Arsenic trioxide poisoning

ppt on arsenic trioxide poisoning

1. ARSENIC TRIOXIDE GROUP A ROLL:1-25

2. Type of poison Identification Mode of action Fatal dose and Fatal period Symptoms and signs Lab diagnosis Treatment Postmortem appearance Medicolegal importance OUTLINES

3. TYPE OF POISON Metallic inorganic irritant poison

4. IDENTIFICATION White , odourless , tasteless poison which is sparingly soluble in water used used in fruit sprays, sheep-dips, weed-killers, insecticides, rat poisons, flypapers, calico-printing, wallpapers, artificial flowers and as mordant in dyeing. It is absorbed orally through the GIT, skin and lungs (arsine) or parenterally and found in this order Liver > kidney > spleen

5. MODE OF ACTION Acute arsenic poisoning from ingestion results in increased permeability of small blood vessels, and inflammation and necrosis of the intestinal mucosa; these changes manifest as haemorrhagic gastroenteritis, fluid loss and hypotension. Toxicity is also attributed to the ability of arsenic to combine with sulphydryl groups in the mitochondrial enzyme systems leading to interference with their action. Arsenate causes uncoupling of mitochondrial oxidative phosphorylation arsenic does not cross the blood-brain barrier easily, it crosses the placenta readily and can give rise to intrauterine death of the foetus . In less severe intoxications it can cause respiratory distress of the newborn due to pulmonary haemorrhage and hyaline membrane formation.

6. FATAL DOSE AND FATAL PERIOD Fatal Dose : ■ 200 to 300 mg for arsenic trioxide. ■ In general, the pentavalent form of arsenic (arsenate) is less toxic than the trivalent form ( arsenite ) because it is less water soluble. ■ The most toxic form is arsine gas. Fatal Period : When a large dose of arsenic is taken and the poison is quickly absorbed, average fatal period may be 2–4 hours . In the gastrointestinal form, the average fatal period may range from 12 to 48 hours.

7. SYMPTOMS AND SIGNS : Acute poisoning

8. SYMPTOMS AND SIGNS : Chronic poisoning

9. Arsenic poisoning—Hyperkeratosis Mees ’ Lines Raindrop pigmentation—arsenic poisoning

10. LAB DIAGNOSIS

11. TREATMENT Butter and greasy substances act as demulcents Gastric lavage with warm water or freshly prepared hydrated ferric oxide solution Hemodialysis is the line of choice in massive arsenic poisoning BAL is the specific antidote. (3 – 5 mg/kg 4 hourly deep IM for 2 days followed by 2 – 3 mg/kg 6 hourly for 2 days and then every 12 hours for 7 days) DMSA, Penicillamine can also be used Symptomatic therapy Inj. Vitamin B 1 helps in peripheral neuritis

12. POSTMORTEM APPEARANCE External i . The body looks emaciated due to dehydration. ii. Rigor mortis appears early. iii. Putrefaction is delayed due to anti-bacterial action of arsenic and partly due to dehydration. iv. The eyeballs are sunken and the skin is cyanosed. v. Blood tinged vomitus and fecal matter may be present on body and clothes.

13. POSTMORTEM APPEARANCE INTERNAL S t o m a c h : velvety re d or b ro w n i sh , pat c h y a r e a s with ulceration. Gastric contents emit garlicky odor Heart: subendocardial haemorrhage Other viscera: fatty degeneration of liver, kidney & heart B ra in m a y s h ow i n f l a mm a ti o n w ith ha e m o rr hagic spots Small intestine: It contains large flakes of mucus with very little fecal matter. The mucosa is pale violet and shows signs of inflammation with submucous hemorrhages along its whole length.

14. MEDICOLEGAL IMPORTANCE It was considered as an ideal homicidal poison as it was- Cheap Easy to obtain Could be easily mixed and given Symptoms were similar to cholera Accidental death may be due to admixture with articles of food or from its improper medicinal use. Chronic poisoning results from drinking well water containing arsenic. It is sometimes ingested or applied locally in the form of a paste or ointment on abortion sticks to procure abortion. It may be used as cattle poison.