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Plant Poisoning Dr. Ravi Nanayakkara.

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Presentation on theme: "Plant Poisoning Dr. Ravi Nanayakkara."— Presentation transcript:

1 Plant Poisoning Dr. Ravi Nanayakkara

2 Objectives Introduction, 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.

3 Plant poisoning More than 300 poisonous plants. Some are edible.
Act on more than one organ, but act principally on one organ system.

4 Classification Neurotoxins Cardiac toxins Gastrointestinal irritants
Cellular poisons

5 Neurotoxins Datura stramonium Substances of abuse Canabis sativa
Erythrocylon coca Papaver somniferum Strychnos Nux vomika

6 Cardiac toxins Nerium odorum Thevetia peruviana

7 Gastro intestinal irritants
Gloria superba Ricinus communis

8 Cellular poisons Manihot utilissma Adenia palmeta

9 Datura stramonium Attana CNS

10 Toxic substances Atropine Hyoscine Hyocyamine Scopolamine
All are alkaloids

11 Circumstances Accidental –Children eat the seed or fruit
Eating the leaves (mistakenly) Intentional – for revenge, confuse an enemy to robbery – mix with thalaguli during long distance bus travels Suicidal ingestion rare.

12 Absorption GIT Skin Mucous membranes

13 Target Organs - Atropine
brain, heart, smooth muscles, glands Excretion - Kidney

14 Clinical features Shown in the table.

15 Organs Pathophysiology Clinical Features CNS
Stimulation Followed by depression Euphoria, delirium aggression, terrifying hallucinations, bizarre behaviour, confusion, convulsions, increased muscle tone, Unconsciousness Heart Parasympathetic block — > stimulation Tachycardia, hypertension, Tachyarrythmias rarely Skin Inhibition of sweat glands, Dilatation of blood vessels Dry, hot Flushes Eyes Relaxation of radial muscles of pupils, Inhibition of lachrymal glands Mydriasis and blurring of vision, photophobia, Dry eyes Alimentary tract Inhibition of salivary glands ,Inhibition of intestinal musculature leading to relaxation Dry mouth, Reduced gut motility GUT Relaxation of detrusor muscle Urinary retention

16 Principles of Management
Eliminate the poison Phytostigmine to reverse the action Diazepam to control fits Manage complications accordingly

17 Mode of death Respiratory paralysis  Asphyxia

18 Postmortem finding Non specific
Seeds or fragments of the plant may be found in the stomach.stomach may show slight inflmmation. Lungs : pulmonary oedema. Other organs will show sings of asphyxia.

19 Specimen collection Stomach and contents Intestine Urine Blood

20 Canabis sativa Ganja – flower Marijuana – flowery tops / cut leaves
Hashish – dried resin H oil – oily extract

21 Toxic substances Alkaloids Cannabinol Cannabidiol Cannabidiolic acid

22 Circumstances Smoking Beverage With datura

23 Clinical features Inhibitions removed – like alcohol Confusion
Restlessness Hallucinations Narcosis Nausea Depression

24 Principles of management

25 Autopsy Non specific Features of addiction

26 Erythrocylon coca Grows in Central/South America Toxic Substances
Alkaloid – cocaine Leaves Synthetic Action – stimulates CNS and CVS similarly to adrenalin

27 Clinical features Shown in the table.

28 Pathophysiology Clinical features CNS - Initial stimulation Late - depression Excitement, hallucinations, euphoria, hyperkinesis, headache, nausea, vomiting, twitching of small facial muscles, stereotype behaviour, hypereflexia, tonic-clonic seizures Hyporeflexia, coma, respiratory and cardiovascular depression CVS - Initial stimulation – Late – depression Tachycardia, hypertension, ventricular dysrhythmias Weak, slow pulse; low blood pressure Respiratory system - Initial stimulation – Late depression Tachypnoea, slow shallow breathing, cyanosis Vasoconstriction, Hyperactivity (psycho-motor) Pyrogenic action on thermoregulatory centre pallor, hyperthermia Sympathomimetic action on intestinal wall Diarrhoea, abdominal cramps Constriction of radial muscles of the pupil Dilatation of pupil

29 Discussed in drugs of abuse

30 Papaver somniferum (Opium / Heroin)
Unriped capsule of poppy plant Alkaloids – morphine codeine narcolin papavarin ……

31 Circumstances Ingestion Inhalation Injections

32 Clinical features Excitement – euphoria Depression of brain stem
Narcosis and death

33 Discussed in drugs of abuse

34 Strychnos Nux vomika Goda/Divi kaduru
Spinal stimulant Commonly found in Southern costal area. Toxin is mainly found in seeds. Poison – Strychnine ( an alkaloid)

35 Circumstances Accidental – Children eat fruit
Suicidal rare due to bitter Homicidal rare due to bitter Abstract of seeds(strychnine) is used to as a rodenticide, kill stray dogs by injecting with a long stick Homicidal injection - rare

36 Absorption All mucosal surfaces
Rapidly absorbed via GIT and spread throughout body

37 Target organ Spinal cord and brain

38 Action Strychnine stimulate the brain and spinal cord by inhibiting the inhibitory pathways. Hyperexcitation of brain stem and spinal cord. Slightest stimulation can cause convulsions.

39 Clinical features Bitter taste in mouth Muscle stiffness Tremors
Twitching Convulsions Concious till death

40 Differential diagnosis
Feature Strychnine Tetanus History Of poisoning (may be) Injury (usually available) Onset of symptoms Sudden Gradual Early symptoms Uneasiness, Restlessness Lock jaw Relaxation in between spasms Complete Never complete Fatal period Few hours Several days Chemical analysis Poison + No poison

41 Management Maintain airway, breathing, circulation Control fits
Minimum stimulation Gastric lavarge and vomiting can precipitate convulsion. Management of complications

42 Mode of death Hypoxia to brain stem Respiratory paralysis Asphyxia

43 Autopsy Non specific Asphyxia Muscle haemorrhages

44 Cardio vascular system
Thevetia peruviana – Yellow oliander Nerium oleander – Pink oliander

45 Circumstances Suicide-consume fruits
Accidental – any part of the plant (children) Homicidal-rare

46 Toxic substance Cardiac glycosides – digitalis like action
Inhibit Na+/K+ ATPase Alteration of membrane potential in myocardium and neurones Increse cardiac Excitability Contractility Automaticity

47 Route of absorption GIT-injestion

48 Target organs Heart (mainly) - Arrhythmias
CNS - Neuronal excitability  depression GIT-irritant

49 Clinical features Faintishness,papitation, irregular pulse,hypotensoin
Yellow vision,blurred vision,dilated pupils, muscular twiching,tetanic spasms,anxiety, confusion Nausea,vomiting Pain in throat and numbness in tongue and lips,abdominal pain,profuse salivation

50 Principles of management
Emesis Activated charcoal Antidote-Kaneru tab (Antibody against cardiac glycosides) Management of complications

51 Mode of death Circulatory failure Arrhythmias
Lethal dose : 8-10 seeds, 15-20g root

52 Autopsy Non specific GIT irritation Fragments of seed in stomach

53 Poisonous part – Fruit seeds
Poison - Cardiogenic glycosides Circumstances - Accidental, suicidal Clinical features - Cardiac arrhythmias

54 Gloriosa superba (Niyangala)
Main suicidal poison before availability of pesticides Grows throughout the island

55 Toxic substances Colchicine- Cellular poison Choline Salicylic acid

56 Mode of action Colchicine-cellular poison Mitosis arrested.
Cell death. Choline – action same as acetyl choline Salicylic acid – Local irritant

57 Circumstances Accidental-yams Suicidal Homicidal

58 Target organs Gastro intestinal tract Bone marrow CNS Smooth muscles

59 Clinical features Shown in the table.

60 Patho – physiology Symptoms and signs Time of onset after ingestion Acute inflammation of alimentary tract mucosa due to local actions of salicylic acid and benzoic acid burning pain, numbness, itching and tingling around mouth and throat. Nausea, vomiting, dehydration, thirst, blood and mucus diarrhoea within hrs Augmentation by choline of autonomic contraction of smooth muscles throughout the body. In gastrointestinal tract , bronchi , uterus abdominal colic, ileus, tenesmus, breathlessness abortion Block of mitosis, by cholchicine in bone marrow→ bone marrow aplasia→ Throinbocytopenia bleeding gums, easy bruising within 6 hrs Acute tubular necrosis of the kidney decreased urine output, haematuria Central nervous system stimulation, then depression. Respiratory centre depression Restlessness, confusion, delirium, convulsions, coma Breathlessness after 36 hrs Arrest of cell division in hair follicles Rapid shedding of stratum corneum Alopecia, generalized depilation Dermatitis after 1-2 weeks

61 Principles of management
Gastric lavage Activated charcoal Management of complications

62 Autopsy Features of acute dehydration and GI irriration
Features of complication

63 Ricinus communis(Endaru)
Entire plant is poisonous Seeds most poisonous Grows throughout the island

64 Absorption GI mucosa

65 Mode of action Ricin Blockage of protein synthesis Cell death
Tissue necrosis Acute inflammation

66 Circumstances Accidental –Children Suicidal Homicidal-rare

67 Clinical features Pathology Clinical features Alimentary tract
Acute inflammation Haemorrhagic gastroenteritis, erosions Burning, sensation of mouth, throat, chest, abdomen, salivation, nausea, vomiting diarrhoea ↙ ↘ Dehydration electrolyte (thirst) imbalance ↓ ↓ shock muscle cramps (oliguria) (abdomen/calves) drowsiness, delirium, convulsions abdominal pain,haematemesis,bloody diarrhoea Kidney Nephritis, Acute renal tailure haematuria. albuminuria. oliguria. uraemia Liver Necrosis. Inflammation jaundice Circulation Haemagglutinatin ->haemolysis haemoglobinuria

68 Management Gastric lavarge Complication

69 Mode of death Circulatory failure Renal failure Respiratory failure

70 Autopsy GIT irritation Seeds in stomach
Non specific (Oedema and foci of necrosis)

71 Specimen Gastric contents Blood Histology Liver Kidney
Stomach and intestine

72 Manihot utilisma Cyanogenic glycoside

73 Clinical features Nausea Vomiting Abdominal pain Diarrhoea
Respiratory failure

74 Management Complications

75 Autopsy Contents in stomach Non specific

76 Poisoning ? National Poisons Information Centre
National Hospital of Sri Lanka Colombo. , Ext 430

77 Summary CNS GIT CVS Cellular toxic

78 Plants Datura stramonium Canabies sativum Erythrocylon cocca
Papova somniferum Strichnus nux vomica Nerium odorum Gloriosa superba Ricinus communis

79 For each plant Toxic substance Circumstances Absorption
Actions / target organs Clinical features Management Modes of death Post mortem findings Samples

80 Thank You.

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