Aconite and Nicotine Poisoning FM Toxicology pptx

About Aconite and nicotine poisonning

1. Aconite and Nicotine Poisoning By- Priyanshu,Varun,Rajendra,Rajni,Sajina

2. ACONITE I ntroduction- All parts poison(most potent-roots and root tuber) Roots are mistaken for horseradish root Common name- Monks hood,mitha zehar,bish,devil helmet or blue rocket

3. Active Principle :- Aconitine Mesaconitine Hypaconitine Pseudo-aconitine Indaconitine Picraconitine Aconine

4. Properties of aconitine Colorless Transparent Rhombic crystals Insoluble in water Readily soluble in benzene and chloroform

5. ACTION :- Toxicity due to their action on voltage sensitive sodium channels First stimulate and then paralyzes CNS and Nerve of myocardium ,skeletal ,smooth muscles Not affect higher center of brain Conscious intact till end

6. Sign and Symptoms Presents with combination of GI, Cardiovascular and Neurological features

7. Cause of death :- Respiratory failure or ventricular fibrillation Fatal dose :- Root: 1-2 gm Aconitine:2-5 gm Fatal period :- 2-6 hrs Terminal stage- severe pain and paralysis of facial muscles Complain of yellow green vision and tinnitus (some)

8. Treatment No specific antidote Gastric lavage with tannic acid/ activated charcoal Ionotropic therapy- hypotension Atropine(0.5-1mg IV)-Bradycardia Ventricular arrhythmia- Amiodarone and Flecainide (1 st line) Cardiopulmonary bypass- refractory cases and cardiogenic shock Symptomatic t/t

9. PM findings Not specific Organ congested Stomach :- fragment of roots Lungs :- haemorrhagic pulmonary edema Heart :-diffuse contraction band necrosis in myocardium

10. Medico-legal aspects Ideal homicidal poison Accidental poison Abortifacient, cattle and arrow poison Suicide not common

11. NICOTIANA TABACUM (TOBACCO) INTRODUCTION All parts of the plant are poisons except ripe seeds Leaves – contain toxic alkaloids like nicotine,anabacin nornicotine and lobeline (in Indian tobacco) Cigarrettes – 1-3mg nicotine

12. Properties of nicotine Colorless Hygroscopic oily liquid Burning acrid taste Disagreeable odor

13. Action :- Acts on autonomic ganglia which are stimulated initially,but depressed and blocked at later stage. Also act on somatic NMJ and afferent fibres from sensory receptors.

14. Signs and symptoms ACUTE POISONING CHRONIC POISONING CVS Tachycardia followed by bradycardia,Hypotension,Arrhythmia Anemia,Palpitation,Angina pectoris,Irregularity of heart,Buerger’s disease GIT Burning acid sensation,Nausea and vomiting,Salivation,odor of tobacco Anorexia,Vomiting,Diarrhea CNS Headache,Restlessness,Confusion , vertigo Impaired memory,Blindness,Tremors,Insomnia RS Tachypnea,Respiratory depression,Collapse Cough,Wheez,Chronic bronchitis,Dyspnea

15. Withdrawal Symptoms: intense urge to smoke,anxity,impaired concertration and memory,depression,headache,muscle cramp,sleep disturbances,increased appetide,weight gain,diaphoresis,inceased breathing Short maintenance period followed by gradual reduction adopted(6-12 weeks) Nicotine replacement therapy: gum,transdermal patch,nasal spray,inhaler FATAL DOSE Nicotine : 60-100mg Tobacco : 15-30g FATAL PERIOD : 5-15 mins

16. Treatment Gastric lavage with charcoal and KMnO 4 Purgatives Cardiac monitoring Hypotension – atropine Convulsions – diazepam Symptomatic treatment Chronic poisoning - Clonidine

17. PM Findings Brownish froth at mouth and nostrils Stomach – fragments of leaves or smell of tobacco Features of asphyxia

18. Medico-legal Aspects Accidental poisoning – Ingestion , excessive smoking Drug of Addiction For malingering, leaves are soaked in water for some hours and placed in axilla at bed time, poisonous symptoms are seen by next morning Suicidal/Homicidal – rare

19. GREEN TOBACCO SICKNESS Occur in tobacco growing states Workers absorb alkaloid through skin Symptoms – Nausea,Vomiting,Diarrhea,Diaphoresis and weakness Symptomatic treatment

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