2ObjectivesIntroduction, classification and identification of poisonous plants.Circumstances, route of entry, metabolism and excretion of plant poisons.Mechanism of action, target organs, clinical features(early and late phase) and principles of management.Autopsy features(external and internal) and sample collection.
3Plant poisoning More than 300 poisonous plants. Some are edible. Act on more than one organ, but act principally on one organ system.
10Toxic substances Atropine Hyoscine Hyocyamine Scopolamine All are alkaloids
11Circumstances Accidental –Children eat the seed or fruit Eating the leaves (mistakenly)Intentional – for revenge, confuse an enemyto robbery – mix with thalaguli during long distance bus travelsSuicidal ingestion rare.
15Organs Pathophysiology Clinical Features CNS Stimulation Followed by depressionEuphoria, delirium aggression, terrifying hallucinations,bizarre behaviour, confusion, convulsions,increased muscle tone,UnconsciousnessHeartParasympathetic block — > stimulationTachycardia, hypertension, Tachyarrythmias rarelySkinInhibition of sweat glands, Dilatation of blood vesselsDry, hot FlushesEyesRelaxation of radial muscles ofpupils, Inhibition of lachrymalglandsMydriasis and blurring of vision, photophobia, Dry eyesAlimentary tractInhibition of salivary glands ,Inhibition ofintestinal musculature leading torelaxationDry mouth,Reduced gut motilityGUTRelaxation of detrusor muscleUrinary retention
16Principles of Management Eliminate the poisonPhytostigmine to reverse the actionDiazepam to control fitsManage complications accordingly
34Strychnos Nux vomika Goda/Divi kaduru Spinal stimulantCommonly found in Southern costal area.Toxin is mainly found in seeds.Poison – Strychnine ( an alkaloid)
35Circumstances Accidental – Children eat fruit Suicidal rare due to bitterHomicidal rare due to bitterAbstract of seeds(strychnine) is used to as a rodenticide, kill stray dogs by injecting with a long stickHomicidal injection - rare
36Absorption All mucosal surfaces Rapidly absorbed via GIT and spread throughout body
49Clinical features Faintishness,papitation, irregular pulse,hypotensoin Yellow vision,blurred vision,dilated pupils,muscular twiching,tetanic spasms,anxiety,confusionNausea,vomitingPain in throat and numbness in tongue and lips,abdominal pain,profuse salivation
50Principles of management EmesisActivated charcoalAntidote-Kaneru tab(Antibody against cardiac glycosides)Management of complications
51Mode of death Circulatory failure Arrhythmias Lethal dose : 8-10 seeds, 15-20g root
52AutopsyNon specificGIT irritationFragments of seed in stomach
53Poisonous part – Fruit seeds Poison - Cardiogenic glycosidesCircumstances - Accidental, suicidalClinical features - Cardiac arrhythmias
54Gloriosa superba (Niyangala) Main suicidal poison before availability of pesticidesGrows throughout the island
60Patho – physiologySymptoms and signsTime of onset after ingestionAcute inflammation of alimentary tract mucosa due to local actions of salicylic acid and benzoic acidburning pain, numbness, itching and tingling around mouth and throat. Nausea, vomiting, dehydration, thirst, blood and mucus diarrhoeawithin hrsAugmentation by choline of autonomic contraction of smooth muscles throughout the body. In gastrointestinal tract , bronchi , uterusabdominal colic, ileus, tenesmus, breathlessnessabortionBlock of mitosis, by cholchicine in bone marrow→bone marrow aplasia→Throinbocytopeniableeding gums, easy bruisingwithin 6 hrsAcute tubular necrosis of the kidneydecreased urine output, haematuriaCentral nervous system stimulation, then depression.Respiratory centre depressionRestlessness, confusion, delirium, convulsions, coma Breathlessnessafter 36 hrsArrest of cell division in hair follicles Rapid shedding of stratum corneumAlopecia, generalized depilation Dermatitisafter 1-2 weeks
61Principles of management Gastric lavageActivated charcoalManagement of complications
62Autopsy Features of acute dehydration and GI irriration Features of complication
63Ricinus communis(Endaru) Entire plant is poisonousSeeds most poisonousGrows throughout the island