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    Phosphorous Poisoning-1

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    Phosphorous Poisoning-1

    Uploaded by

    pushpa05rathore
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    Phosphorous Poisoning-1 (1)

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    2 views24 pages

    Phosphorous Poisoning-1

    Uploaded by

    pushpa05rathore

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    PHOSPHOROUS

    POISONING
    ANNA ANU ANTONY
    ANNA SUSAN ROY
    ANNAMOL SUNNY
    ANOOP BIJU
    OBJECTIVES
     To know the varieties of phosphorous and their major differences

     To list out important sources of phosphorous poisoning

     Study the mechanism of action of phosphorous as a poison

     List out the manifestations of acute and chronic phosphorous poisoning

     Understand the treatment of acute phosphorous poisoning

     To list out important post mortem findings in phosphorous poisoning

     Understand the related medico legal aspects


    INTRODUCTION
     There are two varieties :
    1. white or crystalline phosphorus
    2. red or amorphous phosphorous
    CHARACTERISTIC WHITE RED
    PHOSPHOROUS PHOSPHOROUS

    Colour White or yellow Reddish brown

    Appearance Waxy, crystalline, Amorphous , opaque


    translucent
    Solubility
     Organic solvents Yes No
     water
    Very low insoluble
    Odor Garlicky odor odorless

    taste Garlicky tasteless

    luminosity Luminous in dark Non luminous


    CHARACTERISTIC WHITE RED
    PHOSPHOROUS PHOSPHOROUS
    Ignitability Inflammable, Non inflammable
    spontaneous ignition in
    air at room temperature
    , emits white fumes
    toxicity Highly toxic Non toxic

    uses Fertilizers, Sides of match boxes


    insecticides,
    rodenticides,
    incendiary bombs,
    smoke screen and
    fireworks
    Uses of white phosphorous

    rodenticide fireworks incendiary bombs

    fertilizers smoke screen fireworks


    MECHANISM OF ACTION

     Protoplasmic poison and affects cellular oxidation


     Metabolism of cell reduces leading to necrobiosis – predominantly
    seen in liver and kidneys
     Impaired glucose homeostasis , Lipoprotein and triglyceride
    metabolism leading to Fatty degeneration of liver , brain and
    kidney
     Lipid peroxidation - cell membrane damage and cell death

     Fatal dose- 60 – 120 mg


     Fatal period- 2 to 8 days
    SIGNS AND SYMPTOMS
    OF
    PHOSPHORUS POISONING
    Fulminant poisoning

     More than 1 gram is ingested


     Usually die within 12 hours – shock and cardiovascular
    collapse
     Those who survive more than 12 hours – restless, delirious,
    maniacal till death
     Thirst, severe nausea, vomiting and retching
    Acute Poisoning

     Fatal dose – 60 to 120 mg


     Fatal period – within 24 hrs, delayed to 5 – 7 days
     Contact injury – painful penetrating second and third degree burn
    injuries.
     Burn has necrotic area, yellow colour and garlic like odour
     White phosphorus – dermal penetration and delayed wound healing.
    First stage
     Burning pain in throat and abdomen
     Intense thirst, nausea, vomiting, diarrhoea and abdominal pain
     Breath, vomitus, faeces – garlic like odour
     Luminescent vomit and faeces are diagnostic

    Second stage – Symptom free period lasting for 2 to 3 days


    Third stage
     Systemic toxicity
     GIT – nausea, vomiting, hematemesis, diarrhoea
     Hepatic – hepatomegaly, jaundice, pruritus
     Renal – Oliguria, hematuria, casts, albuminuria,
    sometimes anuria
     Hematologic – Purpura, hemorrhage
     CNS – Restlessness, anxiety, insomnia, headache
     PNS – tetany, stridor, paresthesia
     CNS manifestations can progress to confusion, hallucination,
    convulsion, delirium and coma.

     Diagnosis – Oral and skin burns, Luminescent smoking vomitus and


    stools with garlic like odour, GIT and biliary damage – white
    phosphorus poisoning.
    TREATMENT FOR PHOSPHORUS
    POISONING
    Treatment

    i. Life support measures-airway support and fluid maintenance should


    be provided.
    ii. External burns should be washed and cleaned with mild disinfectant
    soap and water, and covered with antibiotic ointment.
    iii. Gastric lavage using 1:5000 solution of KMnO4 (chemical antidote)
    oxidizes phosphorus into harmless phosphoric acid and phosphates.
    iv. Activated charcoal is given.
    v. Demulcents (oily or fatty substances) are contra- indicated, as
    phosphorus gets dissolved and gets absorbed
    vi. Purgatives (magnesium sulfate) may be given.
    vii. Vitamin K 20 mg IV in repeated doses, or blood transfusion.
    viii. Transfusion of glucose-saline and plasma with vitamins is useful to
    protect the liver and to correct shock and dehydration.
    ix. Peritoneal or hemodialysis may be required (for correction of
    hyperphosphatemia, hyperkalemia and hypocalcemia).
    x. N-acetylcysteine, ubiquinone and sulfate have been tried to prevent
    liver damage
    Post mortem findings

     External-
    i. Emaciation, purpuric hemorrhages in the skin, jaundice, and smell
    of garlic may be present.
    ii. Mucous membrane of the mouth is corroded.
    iii. Hypostasis is dark brown in color
     Internal.
    i. Multiple hemorrhages are seen in the muscles, serosal and mucosal membranes of
    the GIT and respiratory tract, liver, kidneys, endocardium, pericardium, epicardium,
    peritoneum, lungs and brain
    ii. Stomach and intestines: Mucous membranes are yellowish or grayish-white in
    color, softened, thickened, inflamed and corroded in patches; luminous material
    may be found in the stomach. Contents may smell of garlic
    iii. Liver Swollen, yellow, soft, fatty and easily ruptured.*
    iv. Kidneys: Enlarged, greasy, yellow.
    v. Heart: Flabby, pale and shows fatty degeneration.
    vi. Lungs: Fat emboli may be found in the pulmonary arterioles and capillaries.
    MEDICOLEGAL ASPECTS
    OF
    PHOSPHOROUS POISONING
    Medico-legal aspects

     Accidental poisoning in children due to chewing of fireworks or by eating rat


    paste may occur.
     It is not preferred for suicide because of painful symptoms and prolonged
    suffering. It may be used for homicide purpose by mixing with alcohol or
    coffee to mask the taste and smell and administered, since:
    a. Symptoms resemble acute liver disease
    b. There is delay in the appearance of symptoms.
    c. The poison is oxidized in the body, hence cannot be detected.
    d. Death occurs after few days.
    ► Sometimes, it is taken by mouth or introduced into the vagina
    to procure abortion.
    ► Cases of poisoning may occur during war, when phosphorus
    enters the body with fragments of hand grenades, smoke
    screens, bombs or bullets.
    ► For arson, white phosphorus covered with dung or wet cloth is
    thrown on huts. When the covering becomes dry, the roof
    catches fire.
    Chronic phosphorus poisoning

     The frequent inhalation of fumes over a period of years causes necrosis of the lower
    jaw in the region of a decayed tooth.
     Initially, there is toothache which is followed by swelling of the jaw, loosening of the
    teeth, necrosis of the gums and sequestration of bone in the mandible with multiple
    sinuses discharging foul-smelling pus. This is known as 'phossy jaw' (glass jaw or
    Lucifer's jaw) in which osteomyelitis and necrosis of jaw occurs.
     Constitutional symptoms include nausea, vomiting, anorexia, pain in the abdomen,
    indigestion, purging, pain in the joints, weakness, loss of weight, bronchitis,
    cirrhosis, jaundice, ascites and anemia.
    ‘PHOSSY’
    JAW
    THANK YOU

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