Thursday, 25 June 2015

Arsenic

Metallic arsenic is not poisonous, as it is not absorbed from the alimentary canal.

     Poisonous compounds:

     1.  Arsenious oxide or Aresenic trioxide (Sankhya or Somalkar): it is known as white arsenic. It has been found to be useful in treatment of Acute Promylocytic Leukemia (APL)*

     2.  Copper acetoarsenate (paris green): It combines with sulphydryl enzymes and inter­feres with cell metabolism.

     3.  Copper Arsenate (Schcele’s green).

 

 

–   Signs and Symptoms:

     1.  The Fulminant type: Large doses of arsenic can cause death in one to 3 hrs from shock.

     2.  The Gastro enteric type: This is acute poison­ing, resembling bacterial food poisoning or cholera.

          –   This is the most common form.

          –   The stools are expelled frequently and involuntarily, are dark coloured, stinking and bloody, but later becomes colorless, odourless and water resembling rice water stools of cholera.**

          –   Sequence of symptoms:

               • Throat pain

               • Vomitting (Bile, Blood and Mucous)

               • Purging (Tenesmus present)

     3.  Narcotic form: Tenderness of the muscle, delirium, coma and death.

 

  •    Arsenic poisoning resembles

          –   Pre malignant condition

          –   Cholera

          –   Fading measles

          –   Addison’s disease.

 

–   Treatment

     1.  Freshly prepared precipitated hydrated ferric oxide (arsenic antidote)* is given. Dialysed Iron is substitute.

     2.  In arsenic poisoning BAL is an antidote. (BAL is contraindicated in cadmium and iron poisoning).

     3.  Calcium disodium versenate

     4.  Alkali is contra indicated.

 

–   Postmortem appearance

     •    Red Velvety* appearance of the stomach mucosa.

     •    Subendocardial haemorrhage of heart.*

 

–   Chronic poisoning:

     1.  CNS—Polyneuritic, optic neuritis

     2.  Skin—finely mottled brown change mostly on the temples, eyelids and neck (RAIN Drop pigmentation)

          •    There may be a rash resembling fading measles rash*

          •    Hyperkeratosis and Hyperpigmentation of the palms and soles with irregular thicken­ing of the nails is seen.

          •    Nails show ALDRICH MEE’s line (Leuko­paronychia).{Confuser*

Beau’s Lines

® Chronic Systemic Disease, also Muehrcke’s Line® hypo proteinemia}

          •    Nails show ALDRICH MEE’s line (Leukoparonychia).

 

–   Arsenophagists are people who take arsenic daily as tonic or as an aphrodisiac and they acquire a tolerance of up to 0.3gm or more in one dose.

 

Medicolegal Importance

•    Arsenic is the most popular homicidal poison.

•    Napoleon was killed using Arsenic poison (c.f. Socrates was killed using Hemlock poisoning).

•    It delays putrefaction.

•    It can be detected in completely decomposed body.

•    It can be found in bones, hair and nails for a long time.

•    It can be detected in charred bone and ashes.

•    It is sometimes used in abortion sticks.

•    Arsenic causes Black foot disease.*

•    Marsh test and Reinsch test are important Chemical tests*.

     Early stages greatest quantity in liver  Later keratin tissues: BONE, HAIR & NAILS.

     Test for Arsenic® 

    I.  Reinsch Test

  II.  Marsh Test (mARSenich)

III.  Gutzeit Test.

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