Inorganic Non-Metallic

Irritants

Presented By:

Sunil Kumar Daha

PAHS-SOM, Nepal

MBBS 4th Batch

Lists of Inorganic Non-Metallic Irritants

• Phosphorus

• Iodine

• Chlorine

• Powdered glass

PHOSPHORUS

It exists in two varieties:

◦ White/ yellow/crystalline phosphorus

Fertilizers, insecticide,rodenticide, screens, firework, incendiary bombs, smoke

screens, fireworks, etc.

◦ Red/ amorphous phosphorus

matchbox

Trait White phosphorus Red phosphorus

Color White or yellow Reddish-brown

Appearances Translucent, waxy cylinders Amorphous, solid mass

Smell Garlicky Odorless

Taste Garlicky Tasteless

Luminosity Luminous in the dark Non-luminous

Exposure to air

Oxidises and emits white fumes: ignites at 34 C. and as such kept under water

Non-oxidized, non-fuming, non-inflammable

Use Fertilizers, vermin-killers, rodenticide, fireworks, gunpowder, etc.

On the sides of match box.

Toxicity Highly toxic Non-toxic

Action: It is protoplasmic poison, which affects cellular oxidation

Phosphorus poisoning

Fulminant Acute

First stage

Second stage

Third stage

Chronic

Contact Injury

- Seen when >1 gm taken- Die within 12 hrs. d/t shock

and CVS collapse- >12hrs. Survivor are

restless, delirious and some maniacal before death

- Thirst, severe nausea, vomiting and retching occurs

• First stage:

• Occur within a few minutes to few hours after exposure and last from 8 hrs. to 3 days

• d/t local irritation

• Burning pain in the throat and abdomen, with intense nausea, vomiting and diarrhea

• Garlic odor of breath and excreta

• Luminescent vomit and faeces (diagnostic) Smoking Stool Syndrome• Skin contact-painful penetrating 2nd and 3rd degree burns

• Second stage: symptom free period lasting for 2-3 days

• Third Stage: symptoms of systemic toxicity (Hematology, renal and CNS)

Acute Phosphorus Poisoning

Phosphorus poisoning

Fulminant Acute

First stage

Second stage

Third stage

Chronic

- frequent inhalation of fumes over years- Causes necrosis of lower jaw in the region

of decayed toothSx: toothache followed by swelling of the jaw, loosening of teeth

- Necrosis of gums and- Sequestration of bone in the mandible

(Phossy Jaw/ Glass jaw)Osteomyelitis and discharging sinuses

- Systemic symptoms

• Fatal dose: 60 to 120 mg

• Fatal Period 2 to 8 days

Treatment:1. Life support measures2. Gastric lavage using potassium permanganate3. Activated charcoal4. Stomach can be washed with 0.2% CuSO4 soln.5. Vit. K, 20 mg i.v. repeated dose6. Bowel should be evacuated with MgSO47. Washout bowel and repeat at intervals for several days8. Oil and fats should be avoided9. Transfusion of glucose-saline and plasma with vitamins and NA to correct shock and

dehydration10. If renal failure, dialysis11. Burns should be thoroughly washed with 1% CuSo4 soln. in water

PHOSPHORUS Poisoning

LD50 of Acute exposure: 1 mg/Kg

Postmortem Changes of Phosphorus poisoning

Fulminating Acute poisoning Chronic

Poisoning

- No obvious changes

- Signs of irritation on GIT

- Luminous material may found in stomach

- Signs of Jaundice, Purpura, smell of Garlic from gastric and intestinal content and may be luminous

- Liver is soft , swollen, fatty and easily ruptured

- Kidney; enlarged greasy and yellow- Heart; flabby, pale and fatty

degeneration- In longer Survivors: Acute yellow

atrophy present- Hypostasis: dark brown in color

- Phossy jaw

Trait Phosphorus poisoning Acute yellow atrophy

Size Enlarged at first, later may be normal or contracted

Smaller, irregular, with a wrinkled capsule

Color Marbled Bright-yellow in earlier stage; deep-red later

Consistency Soft, greasy and friable Very soft and flabby

Structure Fatty degeneration of liver with some cellular necrosis; small hemorrhages on the surface and in the substance

Disintegration and necrosis of most cells. Supporting tissue is not damaged

• Accidental poisoning among children (d/t chewing of fireworks or by eating rat paste)

• Occasionally used for homicide mixed with alcohol, coffee, etc. to diminish the taste and smell and administered for the following reasons: • There is delay in appearance of symptoms.• Death occurs after few days• Symptoms resemble acute liver disease• The poison is oxidized in the body, if the patient survives long and as such cannot be detected

• Used for abortion as well• Cases of poisoning during war• For arson,

PHOSPHORUS Poisoning

Medico-Legal aspects

IODINE

• Bluish-black, soft and scaly crystals,

• Has a metallic lustre and an unpleasant taste

• Gives off a violet-colored vapor at all temperatures, which has a characteristics odor

CHLORINE

• Action: It is a protoplasmic poison fixing protein and causing necrosis. Vapours irritate respiratory passages

• Symptoms after inhalation: (Acute)• Burning pain extending from mouth to stomach

• Intense thirst, salivation

• Nausea, vomiting and spasm of glottis

• Convulsive movements of limbs and fainting

• Lips and angle of mouth stained brown

• Solid form corrosive

• Red-brown colored urine, nephritis and renal failure may occur

IODINE Poisoning

• Pain over the frontal sinus,

• Running of the nose, conjunctivitis

• Salivation, nausea, vomiting, purging

• Parotid swelling (Iodine Mumps)

• Wasting of breast, testes etc.

• Acne or erythematous patches of the skin, etc. (Ioderma)

Chronic Iodine Poisoning (Iodism)

• Fatal dose: 2-4 gm

• Fatal Period 24 hrs.

CHLORINE contd..

Treatment:

1. evacuate the stomach by emetics2. Give 1-5% soln. of sodium thiosulfate3. NaCl promotes excretion of Iodine4. Give alkalis, arrow root, and barley water and treat symptomatically5. For skin lesion 20% alcohol

IODINE Poisoning contd..

• Postmortem changes:

• Inflammation of the stomach and intestines, excoriated and may be brown

• Fatty degeneration of heart, liver and Kidney and• Edema of Brain

IODINE Poisoning contd..

CHLORINE

• A greenish-yellow gas, unpleasant irritating odor

• An oxidizing agent and causes destruction of organic tissue

• Exposure is likely in laboratories, bleaching-powder factories

CHLORINE

• Symptoms after inhalation:• Intense irritation of the eyes and throat and mucous membrane of respiratory

passage

• Violent coughing and extreme dyspnea

• Nausea, vomiting and spasm of glottis

• Death by cardiac failure following inflammatory edema of the lungs and pulmonary congestion

CHLORINE contd..

• Fatal dose: exposure to one part in 1000 may prove fatal in five minutes

• Fatal Period within 2 days

CHLORINE contd..

Treatment: remove from poisonous atmosphere. Treat the shock, circulatory collapse and pulmonary edema

Powdered Glass contd..

• Postmortem changes: (Asphyxial)• Inflammation of the respiratory tract, pulmonary edema,

• Rupture of alveolar walls, hemorrhages and

• Thrombosis in the lung beds and

• Increased viscosity of the blood

CHLORINE contd..

Powdered Glass

• Symptoms:• Sharp burning pain in the throat, stomach and intestines

• Nausea, vomiting

• Usually constipation (rarely diarrhea)

• Fatal dose and fatal Period Uncertain

• Death may result from shock, if stomach or the intestine is perforated

Treatment: Give bulky food and later emetics and purgatives

Powdered Glass contd..

• Postmortem changes: (May be)• Erosion extending from mouth to upper part of small intestine

• Glass particles in the stomach and intestine

• Congested/inflamed mucosa of GI tract

• Medicolegal Importance:• Rarely used for suicide or homicide

• Taken in powdered form mixed with some articles of food

• Occasionally, used as cattle poison

Powdered Glass contd..

References

• The essentials of Forensic Medicine & Toxicology, Reddy 34th edition

• Textbook of Forensic Medicine and Toxicology, Krishnan Vij

• Textbook of Forensic Medicine and Toxicology, Nageshkumar G Rao

• Up-to-date

Thank you