SlideShare ist ein Scribd-Unternehmen logo
1 von 51
Downloaden Sie, um offline zu lesen
Dr Kaleem Khan
Assistant Professor
JNMCH
 It is the common environmental toxicant and is found in
soil, water, and air.
 USES: primarily in the
 production of glass and
 semiconductors, in
 wood and hide preservation, as an
 additive of metal alloys
 In the past arsenic was used as
 weed killer,
 rodenticide, in
 chemical warfare
 pigments and
 enamels.
Arsenic poisoning( acute, subacute and chronic)
Arsenic poisoning( acute, subacute and chronic)
 Arsenious oxide (As2o3): most toxic form white arsenic/arsenious
acid/ arsenic trioxide/ sankhya/ somalkar.
 It occurs in two forms white
 Crystalline powder or
 Opaque mass.
 No taste or smell and sparingly soluble in water
 It is widely used in a) –
 Calico printing ,
 Taxidermy (preparing mounting skin of animals),
 Artificial flowers,
 Wall papers preparation,
 Preservation of timber against ants ,
 For treatment of
 Rheumatic arthritis,
 Impotence,
 Syphilis.
Rat poisons Calico print Fruit sprays Sheep-dips
Weed-killer Taxidermy Fly papers preserving timber
against white
ants
 Sulphides of Arsenic: colouring agent, depilatory, fly paper
 Arsenic trisulphide (As2S3)/ yellow orpiment/ hartal
 Arsenic disulphide (As2S2)/ red realgar/ manseel
 Copper compounds of Arsenic: colouring agent
 Scheels green/ copper arsenite
 Paris green / copper acetoarsenite
 Organic compounds:
 Cacodylates,
 Atoxyl,
 Salvarson,
 Arsenobentine (trimethylated arsenic)
 Arsine gas
• It is cheap
• Easily obtained
• Colourless
• No smell
• No taste
• Small quantity is required to cause death.
• Can be easily administered with food or drink.
• Onset of symptoms is gradual
• Symptoms simulate those of Cholera.
Disadvantages Of Arsenic:
• It delays putrefaction
• Can be detected in completely decomposed bodies.
• Can be found in bones, hairs and nails for several
years.
• Can be detected in charred bones or ashes.
 Interferes with cellular respiration: It combines with sulphydryl groups of
mitochondrial membrane especially pyruvate dehydrogenase
 It is a capillary poison: increased permeability, causes tissue oedema and
hemorrhage
 Hyperaemia and haemorrhage in the intestine.
 Interferes with glucose uptake, gluconeogenesis, fatty acid oxidation: Fatty
degeneration of liver
 Renal tubular necrosis
 Peripheral nerves show axonal neuropathy: depression of nervous system.
 Arsenolysis is a major form of toxicity in which the arsenic anions can substitute
for phosphate in many reactions.
Arsenic poisoning( acute, subacute and chronic)
It can be inhaled and absorbed through the skin or through GIT after
ingestion.
Once absorbed arsenic rapidly combines with the globins portion of haemoglobin
and therefore localize in the blood, within 24 hours it redistribute to liver, kidney,
spleen, lung and GI tract, with lesser accumulation in the muscle and nervous
tissue.
Excreted mainly through kidneys as methylated arsenic and some part by
faeces, sweat, bile.
It is excreted in stomach and intestine even when given by other routes
(enterohepatic circulation ).
It becomes fixed in cancellous tissue or bones. Replaces phosphorous.
It is a known carcinogen: skin, liver, bladder
 Fatal dose-
 Arsenic trioxide: 180 mg,
 But it varies on ingestion,
 Inherent tolerance of the patient.
 Fatal period:-
 12-48 hours.
 But can be fatal within 2-3 hours.
 Patient experience a
 Metallic taste,
 Garlicky odour in the breath
 Xerostomia
 Dysphagia.
 Increased salivation
 Excessive thirst.
 Severe nausea
 Vomiting.
 Colicky abdominal pain and
 Profuse diarrhoea.
 The stool are dark coloured and bloody and
 Later on
 Colourless,
 Odourless, and
 Watery resembling rice watery
 Due to vasodilatation with transudation of fluid into the bowel lumen in addition to
mucosal vesicle formation and sloughing leading to increased peristalsis.
Vomiting is
Projectile ,
Dark brown or yellow colour and
Contain stomach contents,
Blood and mucus
Purging, tenesmus , pain and irritation around anus.
Severe headache, vertigo, periorbtal odema, skeletal muscles cramps.
Renal damage manifested as
Oligurea,
Proteinurea, and
Haematuria.
Fatty infilteration of liver
Delayed loss of hair, skin eruptions
Trait Arsenic poisoning Cholera
1.Pain in throat Before vomiting After vomiting
2.Purging Follows vomiting Precedes vomiting
3.StoolsLike Bloody
later rice-water in early stage,
Rice-watery and pass in
continuous involuntary jet
4.Tenesmus Present Absent
5.Vomited matter Contains mucous, bile and blood Watery without mucou
s, bile and blood
Arsenic poisoning( acute, subacute and chronic)
When massive dose (> 3-5 mg) is rapidly absorbed.
Gastric sign are usually absent
Cyanosis, cold clammy skin,
Hypoxic encephalopathy, convulsion,
Acute tubular necrosis and renal failure
Hyperpyrexia and acute haemolysis
Acute hepatic failure, cirrhosis, ascitis,
Cardiomyopathy, subendocardial haemorrhages,
Decreased cardiac output due to hypovolemia by vasodilatation.
Death d/t shock and peripheral vascular failure
 It produces mainly CNS symptoms:
 Giddiness
 Precordial distress.
 Tenderness of muscles.
 Delirium.
 Dilated pupils and complete paralysis of the muscles at times
 Usual symptoms can also be produced such as
 Convulsion,
 Lockjaw,
 Raised temperature,
 Loss of speech and
 Memory ,
 Joint pain
 Arsine gas act as a poison to haemoglobin and causes
haemolysis.
 It most commonly produces haemoglobinuria and anaemia.
 The other symptoms produced as a result of poisoning are
 Jaundice,
 Dark red urine,
 Renal failure,
 Heart failure,
 Delirium and
 Coma.
 Death usually instantaneous.
 Urine: proteinuria, cast and albuminuria are there.
 Arsenic poisoning is usually diagnosed with the urine test for
arsenic as arsenic ions are present very shortly after ingestion.
 A urinary excretion of arsenic >100mg/24 hours is regarded as
indicative of exposure to a potentially toxic amount of arsenic
 Monomethylarsine and dimethylarsine are present in the urine
24 hours after ingestion. acute poisoning).
 Blood: 0.9 µg/dl, monocytic hypochromic anaemia, leukocytosis
and mild eosinophilia.
 Liver function test: serum alkaline phosphatase and bilirubin is
raised and there is excretion of urobilinogen in the urine.
 Hair and nails samples containing >300 ppm or 100 mg of arsenic
per 100 gm of specimen are diagnostic of arsenic poisoning
 Radiopaque sign on abdominal x-ray
 Effective methods for arsenic detection.
 Colorimetry,
 Atomic absorption spectroscopy and
 Neutron activation analysis
 Stomach wash should be done with milk and warm water.
 For Gastric Lavage 1% sodium thiosulphate in water is
helpful
 Demulcent such as ghee and barley water are given.
 Purgatives like Castor oil and magnesium sulphate is
administered to diminish intestinal absorption of arsenic
 British anti lewisite (B.A.L.) Is administered
 4 hourly for 2 days,
 6 hourly for 1 day and
 Total dose 12 hourly after wards,
 Total dose is 2.5-3 mg/kg body wt.
 To know when the chelation is to be stopped, 24 hour urine
sample is to be collected and if arsenic level is fall below
50mg/24 hours,
 It should be stopped for 5 days and then started again so that
the tissue arsenic is mobilized and ready for chelation.
 Oral Penicillamine
 100mg/kg. Body wt.
 In 4 divide doses in 24 hours for 4-8 days after initial
12-48 hours of B.A.L therapy.
 Morphine is given to relieve pain.
 Saline is administered i.v. for dehydration and enuresis.
 To relieve cramps , massage employed, body temperature to be
maintained.
◦ Patient to be taken to fresh air.
◦ Oxygen inhalation to be started .
◦ Exchange transfusion should be undertaken.
◦ Haemodialysis is ensued.
◦ Alkaline drinks are given.
◦ All of the methods help to eliminate arsine gas from the blood.
◦ B.A.L. is not effective in arsine gas poisoning.
◦ Emaciated body d/t dehydration
◦ Rigor mortis lasts longer
◦ Blood tinged vomitus and faecal matter
◦ Mucus membrane of small intestine are inflamed
◦ Stomach red velvety appearance
◦ Liver, heart and kidney: congested, enlarged, swelling and
fatty degeneration may be seen
 Chronic arsenic poisoning result from chronic repetitive
ingestion or inhalation of arsine gas by:
 Arsenic Extraction
 Extraction of metals from ore by melting .
 Refining of the ores.
 Manufacture of
 The weed killers,
 Insecticides,
 Paints,
 Dyes and
 Cosmetics
 Person who ingest it as medicine for long periods may follow
the acute poisoning after recovery.
 When the dose is not large enough to kill the patient, a number
of secondary effects can be seen 2-4 weeks after ingestion of
the poison
Arsenic poisoning( acute, subacute and chronic)
 FIRST STAGE: GIT disturbances
◦ Loss of weight .
◦ Loss of appetite and salivation.
◦ Colicky pain and constipation.
◦ Vomiting and diarrhoea.
◦ Gums are red and soft.
◦ Tongue is coated, is thin white salivary furred.
◦ Oedema of eyelids and ankles
◦ Temperature and pulse is raised
 Second Stage: Cattarhal Stage
 Dryness and etching of the skin.
 Voice is hoarse and husky,
 Runing nose,
 Cough
 Bronchial coryza .
 Photophobia and conjunctivitis
 Liver is enlarged and cirrhotic,
 Chronic nephritis.
Erythematous flushing caused by cutaneous capillary
dilation, generalised and localised.
 RAIN DROP TYPE of pigmentation of the skin involving
the covered part of the body such as flexors, nipples,
lower abdomen, temples and eye lids.
 Epithelial hyperplasia, discrete multiple wart like keratosis
on the palms and sole, head and trunk.
 Hyperkeratosis then occurs with desquamation of the palm
and soles
Arsenic poisoning( acute, subacute and chronic)
Arsenic poisoning( acute, subacute and chronic)
Arsenic poisoning( acute, subacute and chronic)
◦ Nails are brittles with linear pigmentation, Aldrich Mee`s
Line ( white transverse line seen on the nail plate up to a
year after arsenic intoxication).
◦ Hair are dry patchy and diffuse alopecia.
◦ Painless perforation in the nasal septum.
 that look much like
traumatic injuries are found
on the fingernails.
◦ Peripheral neuritis with glove and stocking type of anaesthesia
resembling alcoholism.
◦ Encephalopathy may be seen in some cases, presenting in
severe headache, personality disturbance, convulsion or coma.
◦ The predominant clinical feature of neuropathy are
parasthesia, numbness, pain on particularly on the soles of the
feet.
◦ It is usually a symmetrical sensorimotor polyneuropathy often
resembling Gullian- Barre Syndrome
◦ Eventually muscular atrophy resulting in wrist drop and Foot
drop.
Arsenic poisoning( acute, subacute and chronic)
 Muscular weakness, ataxia, cramps tremors and general emaciation and
death is due to failure of heart muscles.
 Oedema of the face, periorbital region or ankle from localised transudation
of intravascular fluid, knee jerk is usually lost.
 Impotence is commonly present.
 There is evidence of
◦ Bone marrow depression
◦ Aplastic anaemia
◦ Normochromic normocytic anaemia
◦ Leucopenia, thrombocytopenia and mild eosinophilia.
◦ Megaloblastic anaemia
Differential Diagnosis:
◦ Chronic arsenic poisoning is to be differentiated from alcoholic
neuritis.
◦ In chronic arsenic poisoning the symptoms and signs are
developed rapidly , are widespread.
◦ There is no glycosuria in as poisoning whereas in alcoholic
neuritis glycosuria is positive.
Arsenic poisoning( acute, subacute and chronic)
◦ Remove the patient from the source of poison.
◦ B.A.L is to be given 6 hourly for 2-3 days.
◦ once daily Vitamin B1 injection for peripheral neuritis.
◦ Improve general health.
◦ Emaciation, pigmentation, keratosis, Aldrich Mees lines,
jaundice , wasting of muscles and ulceration of nasal septum
◦ Internally stomach shows patchy inflammation, fatty
degeneration of liver, tubular necrosis of kidney, and
myocardial necrosis
◦ Preserve hair, nail and bone(lower end of femur)
 It is ideal homicidal poisoning that is used frequently in India.
 It is used as a cattle poison.
 It is used for suicidal purpose.
 Poisoning can result accidentally due to its improper medicinal use
when it is applied locally as a cure for impotence.
 Poisoning can result from its application on the abraded skin, when it
is used as vaginal pessaries or when it is mistaken for baking powder
or soda.
 Arsenophagist: Use the drug as a habit as aphrodisiac and can acquire
tolerance upto .03gm or more in one dose
 Accidental cases of poisoning sometimes occur from its admixture with
drink or articles of food.
 White arsenic has been mistaken for baking powder, soda, salt or flour and
has caused mass accidental poisoning.
 The mountaineers of Styriaand Tyrol used it daily with a view to becoming
hardier tocarry weights and climb mountains.
 The greatest concentration of arsenic is found in hair and nails. Its
deposition in hair may begin in 15 days after administration.
 Exhumed body: Arsenic cannot percolate in the
cadaver from the soil, as it is an insoluble form ofsalt.
The nails and hair will have a higher concentrationfrom
the soil. The soil is to be kept forchemical analysis.
 Napoleon Bonaparte (Emperor of France from 1804 to 1815)
has been the source of attention of the historians because of his
flamboyance and daring exploits, and perhaps also because of his
tragic demise. On being defeated in legendary Battle of Waterloo
in 1815, he was exiled to the very remote island of St. Helena (a
British colony in the Atlantic),where he died a mysterious death.
His death remained speculative until the scientific authenticity
was finally established.
 Some hair from the scalp were procured by Ben Wielder(a
Napoleonic scholar) submitted to neutron activation analysis,
revealing fluctuating levels of arsenic throughout the length of
the hair, ranging from 4.4 to 23.0 parts per million.
Arsenic poisoning( acute, subacute and chronic)
thanks

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Arsenic poisoning
Arsenic poisoningArsenic poisoning
Arsenic poisoning
 
Lead poisoning
Lead poisoningLead poisoning
Lead poisoning
 
Semecarpus anacardium
Semecarpus anacardiumSemecarpus anacardium
Semecarpus anacardium
 
Forensic toxicology Introduction and General Management
Forensic toxicology  Introduction and General ManagementForensic toxicology  Introduction and General Management
Forensic toxicology Introduction and General Management
 
Corrosive poisons
Corrosive poisons Corrosive poisons
Corrosive poisons
 
Metal poisoning
Metal poisoningMetal poisoning
Metal poisoning
 
Mercury Poisoning
Mercury PoisoningMercury Poisoning
Mercury Poisoning
 
Aluminium Phosphide Poisoning
Aluminium Phosphide PoisoningAluminium Phosphide Poisoning
Aluminium Phosphide Poisoning
 
Inorganic (non metallic) irritant Poisons by Sunil Kumar Daha
Inorganic (non metallic)  irritant Poisons by Sunil Kumar DahaInorganic (non metallic)  irritant Poisons by Sunil Kumar Daha
Inorganic (non metallic) irritant Poisons by Sunil Kumar Daha
 
Corrosive poisons (Sulphuric acid)
Corrosive poisons (Sulphuric acid)Corrosive poisons (Sulphuric acid)
Corrosive poisons (Sulphuric acid)
 
Agricultural Poisons
Agricultural PoisonsAgricultural Poisons
Agricultural Poisons
 
Lead poining
Lead poiningLead poining
Lead poining
 
Cyanide poisoning_Forensic Medicine
Cyanide poisoning_Forensic MedicineCyanide poisoning_Forensic Medicine
Cyanide poisoning_Forensic Medicine
 
Alcohol poisoning
Alcohol poisoningAlcohol poisoning
Alcohol poisoning
 
Abrus precatorius
Abrus precatoriusAbrus precatorius
Abrus precatorius
 
Animal Poisons
Animal PoisonsAnimal Poisons
Animal Poisons
 
Lead poisoning
Lead poisoningLead poisoning
Lead poisoning
 
Opium
OpiumOpium
Opium
 
Poisons
PoisonsPoisons
Poisons
 
Abrus precatorius
Abrus precatoriusAbrus precatorius
Abrus precatorius
 

Ähnlich wie Arsenic poisoning( acute, subacute and chronic)

ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATION
ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATIONARSENIC POISONING - A FORENSIC MEDICINE PRESENTATION
ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATIONnoelsk21
 
Arsenic trioxide poisoning
Arsenic trioxide poisoningArsenic trioxide poisoning
Arsenic trioxide poisoningAkash Agarwal
 
Arsenic poisoning roll no.82
Arsenic poisoning  roll no.82Arsenic poisoning  roll no.82
Arsenic poisoning roll no.82priyankaN44
 
Metallic poison - As & Ba
Metallic poison - As & BaMetallic poison - As & Ba
Metallic poison - As & BaPurviBhalave
 
ARSENIC AND LEAD POISONING
ARSENIC AND LEAD POISONINGARSENIC AND LEAD POISONING
ARSENIC AND LEAD POISONINGNiby Mariyam
 
Corrosive poisons
Corrosive poisonsCorrosive poisons
Corrosive poisonsBitamSalam
 
Arsenic, lead and mercury toxicity
Arsenic, lead and mercury toxicityArsenic, lead and mercury toxicity
Arsenic, lead and mercury toxicityShreeya Sharma
 
10. ac. diarrhoea, vomiting & rec abd pain
10. ac. diarrhoea, vomiting & rec abd pain10. ac. diarrhoea, vomiting & rec abd pain
10. ac. diarrhoea, vomiting & rec abd painWhiteraven68
 
Organophosphorus poisoning
Organophosphorus poisoningOrganophosphorus poisoning
Organophosphorus poisoningManazir Athar
 
Presentation Mdc Nephro Uro
Presentation Mdc Nephro UroPresentation Mdc Nephro Uro
Presentation Mdc Nephro UroMiami Dade
 
Session 9 Common Toxicities
Session 9   Common ToxicitiesSession 9   Common Toxicities
Session 9 Common Toxicitieswindleh
 

Ähnlich wie Arsenic poisoning( acute, subacute and chronic) (20)

ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATION
ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATIONARSENIC POISONING - A FORENSIC MEDICINE PRESENTATION
ARSENIC POISONING - A FORENSIC MEDICINE PRESENTATION
 
Arsenic trioxide poisoning
Arsenic trioxide poisoningArsenic trioxide poisoning
Arsenic trioxide poisoning
 
INSECTICLDAL.ppt
INSECTICLDAL.pptINSECTICLDAL.ppt
INSECTICLDAL.ppt
 
Toxicology
ToxicologyToxicology
Toxicology
 
Arsenic poisoning roll no.82
Arsenic poisoning  roll no.82Arsenic poisoning  roll no.82
Arsenic poisoning roll no.82
 
Metallic poison - As & Ba
Metallic poison - As & BaMetallic poison - As & Ba
Metallic poison - As & Ba
 
ARSENIC AND LEAD POISONING
ARSENIC AND LEAD POISONINGARSENIC AND LEAD POISONING
ARSENIC AND LEAD POISONING
 
Gout kd22
Gout kd22Gout kd22
Gout kd22
 
ARSENIC-AIIMS KALYANI.pptx
ARSENIC-AIIMS KALYANI.pptxARSENIC-AIIMS KALYANI.pptx
ARSENIC-AIIMS KALYANI.pptx
 
Corrosive poisons
Corrosive poisonsCorrosive poisons
Corrosive poisons
 
Arsenic, lead and mercury toxicity
Arsenic, lead and mercury toxicityArsenic, lead and mercury toxicity
Arsenic, lead and mercury toxicity
 
Heavy metal poisoning PPT.pptx
Heavy metal poisoning PPT.pptxHeavy metal poisoning PPT.pptx
Heavy metal poisoning PPT.pptx
 
10. ac. diarrhoea, vomiting & rec abd pain
10. ac. diarrhoea, vomiting & rec abd pain10. ac. diarrhoea, vomiting & rec abd pain
10. ac. diarrhoea, vomiting & rec abd pain
 
Specific and nonspecific lesions of different organs of the body
Specific and nonspecific lesions of different organs of the bodySpecific and nonspecific lesions of different organs of the body
Specific and nonspecific lesions of different organs of the body
 
Poisoning
PoisoningPoisoning
Poisoning
 
Organophosphorus poisoning
Organophosphorus poisoningOrganophosphorus poisoning
Organophosphorus poisoning
 
Sangamesh
SangameshSangamesh
Sangamesh
 
Approach to a poisoned child
Approach to a poisoned childApproach to a poisoned child
Approach to a poisoned child
 
Presentation Mdc Nephro Uro
Presentation Mdc Nephro UroPresentation Mdc Nephro Uro
Presentation Mdc Nephro Uro
 
Session 9 Common Toxicities
Session 9   Common ToxicitiesSession 9   Common Toxicities
Session 9 Common Toxicities
 

Mehr von Dr. Mohd Kaleem Khan

MEDICOLEGAL CASES IN EMERGENCY.pptx
MEDICOLEGAL CASES IN EMERGENCY.pptxMEDICOLEGAL CASES IN EMERGENCY.pptx
MEDICOLEGAL CASES IN EMERGENCY.pptxDr. Mohd Kaleem Khan
 
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptx
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptxRole of Forensic Pathologists in Mass Aviation Disasters[1].pptx
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptxDr. Mohd Kaleem Khan
 
Medico Legal Responsibilities of Doctors.pptx
Medico Legal Responsibilities of Doctors.pptxMedico Legal Responsibilities of Doctors.pptx
Medico Legal Responsibilities of Doctors.pptxDr. Mohd Kaleem Khan
 
Medicolegal Aspect for upcoming doctors.pptx
Medicolegal Aspect for upcoming doctors.pptxMedicolegal Aspect for upcoming doctors.pptx
Medicolegal Aspect for upcoming doctors.pptxDr. Mohd Kaleem Khan
 
Witness ( legal procedures for doctors in India )
Witness ( legal procedures for doctors in India )Witness ( legal procedures for doctors in India )
Witness ( legal procedures for doctors in India )Dr. Mohd Kaleem Khan
 
Road Traffic Accidents - Medicolegal Aspect
Road Traffic Accidents - Medicolegal AspectRoad Traffic Accidents - Medicolegal Aspect
Road Traffic Accidents - Medicolegal AspectDr. Mohd Kaleem Khan
 
Injury to thorax and abdomen-Medicolegal Aspect
Injury to thorax and abdomen-Medicolegal AspectInjury to thorax and abdomen-Medicolegal Aspect
Injury to thorax and abdomen-Medicolegal AspectDr. Mohd Kaleem Khan
 
Vegetable irritant poisoning(castor abrus croton)
Vegetable irritant poisoning(castor abrus croton)Vegetable irritant poisoning(castor abrus croton)
Vegetable irritant poisoning(castor abrus croton)Dr. Mohd Kaleem Khan
 

Mehr von Dr. Mohd Kaleem Khan (20)

MEDICOLEGAL CASES IN EMERGENCY.pptx
MEDICOLEGAL CASES IN EMERGENCY.pptxMEDICOLEGAL CASES IN EMERGENCY.pptx
MEDICOLEGAL CASES IN EMERGENCY.pptx
 
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptx
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptxRole of Forensic Pathologists in Mass Aviation Disasters[1].pptx
Role of Forensic Pathologists in Mass Aviation Disasters[1].pptx
 
Medico Legal Responsibilities of Doctors.pptx
Medico Legal Responsibilities of Doctors.pptxMedico Legal Responsibilities of Doctors.pptx
Medico Legal Responsibilities of Doctors.pptx
 
Medicolegal Aspect for upcoming doctors.pptx
Medicolegal Aspect for upcoming doctors.pptxMedicolegal Aspect for upcoming doctors.pptx
Medicolegal Aspect for upcoming doctors.pptx
 
Witness ( legal procedures for doctors in India )
Witness ( legal procedures for doctors in India )Witness ( legal procedures for doctors in India )
Witness ( legal procedures for doctors in India )
 
Death and its Medicolegal aspect
Death and its Medicolegal aspectDeath and its Medicolegal aspect
Death and its Medicolegal aspect
 
Infanticide
InfanticideInfanticide
Infanticide
 
Criminal abortion
Criminal abortion Criminal abortion
Criminal abortion
 
Food poisoning Medicolegal aspect
Food poisoning Medicolegal aspectFood poisoning Medicolegal aspect
Food poisoning Medicolegal aspect
 
Forensics of hair analysis
Forensics of hair analysis Forensics of hair analysis
Forensics of hair analysis
 
Drowning
DrowningDrowning
Drowning
 
Road Traffic Accidents - Medicolegal Aspect
Road Traffic Accidents - Medicolegal AspectRoad Traffic Accidents - Medicolegal Aspect
Road Traffic Accidents - Medicolegal Aspect
 
Head injury- Medicolegal aspect
Head injury- Medicolegal aspectHead injury- Medicolegal aspect
Head injury- Medicolegal aspect
 
Injury to thorax and abdomen-Medicolegal Aspect
Injury to thorax and abdomen-Medicolegal AspectInjury to thorax and abdomen-Medicolegal Aspect
Injury to thorax and abdomen-Medicolegal Aspect
 
Metalic (Cu,fe,th,mg) poisoning
Metalic (Cu,fe,th,mg) poisoningMetalic (Cu,fe,th,mg) poisoning
Metalic (Cu,fe,th,mg) poisoning
 
Vegetable irritant poisoning(castor abrus croton)
Vegetable irritant poisoning(castor abrus croton)Vegetable irritant poisoning(castor abrus croton)
Vegetable irritant poisoning(castor abrus croton)
 
Vegetable
Vegetable Vegetable
Vegetable
 
Drug addiction a& dependence
Drug addiction a& dependenceDrug addiction a& dependence
Drug addiction a& dependence
 
Non Metallic Irritant Poisoning
Non Metallic Irritant PoisoningNon Metallic Irritant Poisoning
Non Metallic Irritant Poisoning
 
Poisoninng by Vegetable irritant
Poisoninng by Vegetable irritantPoisoninng by Vegetable irritant
Poisoninng by Vegetable irritant
 

Kürzlich hochgeladen

Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 

Kürzlich hochgeladen (20)

Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 

Arsenic poisoning( acute, subacute and chronic)

  • 1. Dr Kaleem Khan Assistant Professor JNMCH
  • 2.  It is the common environmental toxicant and is found in soil, water, and air.  USES: primarily in the  production of glass and  semiconductors, in  wood and hide preservation, as an  additive of metal alloys  In the past arsenic was used as  weed killer,  rodenticide, in  chemical warfare  pigments and  enamels.
  • 5.  Arsenious oxide (As2o3): most toxic form white arsenic/arsenious acid/ arsenic trioxide/ sankhya/ somalkar.  It occurs in two forms white  Crystalline powder or  Opaque mass.  No taste or smell and sparingly soluble in water  It is widely used in a) –  Calico printing ,  Taxidermy (preparing mounting skin of animals),  Artificial flowers,  Wall papers preparation,  Preservation of timber against ants ,  For treatment of  Rheumatic arthritis,  Impotence,  Syphilis.
  • 6. Rat poisons Calico print Fruit sprays Sheep-dips Weed-killer Taxidermy Fly papers preserving timber against white ants
  • 7.  Sulphides of Arsenic: colouring agent, depilatory, fly paper  Arsenic trisulphide (As2S3)/ yellow orpiment/ hartal  Arsenic disulphide (As2S2)/ red realgar/ manseel  Copper compounds of Arsenic: colouring agent  Scheels green/ copper arsenite  Paris green / copper acetoarsenite  Organic compounds:  Cacodylates,  Atoxyl,  Salvarson,  Arsenobentine (trimethylated arsenic)  Arsine gas
  • 8. • It is cheap • Easily obtained • Colourless • No smell • No taste • Small quantity is required to cause death. • Can be easily administered with food or drink. • Onset of symptoms is gradual • Symptoms simulate those of Cholera.
  • 9. Disadvantages Of Arsenic: • It delays putrefaction • Can be detected in completely decomposed bodies. • Can be found in bones, hairs and nails for several years. • Can be detected in charred bones or ashes.
  • 10.  Interferes with cellular respiration: It combines with sulphydryl groups of mitochondrial membrane especially pyruvate dehydrogenase  It is a capillary poison: increased permeability, causes tissue oedema and hemorrhage  Hyperaemia and haemorrhage in the intestine.  Interferes with glucose uptake, gluconeogenesis, fatty acid oxidation: Fatty degeneration of liver  Renal tubular necrosis  Peripheral nerves show axonal neuropathy: depression of nervous system.  Arsenolysis is a major form of toxicity in which the arsenic anions can substitute for phosphate in many reactions.
  • 12. It can be inhaled and absorbed through the skin or through GIT after ingestion. Once absorbed arsenic rapidly combines with the globins portion of haemoglobin and therefore localize in the blood, within 24 hours it redistribute to liver, kidney, spleen, lung and GI tract, with lesser accumulation in the muscle and nervous tissue. Excreted mainly through kidneys as methylated arsenic and some part by faeces, sweat, bile. It is excreted in stomach and intestine even when given by other routes (enterohepatic circulation ). It becomes fixed in cancellous tissue or bones. Replaces phosphorous. It is a known carcinogen: skin, liver, bladder
  • 13.  Fatal dose-  Arsenic trioxide: 180 mg,  But it varies on ingestion,  Inherent tolerance of the patient.  Fatal period:-  12-48 hours.  But can be fatal within 2-3 hours.
  • 14.  Patient experience a  Metallic taste,  Garlicky odour in the breath  Xerostomia  Dysphagia.  Increased salivation  Excessive thirst.  Severe nausea  Vomiting.  Colicky abdominal pain and  Profuse diarrhoea.  The stool are dark coloured and bloody and  Later on  Colourless,  Odourless, and  Watery resembling rice watery  Due to vasodilatation with transudation of fluid into the bowel lumen in addition to mucosal vesicle formation and sloughing leading to increased peristalsis.
  • 15. Vomiting is Projectile , Dark brown or yellow colour and Contain stomach contents, Blood and mucus Purging, tenesmus , pain and irritation around anus. Severe headache, vertigo, periorbtal odema, skeletal muscles cramps. Renal damage manifested as Oligurea, Proteinurea, and Haematuria. Fatty infilteration of liver Delayed loss of hair, skin eruptions
  • 16. Trait Arsenic poisoning Cholera 1.Pain in throat Before vomiting After vomiting 2.Purging Follows vomiting Precedes vomiting 3.StoolsLike Bloody later rice-water in early stage, Rice-watery and pass in continuous involuntary jet 4.Tenesmus Present Absent 5.Vomited matter Contains mucous, bile and blood Watery without mucou s, bile and blood
  • 18. When massive dose (> 3-5 mg) is rapidly absorbed. Gastric sign are usually absent Cyanosis, cold clammy skin, Hypoxic encephalopathy, convulsion, Acute tubular necrosis and renal failure Hyperpyrexia and acute haemolysis Acute hepatic failure, cirrhosis, ascitis, Cardiomyopathy, subendocardial haemorrhages, Decreased cardiac output due to hypovolemia by vasodilatation. Death d/t shock and peripheral vascular failure
  • 19.  It produces mainly CNS symptoms:  Giddiness  Precordial distress.  Tenderness of muscles.  Delirium.  Dilated pupils and complete paralysis of the muscles at times  Usual symptoms can also be produced such as  Convulsion,  Lockjaw,  Raised temperature,  Loss of speech and  Memory ,  Joint pain
  • 20.  Arsine gas act as a poison to haemoglobin and causes haemolysis.  It most commonly produces haemoglobinuria and anaemia.  The other symptoms produced as a result of poisoning are  Jaundice,  Dark red urine,  Renal failure,  Heart failure,  Delirium and  Coma.  Death usually instantaneous.
  • 21.  Urine: proteinuria, cast and albuminuria are there.  Arsenic poisoning is usually diagnosed with the urine test for arsenic as arsenic ions are present very shortly after ingestion.  A urinary excretion of arsenic >100mg/24 hours is regarded as indicative of exposure to a potentially toxic amount of arsenic  Monomethylarsine and dimethylarsine are present in the urine 24 hours after ingestion. acute poisoning).
  • 22.  Blood: 0.9 µg/dl, monocytic hypochromic anaemia, leukocytosis and mild eosinophilia.  Liver function test: serum alkaline phosphatase and bilirubin is raised and there is excretion of urobilinogen in the urine.  Hair and nails samples containing >300 ppm or 100 mg of arsenic per 100 gm of specimen are diagnostic of arsenic poisoning  Radiopaque sign on abdominal x-ray  Effective methods for arsenic detection.  Colorimetry,  Atomic absorption spectroscopy and  Neutron activation analysis
  • 23.  Stomach wash should be done with milk and warm water.  For Gastric Lavage 1% sodium thiosulphate in water is helpful  Demulcent such as ghee and barley water are given.  Purgatives like Castor oil and magnesium sulphate is administered to diminish intestinal absorption of arsenic
  • 24.  British anti lewisite (B.A.L.) Is administered  4 hourly for 2 days,  6 hourly for 1 day and  Total dose 12 hourly after wards,  Total dose is 2.5-3 mg/kg body wt.  To know when the chelation is to be stopped, 24 hour urine sample is to be collected and if arsenic level is fall below 50mg/24 hours,  It should be stopped for 5 days and then started again so that the tissue arsenic is mobilized and ready for chelation.
  • 25.  Oral Penicillamine  100mg/kg. Body wt.  In 4 divide doses in 24 hours for 4-8 days after initial 12-48 hours of B.A.L therapy.  Morphine is given to relieve pain.  Saline is administered i.v. for dehydration and enuresis.  To relieve cramps , massage employed, body temperature to be maintained.
  • 26. ◦ Patient to be taken to fresh air. ◦ Oxygen inhalation to be started . ◦ Exchange transfusion should be undertaken. ◦ Haemodialysis is ensued. ◦ Alkaline drinks are given. ◦ All of the methods help to eliminate arsine gas from the blood. ◦ B.A.L. is not effective in arsine gas poisoning.
  • 27. ◦ Emaciated body d/t dehydration ◦ Rigor mortis lasts longer ◦ Blood tinged vomitus and faecal matter ◦ Mucus membrane of small intestine are inflamed ◦ Stomach red velvety appearance ◦ Liver, heart and kidney: congested, enlarged, swelling and fatty degeneration may be seen
  • 28.  Chronic arsenic poisoning result from chronic repetitive ingestion or inhalation of arsine gas by:  Arsenic Extraction  Extraction of metals from ore by melting .  Refining of the ores.  Manufacture of  The weed killers,  Insecticides,  Paints,  Dyes and  Cosmetics
  • 29.  Person who ingest it as medicine for long periods may follow the acute poisoning after recovery.  When the dose is not large enough to kill the patient, a number of secondary effects can be seen 2-4 weeks after ingestion of the poison
  • 31.  FIRST STAGE: GIT disturbances ◦ Loss of weight . ◦ Loss of appetite and salivation. ◦ Colicky pain and constipation. ◦ Vomiting and diarrhoea. ◦ Gums are red and soft. ◦ Tongue is coated, is thin white salivary furred. ◦ Oedema of eyelids and ankles ◦ Temperature and pulse is raised
  • 32.  Second Stage: Cattarhal Stage  Dryness and etching of the skin.  Voice is hoarse and husky,  Runing nose,  Cough  Bronchial coryza .  Photophobia and conjunctivitis  Liver is enlarged and cirrhotic,  Chronic nephritis.
  • 33. Erythematous flushing caused by cutaneous capillary dilation, generalised and localised.  RAIN DROP TYPE of pigmentation of the skin involving the covered part of the body such as flexors, nipples, lower abdomen, temples and eye lids.  Epithelial hyperplasia, discrete multiple wart like keratosis on the palms and sole, head and trunk.  Hyperkeratosis then occurs with desquamation of the palm and soles
  • 37. ◦ Nails are brittles with linear pigmentation, Aldrich Mee`s Line ( white transverse line seen on the nail plate up to a year after arsenic intoxication). ◦ Hair are dry patchy and diffuse alopecia. ◦ Painless perforation in the nasal septum.
  • 38.  that look much like traumatic injuries are found on the fingernails.
  • 39. ◦ Peripheral neuritis with glove and stocking type of anaesthesia resembling alcoholism. ◦ Encephalopathy may be seen in some cases, presenting in severe headache, personality disturbance, convulsion or coma. ◦ The predominant clinical feature of neuropathy are parasthesia, numbness, pain on particularly on the soles of the feet. ◦ It is usually a symmetrical sensorimotor polyneuropathy often resembling Gullian- Barre Syndrome ◦ Eventually muscular atrophy resulting in wrist drop and Foot drop.
  • 41.  Muscular weakness, ataxia, cramps tremors and general emaciation and death is due to failure of heart muscles.  Oedema of the face, periorbital region or ankle from localised transudation of intravascular fluid, knee jerk is usually lost.  Impotence is commonly present.  There is evidence of ◦ Bone marrow depression ◦ Aplastic anaemia ◦ Normochromic normocytic anaemia ◦ Leucopenia, thrombocytopenia and mild eosinophilia. ◦ Megaloblastic anaemia
  • 42. Differential Diagnosis: ◦ Chronic arsenic poisoning is to be differentiated from alcoholic neuritis. ◦ In chronic arsenic poisoning the symptoms and signs are developed rapidly , are widespread. ◦ There is no glycosuria in as poisoning whereas in alcoholic neuritis glycosuria is positive.
  • 44. ◦ Remove the patient from the source of poison. ◦ B.A.L is to be given 6 hourly for 2-3 days. ◦ once daily Vitamin B1 injection for peripheral neuritis. ◦ Improve general health.
  • 45. ◦ Emaciation, pigmentation, keratosis, Aldrich Mees lines, jaundice , wasting of muscles and ulceration of nasal septum ◦ Internally stomach shows patchy inflammation, fatty degeneration of liver, tubular necrosis of kidney, and myocardial necrosis ◦ Preserve hair, nail and bone(lower end of femur)
  • 46.  It is ideal homicidal poisoning that is used frequently in India.  It is used as a cattle poison.  It is used for suicidal purpose.  Poisoning can result accidentally due to its improper medicinal use when it is applied locally as a cure for impotence.  Poisoning can result from its application on the abraded skin, when it is used as vaginal pessaries or when it is mistaken for baking powder or soda.  Arsenophagist: Use the drug as a habit as aphrodisiac and can acquire tolerance upto .03gm or more in one dose
  • 47.  Accidental cases of poisoning sometimes occur from its admixture with drink or articles of food.  White arsenic has been mistaken for baking powder, soda, salt or flour and has caused mass accidental poisoning.  The mountaineers of Styriaand Tyrol used it daily with a view to becoming hardier tocarry weights and climb mountains.  The greatest concentration of arsenic is found in hair and nails. Its deposition in hair may begin in 15 days after administration.
  • 48.  Exhumed body: Arsenic cannot percolate in the cadaver from the soil, as it is an insoluble form ofsalt. The nails and hair will have a higher concentrationfrom the soil. The soil is to be kept forchemical analysis.
  • 49.  Napoleon Bonaparte (Emperor of France from 1804 to 1815) has been the source of attention of the historians because of his flamboyance and daring exploits, and perhaps also because of his tragic demise. On being defeated in legendary Battle of Waterloo in 1815, he was exiled to the very remote island of St. Helena (a British colony in the Atlantic),where he died a mysterious death. His death remained speculative until the scientific authenticity was finally established.  Some hair from the scalp were procured by Ben Wielder(a Napoleonic scholar) submitted to neutron activation analysis, revealing fluctuating levels of arsenic throughout the length of the hair, ranging from 4.4 to 23.0 parts per million.