Cardiac Poisons These poisons have the main toxic

Cardiac Poisons These poisons have the main toxic effect on heart (cardiac muscles). They include: n Digitalis Purpara n Oleander n Aconite n Nicotine

Digitalis Purpurea (Fox Glove) n 1. 2. 3. 4. This is a poisonous plant. Its roots , leaves & seeds contain several glycosides of which Digitoxin Digitalein Digitonin.

Mode of Action n Digitalis glycosides inhibit active transport of Na+ and k+ across cell membranes by bonding onto a specific site on the extra cytoplasmic face of the alpha subunit of Na+-K+ -ATPase.

n They act directly on the heart muscle & improve the function of a failing heart. The normal heart is effected very little unless toxic doses are administered. Its main toxic effects are, irritation of the stomach, slowing of heart rate leading to heart block, extra systoles & ventricular fibrillation.

Signs & Symptoms n Cardiac: AV block, Ventricular ectopy, Tachycardia, Fibrillation, NON-paroxysmal atrial tachycardia, Sinus Bradycardia. Non Cardiac: Anorexia, Nausea, Vomiting, Confusion and Hyperkalemia

Fatal Dose & Period Fatal Dose: 15 – 30 mg of digitalin or 4 mg of digitoxin Fatal Period: Half an Hour to 24 hours.

Treatment 1. 2. 3. 4. 5. 6. 7. Stomach wash with solution of tannic acid. Bowels should be evacuated. Atropine 0. 6 mg hypo dermally to control bradycardia. Potassium salts given to reduce extra systoles Specific antidotes as Novocain or propranolol for arrhythmias. Tri sodium EDTA to lower serum calcium. Rest is symptomatic

Postmortem Appearance n Not characteristic n Irritation of gastric mucosa. n Digitalis leaves or seeds may be found in stomach. The seeds are reddish brown, remarkably small & some what angular in shape with peculiar markings.

Medicolegal Aspects. n Accidental Poisoning mainly from over dose of medicine or from eating leaves by mistake. n Suicide & homicide are Rare.

Two Varieties: 1. Nerium Odorum (White Oleander) 2. Cerbera Theveta (Yellow Oleander) The white one bears white or pink flowers & is called Nerium odorum or true oleander. The yellow one bears yellow bell shaped flowers.

All parts of plants are poisonous. Active Principle: Is Nerin consisting of three glycosides. 1. Neriodorin 2. Neri odorein 3. Karabin

Principal Action n Principal action of Neriodorin is similar to that of digitalis causing death from cardiac failure. n Neriodorein causes Muscular Twitching & tetanic spasm more powerful than those of strychnine. n Karabin act on the heart like digitalis & on spinal cord like strychnine.

Signs & Symptoms: Vomiting, Pain abdomen, Frothy salivation. Signs: Pulse is slow & weak, difficulty in swallowing & lock jaw. Muscular twitching of extremities deepen in to tetanic spasms frequently affecting one side more than the other. This is followed by drowsiness coma & death form heat failure.

Fatal dose & Period 15 gm of root can kill an adult in about 24 hours Treatment: 1. 2. 3. 4. Stomach wash Administration of an anesthetic agent. Morphine injection may be beneficial. Symptomatic

Postmortem Appearance n Non specific n Petechial Haemorrhages on heart are a characteristic feature. n Nerium odorum resist heat & can be detected even from burnt remains of the dead body.

Medicolegal Aspects n Suicide with decoction (concentrated water extract) of root, leaves or fruit of Nerium odorum is common. n As abortifacient n As accidental poison n As cattle poison.

Active Principles: 3 glycosides Thevetin , Thevotoxin, Cerberin Glycosides are substances found in plants & are composed a sugar & a non – sugar compound, the latter having a toxicological action. n Thevetin Is a powerful cardiac poison. n Thevotoxin is less toxic n Cerberin has an action like strychnine. n

Symptoms & Signs n Burning sensation in mouth with tingling of the tongue, dryness of throat, vomiting diarrhea, headache, dizziness, dilated pupils, irregular action of heart, drowsiness, collapse, coma & death, Tetanic convulsions are rare.

Fatale Dose & Period n 8 -10 seeds or 15 – 20 gm of the root can kill on adult in 24 hours.

Treatment n Same as Nerium odorum (I / V molar solution of sodium lactate to combat acidosis + 5% glucose solution with 1. 2 mg Atropine. 2 ml of adrenaline 1 =1000 & 2 mg of noradrenalin if BP is low to contract heart block.

Postmortem Appearance Signs of GIT: Irritation, congestion of various organs, generalized engorgement of veins & subendcardial Ecchymosis. Yellow oleander resist putrefaction. So can be detected even years after death in exhumed putrefied bodies.

Medicolegal Aspects n Suicidal n Used for abortion n Cattle poisoning

Also know as scopolamine, Kharasani Ajwayan The plant grows at high altitudes in Hamalayan ranges. All parts of plant are poisonous. They contain the alkaloids. n Atropine n Hyoscyamine

Symptom and Sings: Closely resemble with that of dhatura. It first stimulates & then depresses the virtual centres. Fatal Dose: 125 mg of Hyoscyamine. 15 – 30 mg of Hyoscine hydrobromide Fatal Period: Within 24 hour Treatment: Same as Dhatura

Post Mortem Appearance: Seeds may be found in stomach. Hyoscine resists putrefaction. Uses: n As medicine: In small doses used as medicine. In parkinsanis disease, in deliriem & psychotic conditions, In spasm of asthma, whooping cough and in depression. n In war it is used to control shell shock

n Truth serum or Lie Detector: It is said that a criminal under its influence is half awake & half asleep. His mental condition becomes such that he is unable to fabricate lies or with hold truth during investigation which he could do during his normal waking state Medicolegal Aspects n Accidental poisoning may occure due to over dosage. n Homicidal is rare.

n Tobacco is the leaf of tobacco plant, “Nicotiana tobacum”. The dried leaves “tambaku” are chewed or used in the form of smoke or snuff. Active Principle: All parts of plant except the ripe seeds contain the alkaloid ‘Nicotine’

Uses: n For humans. n Used extensively in agricultural & horticultural work as fertilizers, fumigants and insecticide sprays. Route of Administration: Poisoning is caused by absorption either through intact or broken skin, by inhalation or ingestion.

Actions: Nicotine first stimulates then depresses & then paralyses autonomic ganglia. Symptoms and sings: Mild poisoning occures when tobacco is chewed, smoked for the first time or when insecticide spray has been inhaled. Dizziness, nausea, vomiting headache, perspiration, general weakness & mild rise in BP with increases pulse rate may occure.

Acute Poisoning n When nicotine is absorbed in poisonous amounts, There is burning in mouth, throat & stomach followed by mild poisoning symptoms, then convulsions, repiratory slowing, cardiac irregularity coma. Death occures from cardiac arrhythmia, exhaustion or reparatory failure.

Chronic Poisoning n Those who chew tobacco suffer from chronic cough, laryngitis, pharyngitis & bronchitis. Those who handle it suffer from dermatitis. Tobacco stains the teeth, bad odorer angiospasms, muscular tremors, amblyopia, blindness & cardiac arrhythmias, occlusive thromboangitis obleterans, cancer of mouth, tongue throat larynx & lungs.

Fatal dose & Period Fatal Dose: 60 mg of nicotine or 2 gm of tobacco. One cigarette contains one gm of tobacco about half the lethal dose. A teaspoonful of insecticide is fatal. Fatal Period: In a few minutes when nicotine is swallowed. In some it may be delayed for a few hours.

Treatment On skin: n Wash It n When ingested, stomach should be washed with warm water containing activated charcoal, tanin (strong tea) or potassium permanganate. n A purgative such as sodium sulphate 15 gm in 100 ml of water is useful.

n In cardiac symptoms, careful cardiac monitoring, artificial respiration & oxygen are necessary. n Symptomatic n In chronic poisoning patient should be removed from risk of further exposure. Risk factor: Patents with leukopenia , hyperacidity, peptic ulcer, respiratory problems, high B. P. angina thromboangitis obliterans & tobacco amblyopia should stop smoking.

Postmortem Appearance n Those of asphyxia. Smell in the stomach & brown discoloration of its wall or of the skin, gastric, irritation & pulmonary oedema. Nicotine resists putrefaction.

Medicolegal Aspects n n n Nicotine is drug of addiction & leads to psychological dependence. Chronic use leads to chronic problems with disability & decreased life expectancy. Accidental poisoning occures from 1. 2. 3. 4. 5. Chewing a large dose Ingesting of decoction (concentrated water extract) Absorption thought skin when applied as a poultice Excessive smoking Exposure to fertilizes insecticides & fumigants.

n Malingers soak tobacco leaves in water & bandage them in armpits to become sick with fever in next 6 -8 hours to avoid duty. n Also used as infanticide.

ACONITE MITHA ZAHAR, MITHA BISH n n The plant is known as Aconitum Napllus or Monkshood All parts of the plant are poisonous, the root being most potent The dry root is tapering, slightly ached usually shriveled and with longitudinal wrinkles. It is 5 – 10 cm long, 1 – 2 cm thick and dark brown externally and pink internally It has an acrid, sweetish taste which gives it the name Mitha Bish (Mitha – Sweet) (Bish – Poison)

ACTIVE PRINCIPAL n Aconitine n Picraconitine n Pseudo Aconitine n Aconine

ACTIONS n It stimulates and then depresses skeletal muscles, central nervous system and peripheral nerves

SYMPTOMS AND SIGNS n Local contact causes Tingling, Numbness which extend over the whole body n Tingling and numbness of lips, mouth, tongue and pharynx followed by salivation, nausea, vomiting and diarrhea n The patient feels giddy, vision and speech impaired, the limbs become week and he is unable to stand or walk. Twitching of muscles and convulsions may occur.

n The pulse is slow and irregular (vagal stimulation). The breathing is rapid at first and soon becomes slow, labored and shallow. The pupils alternating contract and dilate but at last remains fully dilated n Death occurs from cardiac arrhythmia or respiratory paralysis

FATAL DOSE n One gram of root n 250 gram of extract n 25 drops of tincture n 4 mg of Alkaloid

FATAL PERIOD n About six hours

TREATMENT n n n Gastric Lavage with solution of Tannic acid (10 gm in 2 liters of water) Strong Tea or potassium per magnate Injection Atropine 1 mg or Digitaline 0. 25 hypodermaly Cardiac arrhythmias are treated by 50 ml of 01. % Novocain I/V slowly Artificial respiration Oxygen inhalation Symptomatic

POST MORTEM APPEARANCE n Non specific n Aconite is largely destroyed in the body and also by alkalis so it is difficult to detect in the body after death n The vomitus is preserved in acetic acid and rectified spirit in 1: 2 ratio

MEDICO LEGAL POINTS n Most potent poison to mankind n Accidental poisoning occurs by root, by quack remedies, by skin application n Homicidal cases are not uncommon n As arrow poison

IDEAL HOMICIDAL POISON n It is cheap n Easily available n The lethal dose is small n Fatal period is short n Its color is disguised by mixing it with sweets or with betel leaves n It is largely destroyed in the body and therefore cannot by detected by chemical analysis