Heavy metal poisoning

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1. DRUGS IN CLINICAL
TOXICITY
HEAVY METALS
POISONING
G.REVATHI., M.PHARM
PHARMACEUTICAL CHEMISTRY
ASSISTANT PROFESSOR, SVCP

2. DEFINITION
HEAVY METAL POISONING
1. Is theAccumulation of heavy metals, in toxic amounts, in the soft tissues of the body.
2. Symptoms associated with heavy metal poisoning →depends on the metal accumulated.
3. Many of the heavy metals, such as zinc, copper, chromium, iron and manganese, are essential to
body function in very small amounts. But, if these metals accumulate in the body in concentrations
sufficient to cause poisoning →serious damage may occur.
4. Most commonly associated with poisoning of humans are lead, mercury, arsenic and cadmium.
5. Heavy metal poisoning may occur as a result of industrial exposure, air or water pollution, foods,
medicines, improperly coated food containers, or the ingestion of lead-based paints.

3. ARSENIC METAL POISONING
I) SYMPTOMS
a) Acute Poisoning
1. Are initiated by nausea,
2. faintness
3. burning pain in stomach and epigartrium(part of upper abdomen immediately over the stomach)
4. Vomiting
5. Diarrhoeaaccompanied by tenesmus (cramping rectal pain)
6. Bloody or watery rice stools with shreds of mucus membrane
7. Painful cramps in legs →dehydration of tissues
8. Dilated pupils
9. When inhaled arsenic dust →pulmonary oedema,restlessness, dyspnoea, cyanosis and cough
DOSE →100 -200 mg

4. B) CHRONIC POISONING
It may occur;
→After effects of an acute attack
→Accidental ingestion of repeated small doses
→Taking food or drinks in which arsenic is present in small quantites.
Symptoms divided into 4 stages;
Stage I of Nutritional and GIT disturbances
Stage II of Catarrhal changes
Stage III of Skin Rashes
Stage IV of Nervous disturbances

5. STAGES SYMPTOMS
Stage I of Nutritional and GIT disturbances
Loss of weight
Malnutrition
Loss of appetite
Nausea
Mental
Physical fatigue
Stage II of Catarrhal changes
Conjuctivitis
Running of eyes
Coughing
Bronchial catarrhal -sinuses(air-filled cavities in the
bones of the face)
Stage III of Skin Rashes
Patchy pigmentation in skin
Hyperkeratosis of palms
Skin irritation
Vesicular eruption
Stage IV of Nervous disturbances
Tingling and numbness of hand and feet
Muscle tenderness
Headache, drowsiness and impaired vision

6. II) TREATMENT
a) Acute Poisoning
Stomach repeatedly washed with warm water
Administered Freshly prepared hydrated ferric oxide
Form ferric arsenic (non-toxic salt)
15 grains in 10ml of sterile W.F.I of sodium thiosulphate given every 4 –6 hrs for first 24 hours
Dimercaprol3 mg/kg -2 hrs interval for first 2 days, 6 hrs for 3 days, 12 hr interval for 10days by IM
Morphineused to control pain and reduce thirst

7. b) Chronic Poisoning
Patient must be removed from further exposure to the poison
Sodium thiosulphate in a dose of 15 grains in 10 ml of sterile distilled water 2 to 3 times per week are used
Dimercaprol should be used in treatment of acute arsenic poisoning

8. LEAD METAL POISONING
I) SYMPTOMS
a) Acute Poisoning
1. Mettalictaste is noticed
2. Cramps in legs and arthralgia
3. Headache Drowsiness
4. Paralysis of limbs
5. Cerebral symptoms predominate →Lead encephalopathy, characterised by;
6. Headache
7. Sleeplessness
8. Tremors of eyes
9. Mouth and fingers
10. Loss of vision, confused thinking and Hallucination
DOSE →100 -200 mg

9. B) CHRONIC POISONING
(PLUMBISM)
1.Facial pallor
2.Anaemia with punctuate basophilia
3.Encephalopathy ( virus infection affects brain )
4.Paralysis of extensor muscles of wrist →degeneration of nerves and atropyof the tissue
5. Colic and constipation
6. Atheriosclerosis
7.Nephritis →inflammation of kidney
8.Leadline→bluish black line due to sub-epithelial deposit of lead sulphideon gums at the junction of teeth

10. II) TREATMENT
a) Acute Poisoning
Stomach should be washed with sodium or magnesium sulphate
Morphine and atropine can be used to relieve colic
Calcium versenate(EDTA) valuable chelating agent for lead

11. B) CHRONIC POISONING
Patient must be removed from the source of exposure
Store lead in the body excreted
EDTA effectively used as chelating agent for lead
5% Glucose saline and NMT 3% of versine is administered
Adult dose →sodium and magnesium sulphate
Morphine and atropine is given 1G ( BD upto5 days )
BAL of 4mg/kg every 4 hrseffective in management of chronic lead poisoning

12. MERCURY METAL POISONING
I) SYMPTOMS
a) Acute Poisoning
1. Mettalictaste in mouth
2. Pain radiating in Abdomen
3. Vomiting followed by profuse purging often bloody and painful
4. Gums may swollen and breath foul
5. Loosening of teeth
6. Renal Lesion
FATAL DOSE →3 –5 grains

13. B) CHRONIC POISONING
1. Excessive salivation
2. Metallic taste in mouth
3. Loosening of teeth
4. Painful inflamed teeth and gums
5. Erethism →Disturbances of nervous system
6. Hallucination
7. Mania
8. Insomnia
9. Tremor →Halter shake

14. II) TREATMENT
Removal and inactivation of mercury present in the body
Stomach should be washed
Egg albumin should be given as it forms coat over the stomach
Charcoal used to adsorb the poison
Administered the BAL to form non-toxic
Pencillamineadministered as antidote →dose –250mg 3 or 4 times in a day
Parenterally transfused fluids given to maintain volume and composition of body fluids

15. B) CHRONIC POISONING
Patient must be removed from source of exposure
Treatment is similar to acute poisoning by mercury
Dry extract of Belladona30 mg thrice daily
Releivesthe excessive salivation
Course IM injection of BAL is also effective

16. BARBITURATE POISONING
I) SYMPTOMS
1. Prolonged Coma
2. Respiratory depression and failure
3. Low blood pressure
4. Oliguria
5. Mental confusion
6. Inco-ordination
7. Muscular weakness
8. Stupor
9. Limbs are flaccid
10. Cyanotic face
DOSE →4 –5 G

17. II) TREATMENT
Artificial respiration should be given using a mixture of 95% oxygen and carbondioxide
Gastric Lavage should be performed using Potassium permanganate
If patient is in coma →5% glucose solution must be given
Amphetamine sulphate in a dose of 10 mg every half an hour given IV till improvement occurs
Cardiazoldose of 5 ml IV, 15 mints by 10 ml and 20 ml every 30 minutes should be given reflexes return
Forced osmotic diuresis ( urea ) →large amounts of fluid & alkalinization
Sodium lactate →treat severe cases of barbiturate poisoning

18. NARCOTIC DRUG POISONING
1. Opium Poisoning 2. Cannabis Poisoning 3. Cocaine Poisoning

19. I) SYMPTOMS
1. OPIUM POISONING
FATAL DOSE of Morphine →200 mg

20. STAGE OF EXCITEMENT
➢Pleasant mental excitement, usually of Very short duration
➢Laughter,
➢Hallucination and
➢Rapid heart rate

21. STATE OF STUPOR
➢Headache
➢Giddiness
➢Sense of weight in limbs
➢Diminution of sensibility
➢Strong tendency to sleep
➢Pupils are contracted
➢Face gets Cyanosed

22. STATE OF NARCOSIS
➢Patient passes into deep coma
➢Pupils are contracted→pinpoint
➢Fall in blood pressure
➢Dysponea
➢Reduces heart rate ( 2-4 per minute )
➢Muscles relaxed and reflexes abolished

23. II) TREATMENT
Stomach washed immediately with tepid water (lukewarm water)
Then washed withKMnO
4( 1: 1000 )
KMnO
4oxidisesMorphine →less toxic substances
Intestines must be cleared out by Enema or Purgative →MgSO
4 ( ½ ounce orally )
Patient must be kept Awake i.e., he should not pass into comatose state
Administered Inj.Atropinedose 1.5 mg is given
Injection of warm saline and glucose
Adrenaline exhibits →Antitoxic effect
Artificial Respiration may be given

24. CONTD.,
Nalorphine →specific antidote of Morphine by IV route
Dosage of 5 to 10 mg every 15 minutes till respirations →normal
Lavallorphantartarate→10 times more active than Nalorphine
Dosage is 0.02 to 0.05 mg
Antibiotics must be administered in cases of prolongesunconsiousness

25. CANNABIS POISONING
I) SYMPTOMS
a) Acute Poisoning
➢Excitement first and then Necrosis
➢Followed by Hallucinations of sexual character
➢In stage of nacrosis→Confusion, drowsiness and dilated pupils
➢May be generalized anaesthesia

26. b) CHRONIC POISONING
Is characterized by;
➢Anorexia
➢Loss of weight
➢Weakness
➢Tremors
➢Moral deterioration
➢Suffers from Hallucination and delusion

27. II) TREATMENT
Initiated by same treatment given by Narcotics
Stomach is washed with warm water
Hypodermic Injection of Strychnine is useful
Saline Purgatives were given
Artificial Respiration may be necessary

28. COCAINE POISONING
I) SYMPTOMS
➢Acts as Stimulant and CNS depression
➢Restlessness
➢Excitement
➢Delirium
➢Dilated Pupils and Flushed Face
➢Blurred vision
➢Tachycardia
➢Increase rate of respiration and Body temperature
➢Muscular twitching and Convulsion
➢Respiratory failure followed by Death
FATAL DOSE of Charas→1 Gm

29. II) TREATMENT
If the drug is injected
Absorption of drug from the site of action is limited by tourniquet
Or by applying Ice
If swallowed→stomach should be washed
Using Dilute solution of KMnO
4or Tannic acid
Medicinal charcoal is employed
Excitement →controlled by Barbiturates
Cardiorespiratory stimulants and Artificial Respiration may be required

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