Hemlock Poisoning (Conium maculatum - Poison Hemlock)

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const path = require("path");

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pres.layout = "LAYOUT_16x9";
pres.author = "Forensic Medicine Seminar";
pres.title = "Hemlock Poisoning";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
// Dark forest green theme (toxic plant aesthetic)
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  danger:    "C0392B",   // Red for danger/death
  lightCard: "EAF4EB",   // Light card bg
  cardBorder:"2D6A2F",
  subtext:   "A8C4A9",
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const IMGS = {
  flowers:   path.resolve(__dirname, "flowers.jpg"),
  spots:     path.resolve(__dirname, "spots.jpg"),
  diagram:   path.resolve(__dirname, "paralysis_diagram.png"),
  stemFern:  path.resolve(__dirname, "stem_fern.jpg"),
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ══════════════════════════════════════════════════════════════════════════════
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    { text: "  |  " },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — INTRODUCTION & THE PLANT
// ══════════════════════════════════════════════════════════════════════════════
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  sectionBand(s, "Introduction — The Plant");

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  // Caption
  s.addText("Conium maculatum\nTall biennial, 8–10 ft\nWaste places & roadsides", {
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  // Right: info cards
  const facts = [
    ["Also Known As", "Spotted Hemlock, Spotted Cowbane, Parsley Hemlock"],
    ["Family", "Apiaceae (Carrot/Parsley family)"],
    ["Toxic Parts", "ALL parts — leaves, stem, root, seeds, flowers"],
    ["Active Toxins", "Coniine & gamma-Coniceine (piperidine alkaloids)"],
    ["Key Odor", "Strong mousy/musty smell when crushed"],
    ["Fatal Dose", "~60 mg of coniine"],
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — PLANT IDENTIFICATION (Images)
// ══════════════════════════════════════════════════════════════════════════════
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  sectionBand(s, "Plant Identification — Key Features");

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  s.addText("White umbrella-shaped UMBEL flowers\nResembles parsley, wild carrot — a key misidentification risk", {
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — MECHANISM OF ACTION
// ══════════════════════════════════════════════════════════════════════════════
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  sectionBand(s, "Mechanism of Action");

  // Central title
  s.addText("Coniine — Nicotinic Acetylcholine Receptor (nAChR) Agonist/Antagonist", {
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    { num:"2", title:"Initial Stimulation", body:"Overstimulates nicotinic receptors at\nautonomic ganglia & neuromuscular junction" },
    { num:"3", title:"Receptor Blockade", body:"Sustained stimulation → depolarization block\nFlaccid paralysis of skeletal muscle" },
    { num:"4", title:"Ascending Spread", body:"Motor nerve terminals → spinal cord\n→ brainstem motor cells" },
    { num:"5", title:"Respiratory Failure", body:"Paralysis of intercostals & diaphragm\n→ Asphyxia → Death" },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — SIGNS & SYMPTOMS
// ══════════════════════════════════════════════════════════════════════════════
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    "💧  Excessive salivation, diarrhea",
    "😵  Ataxia, dizziness, tremor",
    "❤️  Tachycardia, hypertension",
    "💪  Muscle fasciculations",
    "👁️  Miosis, visual disturbances",
    "😓  Diaphoresis, tachypnea",
    "🔥  Burning pain in mouth/throat",
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    "⬆️  Ascending paralysis — legs → trunk → arms",
    "👁️  Blindness, blurred vision",
    "🗣️  Slurred speech, dysphagia",
    "😕  Confusion, delirium, seizures",
    "🫁  Respiratory muscle paralysis",
    "💀  Death from ASPHYXIA",
    "",
    "🧠  KEY: Consciousness preserved until end!",
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — ASCENDING PARALYSIS DIAGRAM
// ══════════════════════════════════════════════════════════════════════════════
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    { icon:"2", color:C.acidGreen, text:"Gradually ascends — trunk, then upper limbs affected" },
    { icon:"3", color:C.gold, text:"Intercostal muscles and diaphragm affected last → respiratory failure" },
    { icon:"⭐", color:C.gold, text:"HALLMARK: Mind remains CLEAR — patient is conscious while paralysed and asphyxiating" },
    { icon:"💀", color:"FF6B6B", text:"Death by respiratory asphyxia — classical description from Plato's account of Socrates" },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — POSTMORTEM FINDINGS
// ══════════════════════════════════════════════════════════════════════════════
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    { title:"External", body:"Cyanosis of lips, fingernails, face\nPetechial hemorrhages — face & conjunctivae\nSigns of asphyxia", color: C.danger },
    { title:"Lungs", body:"Pulmonary oedema\nCongestion & engorgement\nPetechiae on pleura", color: C.danger },
    { title:"Brain", body:"Cerebral congestion\nPetechial haemorrhages\nSigns of hypoxic-ischaemic injury", color:"8B6914" },
    { title:"Viscera", body:"Generalised venous congestion\nKidney: Acute tubular necrosis\n(rhabdomyolysis-related)", color:"8B6914" },
    { title:"Stomach / GI", body:"Plant remains visible: leaves, roots, seeds\nCharacteristic MOUSY ODOUR in contents\nPreserve for toxicology!", color: C.leafGreen },
    { title:"Muscle", body:"Rhabdomyolysis changes\nMyoglobinuria (dark urine)\nIn cases with prolonged course", color: C.leafGreen },
    { title:"Toxicology", body:"Blood, urine, gastric contents, liver\nGC-MS / HPLC for coniine &\ngamma-coniceine confirmation", color: C.acidGreen },
    { title:"Special Note", body:"No specific pathognomonic internal lesion.\nDiagnosis requires: clinical Hx + plant ID\n+ toxicological analysis", color: C.gold },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CIRCUMSTANCES OF POISONING
// ══════════════════════════════════════════════════════════════════════════════
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      icon:"🌿", title:"Accidental (Most Common)",
      color: C.acidGreen,
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        "Plant misidentification — mimics parsley, wild carrot, parsnip, anise",
        "Foraging for wild edible plants",
        "Children chewing leaves/stems",
        "Child died blowing whistles from conium twigs (volatile coniine inhaled)",
        "Inhalation possible — coniine is a volatile alkaloid",
      ]
    },
    {
      icon:"⚔️", title:"Homicidal",
      color: C.gold,
      points:[
        "Historically significant — used as state poison in ancient Greece",
        "Socrates executed in 399 BC with hemlock potion",
        "Oral, injectable (parenteral), or inhalation routes possible",
        "Modern cases rare but documented",
      ]
    },
    {
      icon:"💊", title:"Suicidal / Intentional",
      color: C.danger,
      points:[
        "Intentional self-harm ingestion (case reports)",
        "Misuse seeking opioid-like effect",
        "Online misinformation has led to intentional use",
      ]
    },
    {
      icon:"🧪", title:"Routes of Exposure",
      color: C.subtext,
      points:[
        "Ingestion — most common",
        "Inhalation — volatile coniine (crushing/burning plant)",
        "Transdermal — possible skin absorption",
        "Parenteral — possible for homicide",
      ]
    },
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — MEDICOLEGAL ASPECTS & FATAL DOSE
// ══════════════════════════════════════════════════════════════════════════════
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  s.addText("Socrates (399 BC) executed with hemlock by Athenian court.\n\nPlato's Phaedo describes ascending paralysis with preserved consciousness — the earliest clinical description of hemlock poisoning.", {
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    { hd:"Manner of Death Classification", bd:"Accidental > Suicidal > Homicidal. Accidental from plant misidentification most common.", c:C.acidGreen },
    { hd:"Investigation Essentials", bd:"Plant remains in stomach\nToxicology: GC-MS/HPLC for coniine\nBotanical identification of plant material", c:C.gold },
    { hd:"Confirmatory Tests", bd:"Coniine & gamma-coniceine in blood, urine, gastric wash, liver", c:C.gold },
    { hd:"Differential Diagnosis", bd:"Nicotine poisoning, organophosphates, curare, botulism (ascending paralysis)", c:C.subtext },
  ];

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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — TREATMENT & MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════════
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    { step:"A", label:"Airway & Breathing", color:C.danger, items:[
      "Secure airway immediately",
      "Mechanical ventilation if respiratory paralysis",
      "Supplemental oxygen",
    ]},
    { step:"B", label:"GI Decontamination", color:C.gold, items:[
      "Activated charcoal (if early, airway protected)",
      "Gastric lavage with dilute tannic acid solution",
      "Do NOT induce emesis (aspiration risk)",
    ]},
    { step:"C", label:"Pharmacological", color:C.acidGreen, items:[
      "Antidysrhythmics (for arrhythmias)",
      "Anticonvulsants (benzodiazepines for seizures)",
      "AChE inhibitors: Physostigmine IV",
      "Aminopyridine (experimental)",
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    { step:"D", label:"Supportive", color:C.subtext, items:[
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      "Monitor renal function (rhabdomyolysis risk)",
      "Urinary alkalinisation if myoglobinuria",
      "Monitor cardiac rhythm continuously",
    ]},
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
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    ["Active Toxins", "Coniine, gamma-Coniceine (piperidine alkaloids)", C.offWhite],
    ["Mechanism", "Nicotinic receptor agonist → depolarization block → flaccid paralysis", C.offWhite],
    ["Onset of Symptoms", "15 minutes to 2 hours after ingestion", C.offWhite],
    ["Fatal Dose", "~60 mg coniine", C.gold],
    ["Fatal Period", "Few hours (1–2 hrs with large dose)", C.gold],
    ["Hallmark Feature", "Ascending paralysis with CLEAR consciousness", C.acidGreen],
    ["Cause of Death", "Respiratory paralysis → Asphyxia", "#FF6B6B"],
    ["PM Findings", "Asphyxia picture + plant material in stomach", C.offWhite],
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — CLOSING SLIDE
// ══════════════════════════════════════════════════════════════════════════════
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  s.addText("Sources: Parikh's Medical Jurisprudence & Toxicology\nEssentials of Forensic Medicine 36e (2026)\nTintinalli's Emergency Medicine", {
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
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