Cardiac poisons

poisons, cardiac, heart , treatment

1. Cardiac Poisons Dr Gopisankar.M.G.

2. Cardiac Poisons Nicotiana Tabacum Digitalis Pupurea Nerium Odorum Cerebera thevetia Cerebera Odallam Cleistanthus Collinus Qunine Aconite

3. Nicotiana Tabacum All parts are poisonous except ripe seeds Dried leaves  1-8% of nicotine Toxic alkaloids Nicotine Anabasine (equally toxic ) Nornicotine (less toxic)

4. Nicotine Agricultural , horticultural works Fumigation , spraying , insecticide , worm powder Each cigarette  15 – 20mg N 1-2 mg is absorbed by smoking 15 – 40 mg /cigar

5. Absorbed from  skin , mucous membrane , lungs 90% is metabolised by liver Some metabolised by lungs and kidneys Excreted by kidneys

6. Action Acts on Autonomic ganglia  stimulated first and then depressed and blocked Also acts on somatic neuromuscular junction and afferent fibers from sensory receptors

7. Acute poisoning GIT Cardiopulmonary  arrhythmias CNS  mydriasis Death  respiratory failure

8. Chronic poisoning Amblyopia

9. Withdrawal symptoms A short period of 6 to 12 weeks of maintenance often followed by a gradual reduction in 6 – 12 weeks is done NRT FD  50 – 100 mg of nicotine 15 – 30 mg of crude tobacco

10. Treatment Stomach wash Colonic washout Inversine /Mecamylamine  specific antidote Atropine / hexamethonium chloride VD Oxygen

11. PMA Asphyxia

12. Digitalis purpurea Entire plant is toxic Over 30 cardiac and steroidal glucosides Roots , leaves ,seeds Digitoxin Digoxin Digitalin Digitonin

13. Signs and symtpoms GIT Cardiac  arrhythmias , block Endocrine  gynaecomastia Visual  transient amblyopia , scotomata , colour aberration , halos Skin  urticaria CNS  nueropsychiatric , delerium , hallucinations , trigeminal nueralgia

14. Death occurs from cardiovascular collapse FD  2 gm leaf 15 – 30 mg digitalin 10 mg digoxin 4 mg digitoxin FP 1 – 24 hours

15. Treatment Stomach wash with tannic acid Bowel wash Activated charcoal Digoxin specific antibody fragments ( Fab ) one vial IV over 30 min 1 vial = 38 mg Fab Total 10 – 20 vials Phenytoin

16. Specific antidote for digitalis induced cardiac arrhythmias  lignocaine 100 mg , Dilantin , Propanalol Trisodium EDTA  to lower s. calcium Potassium suppliment Atropine if brady

17. Nerium Odorum White oleander or kaner All parts except roots , including nectar are poisonous Cardiac glycosides Oleandroside ( oleandrin ) digitalis in action Nerioside ( nerin )  digitalis in action Folinerin Rosagenin

18. Signs and symptoms Contact dermatitis Emenations  Headache, dizziness, respiratpry difficulty, Nausea Ingestion difficulty in swallowing and articulation , V, profuse frothy salivation and diarrhoea , abdominal pain Pulse is first slow and later rapid and weak Arrhythmias , block Mydriasis , tetanic spasm, lock jaw , Death usually results from cardiac failure

19. FD  15 – 20 g of root 5 to 15 leaves FP  20 – 36 hours Treatment  symtpomatic PMA -

20. Circumstances Root  abortifacient , veneral disease Cattle poison  into anus of cattle Smoke from the burning plant is toxic When plant material is used to roast food over a fire , the poisonous sap transferred to the food may be lethal

21. Cerebera Thevetia Yellow oliander / pila kaner All parts are poisonous Seeds (A) 4% thevetin  which is 1/8 th as potent as ouabain Similar to digitalis in action (B) thevetoxin ( C) nerifolin (D) Peruvoside (E) Ruvoside (F) Cereberin

22. And a bitter principle that act on CNS to produce tetanic convulsions All active principles are glycosides Milky juice exudes from all parts of the plant

23. Signs and symptoms Contact dermatitis Chewing bark /seed  numbing sensation , feeling of heat in the mouth Mydriasis Heart block Death due to peripheral circulatory failure

24. FD  8 – 10 seeds 15 – 20 g of root 5 – 10 leaves FP  2- 3 hours

25. Treatment Stomach wash Sodium Molar lactate solution with glucose and 1 mg atropine , 2 ml adrenaline, 2 mg noradrenaline PMA Circumstances  criminal abortion , cattle poison

26. Cerebera Odallam Pilikirbir Contains glycosides Cerberin Cerberoside Odollin Odolotoxin Thevetin Cerapain

27. Milky acrid juice (toxic) from all parts of the plant

28. S & S Within 1 hour GI Cardiac  3 hours  brady , AF , Irregular respiration Death from heart failure Hyperkalemia and depression of transaminase activity are chief biochemical changes

29. FD  Kernal of 1 fruit FP  1-2 days or more PMA asphyxia Sub epi , endo , plueral ptecheal bleed

30. Treatment Stomach wash Atropine Correct hyperkalemia Circumstances

31. Cleistanthus Collinus Odovan , karlajuri , karada , garari All parts of the plant are poisonous Toxic principle  Oduvin  glucoside MOA blocks nueromuscular transmission , and cardiac conductive system

32. FD  200 – 400 gm of leaves FP  1 – 3 days

33. Mydriasis Hyperpyrexia Cardiac conductive

34. Quinine Species of cinchona plants Quinine Cinchonidine Alkaloids

35. MOA It is a strong protoplasmic poison Anaesthetic Sclerosing action It stimulates and depresses CNS

36. S and S Starts in 15 – 30 min Partial deafness, disorders of vision , pupils fixed dilated Rash Methhaemoglobinemia Death occurs due to respiratory failure Large doses cause hemolysis Renal tubule block  uremia

37. Cinchonism Repeated therapeutic doses or over dose Tinnitus, vertigo , deafness, diplopia , scotomata , blindness, skin rash , hypoglycemia , and cardiac arrhythmias

38. FD  8 – 15 g FP  6 hours Quinidine  4 – 6 g

39. Treatment Gastric lavage Concentrated solution of magnesium sulphate left in stomach for rapid elimination of poison Activated charcoal +MgSo4  until stool looks black Forced acid diuresis Bilateral Stellate ganglion block cause immediate return of vision

40. PMA Hemolysis Renal tubules blocked with Hb Circumstances  abortifacient

41. Aconite Monk’s hood Blue rocket Mitha zaher Bish Bikh

42. Aconitum napellus Aconitum ferox Roots are used All varieties and all parts are poisonous Most when seeds ripen and bloom

43. Roots and seeds are most potent Contains Aconitin Pseudo aconitine Indaconitine Bikhaconitine Picraconitine Aconine Mesaconitine Jesaconitine

44. S and S Contact  tingling and numbness Odour has narcotic action Pollen causes pain and swelling of the eyes Symptoms immediately or within min GI Salivation  dry and difficulty in swallowing Limbs weak , paraestheisa , ataxia, slurred speech

45. The pupils alternate contract and dilate  Hippus … but remain dilated in later stages Diplopia Dim vision cardiac arrhythmia , blocks Mind clear =+/_ hallucinations Death  paralysis of cardiac or respiratory centres or both

46. FD  1 g root 2 – 5 mg Aconitine 250 mg extract 2 – 30 ml tincture FP  2 – 6 hours

47. Treatment Gastric lavage Weak solution of iodine , in KI , or tannic acid to precipitate alkaloid Animal charcoal Cathartic Atropine Eliminated mainly by urine

48. Thank you