
BAL (british antilewisite)
CDTA: (calcium diethyl tetra acetate)
EDTA: ( ethylene diamine tetra acetate)
PENCILL AMINE:
all these four are effective against heavy metals
Toxicology

BAL:
This substance was developed against a war gas used in world
war two and its name was lewisite gas it is very much effective
against heavy metals
it is effective for arsenic and mercury poisoning
Dose: 3mg/kg body weight
Side effects
anorexia
restlessness
body aches
nausea
vomiting
convusions
comma and death
Toxicology

EDTA:
therapeutic uses: effective against arsenic lead
mercury
side effects:
Hypotension, neuro toxicity, hypokalaemia,
Pencillamine:
Therapeutic uses: mercury, lead, & in copper
poisoning
side effects:
Allergy anapylactic shock, nausea, vomiting, fever,
aplastic anaemia, optic neuritis, nephrotic syndrome
etc.
Toxicology

House hold Antidotes:

1. Milk, banana, ghee, cooking oil, lemon, vinegar,

soda bicarb
Necessary specimens are 1) blood 2) urine 3) vomitus
4) gastric levage 5) any stain present on the dress 6)
any poison left in the bottle or any left over poison
found