STRYCHNOS NUX VOMICA Strychnine (kuchila) is a powerful alkaloid obtained from the seeds of strychnos nux vomica, and other species of strychnos, which are found in the jungles in India. Fruit is round, hard, slightly rough, glossy-orange, 4 to 5 cm. wide, with jelly-like white or pale yellow pulp. It has 3 to 5 seeds Fig. (34-1). Strychnine occurs as colourless, odourless, rhombic prisms, having an intensely bitter taste. The bark contains only brucine. The fruit pulp has very low strychnine content. All parts of the tree are toxic. Seeds: The seeds are flat, circular dises or slightly convex on one side, concave on the other, two-and-half cm. in diameter, 6 mm. in thickness Figs. (34-2 and 34-3). They are ash-grey or light-brown in colour, have a shining surface and covered with radiating silky fibres. They are very hard, tough and difficult to pulverize. The seeds of nux vomica contained in the ripe fruit are poisonous. The seeds contain two principal alkaloids; strychnine and brucine one-and-half percent each. The seeds also contain a glucoside, loganin. The bark, wood and leaves contain brucine but no strychnine. Brucine is allied to strychnine in composition and action. Strychnine is 10 to Surface covered with silky fibers Albumin and emovo Fig. (34-2). Nux vomica seeds. Central cavity Fig. (34-3). Nux vomica. 20 times more poisonous than brucine. Strychnine is used as a respiratory stimulant, as a rodenticide and for killing stray dogs. Absorption and Excretion: All mucous membranes absorb strychnine. Much is taken up by the liver and muscles to be either released again to blood stream or to be destroyed. The release of strychnine from the liver and muscles produces convulsions on second or third day of poisoning, after sedation is discontinued. About 80% is oxidised mainly in the liver. It is excreted slowly by the kidneys and traces in bile, milk and saliva. It may be found in the cadaver up to four years. Action: It competitively blocks ventral horn motor neurone postganglionic receptor sites in the spinal cord and brainstem and prevents the effects of glycine (the presumed inhibitory transmitter). Widespread inhibition in the spinal cord results in 'release' excitation. The action is particularly

Make simplified notes from this text STRYCHNOS NUX VOMICA Strychnine (kuchila) is a powerful alkaloid obtained from the seeds of strychnos nux vomica, and other species of strychnos, which are found in the jungles in India. Fruit is round, hard, slightly rough, glossy-orange, 4 to 5 cm. wide, with jelly-like white or pale yellow pulp. It has 3 to 5 seeds Fig. (34-1). Strychnine occurs as colourless, odourless, rhombic prisms, having an intensely bitter taste. The bark contains only brucine. The fruit pulp has very low strychnine content. All parts of the tree are toxic. Seeds: The seeds are flat, circular dises or slightly convex on one side, concave on the other, two-and-half cm. in diameter, 6 mm. in thickness Figs. (34-2 and 34-3). They are ash-grey or light-brown in colour, have a shining surface and covered with radiating silky fibres. They are very hard, tough and difficult to pulverize. The seeds of nux vomica contained in the ripe fruit are poisonous. The seeds contain two principal alkaloids; strychnine and brucine one-and-half percent each. The seeds also contain a glucoside, loganin. The bark, wood and leaves contain brucine but no strychnine. Brucine is allied to strychnine in composition and action. Strychnine is 10 to Surface covered with silky fibers Albumin and emovo Fig. (34-2). Nux vomica seeds. Central cavity Fig. (34-3). Nux vomica. 20 times more poisonous than brucine. Strychnine is used as a respiratory stimulant, as a rodenticide and for killing stray dogs. Absorption and Excretion: All mucous membranes absorb strychnine. Much is taken up by the liver and muscles to be either released again to blood stream or to be destroyed. The release of strychnine from the liver and muscles produces convulsions on second or third day of poisoning, after sedation is discontinued. About 80% is oxidised mainly in the liver. It is excreted slowly by the kidneys and traces in bile, milk and saliva. It may be found in the cadaver up to four years. Action: It competitively blocks ventral horn motor neurone postganglionic receptor sites in the spinal cord and brainstem and prevents the effects of glycine (the presumed inhibitory transmitter). Widespread inhibition in the spinal cord results in 'release' excitation. The action is particularly Table (34-1). Difference between strychnine poisoning and tetanus Strychnine poisoning No history of injury. Sudden. All muscles of the body are affected at a time. Does not start in, nor especially affects the jaw. Between fits, muscles are completely relaxed. 1-2 hours. Chemical analysis: Strychnine found. Chapter 34: Spinal Poisons 467 History of injury present. Gradual. All muscles are not affected at a time. Usually starts in, and especialle afeets lower iaw. Between fits, muscles are slightly rigid. More than 24 hours. No poison found. die the anterior horn cells. It stimulates the cerebral contex. intervals between the convulsions become longer and the spasm Poste neurotransmitter for presynaptic inhibitory neurons less, until these entirely stop within 12 to 24 hours, and recovery signs and Symptoms nous alive unryshed, the seeds of takes place in a day or two Table (34-1). mica have no poisonous action, as they are not dissolved Fatal Dose: 50to 100 mg.; one crushed seed. are When crushed seeds are taken, the symptoms are delayed he castrointestinal tract, and are passed entire in the Fatal Period: 1 to 2 hours. Treatment: (1) The first step is the effective control of sia bour or more. IF the alkaloid is swallowed, the symptoms convulsions, ie the symptoms treated before the disease a very rapidly, usually within five to fiteen minutes. Bitter The patient should bekept in a dark room, free from noise and ara h mouth, sense of unting i swallotesness, feling disturbance. Convulsions may be controlled initially with diazepam 0.1 to 0.5 mg/kg. i.v. slowly, and then phenobarbital -focation and fear, and difficulty in swallowing occur. The i.v. If these prove ineffective consider general anaesthesia and/or mukions are preceded by such prodromal symptoms as muscle relaxation immediately by using succinylcholine, curare, erased cuity of perception, increased rigidity of muscles, gallamine or pancuronium bromide. Inhalation anaesthetics muscular twitchings. Convulsions are produced due to et action on the reflex centres of spinal cord, and affect all are of little value during convulsion, because of fixation of respiratory muscles and therefore failure of absorption of muscles at a time. These are at first clonic, but eventually me tonic. During the convulsions, the face is cyanosed vapour. Between convulsions, ether may be administered to has anxious look, eyes are staring, eyeballs prominent and the point of unconsciousness. (2) Short-acting barbiturates like pentobarbital sodium, or sodium amytal are antidotes - are dilated. Risus sardonicus results from contraction to strychnine and should be given in dose of 0.3 to 0.6 g. i.v. the jaws and facial muscles in which the corners of the (3) Wash the stomach with warm water and dilute solution ath are drawn back. The mouth is covered with froth. of potassium permanganate, and then introduce a suspension gently bloodstained. The convulsions are most marked of activated charcoal to adsorb strychnine, which should a aat-gravity muscles, so that the body typically arches in be removed later. Tannic acid may be used if charcoal is not hiperestension (opisthotonus). In supine position, the body available. (4) Acidifying the urine will increase excretion of Supported by the heels and head. The legs are adducted and strychnine. (5) Treat the symptoms on general lines. etended, the arms are flexed over the chest or rigidly extended, Postmortem Appearances: They are not characteristic. Rigor ed the hands are tightly clenched. The head is bent backwards, and the whole of the body becomes rigid, often assuming a mortis appears early but is not necessarily prolonged. There may be signs of asphyxia. Extravasated blood may be found in the on-like form. Sometimes, the spasm of the abdominal muscles muscles. Haemorrhages are sometimes found under the peritoneal ay bend the body forward (emprosthotonus), or to the side coat of the stomach. The mucosa of the stomach and duodenum pleurosthotonus). Consciousness is not lost and the mind may show patches of ecchymoses or congestion. The lungs, liver, emains clear till death. The suffering during the spasm is severe, kidneys, brain and spinal cord are congested. the patient is conscious of impending danger of death. The Physiological Test: Injection of an aqueous solution of duration of convulsion varies from half to two minutes. In the suspected material into the dorsal lymph sac of a frog, will etween the convulsions the muscles are completely relaxed, ud the patient looks well though somewhat exhausted, produce tetanic convulsions in a few minutes if strychnine is present. Later stimulation of the frog will produce convulsions. and the breathing is resumed. The cyanosis lessens, cold perspirations cover the skin; dilated pupils may contract. After 5 The Circumstances of Poisoning: (1) It is sometimes used for homicide in the form of alkaloid, or as powdered nux vomica • 5 minutes or on slightest impulse, e.g. a sudden noise, a current fair, or gently touching the patient, another convulsion occurs. seeds, in spite of bitter taste. (2) Suicide is rare because of the la fatal cases, the convulsions rapidly succeed one another, and painful death. (3) Accidental deaths are more common, due to rease in severity and in duration, and death usually occurs an overdose of medicinal preparation, or the poison being given aler four to five convulsions. The patient cannot breathe because by mistake, or in children by eating the seeds. (4) Sometimes, se diaphragm and thoracic muscles are fully contracted. Hypoxia the seeds are used for killing the cattle, and as arrow poison. (5) cases medullary paralysis and death. in non-fatal cases the Sometimes, it is taken as an aphrodisiac.

CARDIAC POISONS NICOTIANA TABACUM All parts are poisonous except the ripe seeds. The dried leaves unlala) contain 1 to 8% of nicotine and are used in the Ma redestor deed, the nes conti act real, mich, Boricotine (less foxic. Nicotine is a colourless, volatile, bitter, ABSORPTION AND EXCRETION: Each cigarette contains about 15 to 20 mg of nicotine of which 1 to 2 mg. is absorbed by smoking; exc dar contains 15 to 40 mg. Nicotine is rapidly absorbed from all sacos membranes, lungs and the skin. 80 to 90 percent is metabolised by deliver, bat some may be metabolised in the kidneys and the lungs. tis excreted by the kidneys. ACTION: It acts on the autonomic ganglia which are stimulated aal, bet are depressed and blocked at later stage. It also acts on ibe somatic neuromuscular junction, and afferent fibres from sensory ACUTE POISONING: G.I.T. Burning acid sensation, nausea, eating, abdominal pain, hypersalivation. CARDIOPULMONARY: Tacbycardia, hypertension, tachypnoea (carly); bradycardia, Sypoteasion, respiratory depression (late). Cardiac arrhythmias may screr. C.N.S.: Miosis, confusion, headache, sweating, ataxia, agitation, redesess, hyperthermia (early); mydriasis, lethargy, convulsions, sou (late). Death may occur from respiratory failure. CHRONIC POISONING: Symptoms are cough, wheezing, eypaoca, anorexia, vomiting, diarrhoca, anaemia, faintness, tremors, Inpaired memory, amblyopia, blindness, irregularity of the heart with estrasstoles and occasionally attacks of pain suggesting angina pectoris. WITHDRAWAL SYMPTOMS: Intense urge to smoke, anxiety, spaired concentration and memory, depression or hostility, headache, ascle cramps, sicep disturbances, increased appetite and weight gain, dapboresis and rapid respirations. A short period (6 to 12 weeks) of malatenance often followed by a gradual reduction in 6 to 12 weeks is Nicotine replacement therapy (NRT) includes use of nicotine reducts including gum, transdermal patch, nasal spray, lozenge and Labaler. Bupropion can be used in those who are motivated to quit. Clonidine and nortryptyline can be used as second line of treatment. FATAL DOSE: 50 to 100 mg. of nicotine. It rivals cyanide as a poison capable of producing rapid death; 15 to 30g. of crude tobacco. FATAL PERIOD: 5 to 15 minutes. TREATMENT: (1 Wash the stomach with warm water containing charcoal, tannin or potassium permanganate. (2) A purge and colonic wash-out. (3) Mccamvlamine (Inversine) Is a specific antidote giver rally. (4) Protect airway. In mild to moderate poisoning, atropine sulphate 1 to 2 mg. i.m. and hexamethonium chloride 25 to 50 mg. s.c. to counteract peripheral autonomic disturbances and as respiratory stimulant. (5) Vasodilators can be given. (6) Oxygen. (7) Symptomatic. THE CIRCUMSTANCES OF POISONING: (I) Accidental poisoning results due to ingestion, excessive smoking and application of Icaves or juice to wound or skin. (2) For malingering tobacco leaves are soaked in water for some hours and placed in axillae at bed time, which is held in position by a bandage. Poisonous symptoms are seen the next morning. (3) Suicidal and homicidal poisoning is rare. DIGITALIS PURPUREA Entire plant is toxic, containing over thirty cardiac and steroidal glucosides Fig. (35-1). The root, leaves and seeds of digitalis contain digitoxin, digoxin, digitalin and digitonin (glycosides). SIGNS AND SYMPTOMS: GIT: Anorexia, nausea, vomiting, diarrhoea. CARDIAC: Arrhythmias: extrasystoles, ventricular tachycardia and fibrillation, atrial flutter and fibrillation, SA block, AV block. ENDOCRINE: Gynaecomastia. VISUAL: Transient amblyopia, photophobia, diplopia, blurring, scotomata, colour aberration, halos. SKIN: Urticaria. CNS: Headache, fatigue, muscle weakness, neuro-psychiatrie disorders, confusion, anxiety, depression, disorientation, drowsiness, delirium, hallucinations, trigeminal neuralgia. Death occurs from cardiovascular collapse. FATALDOSE: 15 to 30 mg. of digitalin: 4 mg. of digitoxin; digoxin FATAL PERIOD: 1 to 24 hours. TREATMENT: (I) Stomach wash with a solution of tannie acid. (2) The bowels should be evacuated. (3) Activated charcoal in repeated doses. (4) Digoxin-specific antibody fragments (Fab) one vial İ.v. in 30 minutes. Each vial, contains 38 mg Fab fragments. Total 10 to 20 vials. (5) In the absence of Fab fragments, ventricular irritability can be treated with phenytoin 50 mg/min. i.v. up to 1 g, followed by 300 to 400 mg. daily. Specific antidote for digitalis induced cardiac arrhythmias are: 100 mg. lignocaine i.v. or dilantin or propranolol. (6) Trisodium EDTA may help to lower the serum calcium. (7) Potassium salts to reduce extrasystoles and tachyarrhythmias. (8) Bradycardia should be treated with atropine sulphate 0.6 mg. i.v. repeated as necessary up to four days. (9) Symptomatic. Poisoning is accidental, due to therapeutic overdose. NERIUM ODORUM Characteristies: Nerium odorum (white oleander, kaner) grows wild in India. Flowers usually fragrant, are borne in terminal clusters. They are white, pink, dark-red or rarely pale-yellow. They are two-and-half to five cm. wide and have five petals or in double blooms, many petals. The leaves are narrow, lanceolate, leathery, dark-green on upper surface, lighter beneath, and 10 to 25 cm. long. Seed pod is slim, cylindrical, ribbed, up to 15 cm. long, turns brown, dries and splits, releasing small seeds tipped with brown hairs Fig. (35-2). Active Principles: All parts of the plant, including nectar are poisonous, containing several cardiac glycosides, primarily oleandroside (oleandrin), and nerioside (nerin), which resemble digitalis in action and folinerin and rosagenin. The nector yields poisonous honey. Signs and Symptoms: The plant is occasionally a source of contact dermatitis. Emanations from flowers, especially when fading cause headache, dizziness, respiratory difficulty and nausea. Ingestion causes difficulty in swallowing and articulation, abdominal pain, vomiting, profuse frothy salivation and diarrhoea. Pulse is first slow and later rapid and weak, blood pressure falls, fibrillation, AV block, respirations are increased, pupils are dilated, muscular twitchings, tetanic spasms, lock-jaw, drowsiness, coma, respiratory paralysis and death occurs. Death usually results from cardiac failure. Fatal Dose: 15 to 20 g. of the root; 5 to 15 leaves. 8 to 10 seeds. Fatal Period: 20 to 36 hours. Treatment: (1) Stomach wash. Activated charcoal. (2) Digoxin immune Fab. Postmortem Appearances: They are not characteristic. Congestion of organs is seen. It can be detected long after death. The Circumstances of Poisoning: (1) The root, leaves or fruit are often used as a paste or decoction for suicidal purposes. (2) Homicide is rare. (3) As an abortifacient, root is used either locally or taken internally. (4) Root is taken internally for treating venereal diseases. (5) Root is used for treating cancers and ulcers in the form of paste. (6) The decoction of leaves is applied externally to reduce swelling. (7) As a cattle poison, the juice of root is applied on piece of cloth and inserted into the anus of the animal. (8) Smoke from the burning plant is toxic. When plant material is used to roast food over a fire, the poisonous sap transferred to the food may be lethal. CERBERA THEVETIA CHARACTERISTICS: All parts of cerbera thevetia (yellow oleander; pila kaner) are poisonous. The Rowers are large, bell-shaped and yellow, to to cm. long and five cm. wide, the five lobes spirally twisted and spreading, and the leaves are lanceolate. The fruit is globular, light-green, about 4 to 5cm. in diameter and contains a single nut which is triangular with a deep groove along the edge. Each nut contains five pale yellow seeds Figs. (35-3 and 35-4). Active Principles: The seeds contain 4% of the cardiac glycoside thevetin, which is one-eighth as potent as ouabain and similar to digitalis in action; thevetoxin is similar to but less toxic than thevetin; nerifolin (more potent than thevetin); peruvoside, me orberin and also a bitter principle that acts on the androduces tetanoid convulsions. All active principles are within three hours of ingestion. There is bitter taste, nausca, severe ads. Milky juice exudes from all parts of the plant. retching, vomiting, abdominal pain and in few cases diarrhoea, Spar and Symptoms: The sap of the plant may cause general weakness, blurring of vision, sinus bradycardia, irregular Armaice in sensitive individuals. Chewing the bark or seed respiration, collapse and death from heart failure. ECG may show sinus bradycardia, S-A block, atrial fibrillation and other belues a slight numbing sensation and feeling of heat in the such ad purging. Ingestion causes burning pain in the mouth, arrhythmias. Hyperkalaemia and depression of transaminase year ef troat, tingling and numbness of tongue, vomiting, activity are chief biochemical changes. doc, adache, giddiness, dilated pupils, loss of muscular Fatal Dose: Kernel of one fruit. yet and fainting. Pulse is rapid, weak and irregular, blood Fatal Period: 1 to 2 days or more. rasure lo: Heart block, collapse and death from peripheral POSTMORTEM APPEARANCES: They are those of asphyxia. Eyes are congested. Lungs are congested and oedematous. Subepicardial, saltrey failure occurs. subendecardiat and sebpleural petechial haemorrhages are found. Fital Dose: S to 10 sceds; 15 to 20 g. of root; 5 to 10 leaves. Stomach mucosa is congested with submacous haemorrhages and Fatal Period: 2 to 3 hours. gastritis. The internal organs are congested. Treatmeat: (1) Wash out the stomach. (2) Digoxin immune Treatment: (I) Stomach wash. (2) Digoxin immune Fab is (a (prise) is effective in poisoning from digitalis, cerbera the specifie antidote. Atropine 0.5 mg. i.v. and repeated every bei, cerera dallam, nerium odorum, etc. Each vial contains 15 to 30 minutes to keep heart rate above 50 per minute. (3) sag Fab which should be dissolved in 4 ml of sterile water and Correct hyperkalaemia. fit i 101020 vials can be given through a membrane filter i.vi Circumstances of Poisoning: (1) For suicide, the kernels xa prisoning. Sodium molar lactate transfusion with glucose are taken as such, or after grinding it with jaggery or adlag atropine, 2 ml. adrenaline and 2 mg. noradrenaline is molasses or by preparing a curry with it. (2) For homicide, ericial (3) Symptomatic. the powdered kernel is added to alcohol. (3) Bark, leaves and Pestmortem Appearances: They are not specific. milky juice are used as emetic and as purgative. The Circumstances of Polsoning: (I) The root and seeds are ACONITE set seetimes for suicide or homicide. (2) Root and seeds are There are several varieties of aconite (monk's hood, blue sla for criminal abortion. (3) For cattle poisoning, the seeds rocket, meetha zeher, bish, bikh), but the roots of Aconitum a crashed and fed to the animal with com or bread napellus and Aconitum ferox are commonly used. It grows in the CERBERA ODALLAM /Pilkber Himalayas. All varieties and all parts of the plant are poisonous; CHARACTERISTICS: This plant is closely allied botanically to least when young, more so when seeds ripen and most when bloom. artera tbevetia. It is a small plant or a shrub that grows wild all over bin The leaves are dark-green, fleshy and lanccolate, 20 to 30 cm. Active Principles: The root and seeds are most potent; leg and 4 to 6 cm. broad. The flowers are white, like these of jasmine. contain aconitine and ten or more other alkaloids, such as De frait resembles a mango, is globular and dark-green and has a sik Shras mesocarp which encloses usually a single seed. The seed pseudo-aconitine, indaconitine, bikhaconitine, picraconitine, Astroid and oseid and contains twe kernels which are pearly-white aconine, mesaconitine, jesaconitine, etc. Aconitine stimulates inite dry it may have a bluish tinge or it may become gelatinous. and then depresses CNS. Gly acrid juice (toxic) exudes from all parts of the plant. The active redpies are cerberin, cerberoside, odollia, odolotoxin, theyetin and Dried roots: The dry root is conical or tapering, and shows arapaía (glycosides) Fig. (35-5). scars or bases of broken rootlets, and is arched or shrivelled with longitudinal wrinkles Fig. (35-6). It is usually 5 to 10 cm. Sipes and Symptoms: They appear within one hour. The long, and 1½ to 2 cm. thick at the upper end. The external colour unil symptoms are gastrointestinal. Cardiac toxicity may occur is dark-brown, and when freshly cut the internal colour is white.. which becomes pink on exposure to air. It is odourless but the taste is sweet, then acrid. When dried and soaked in oil the root is black, heavy, hard and brittle with a strong offensive odour. The root is mistaken for horse-radish root which is long, cylindrical, yellowish-white externally and whitish internally, does not change on exposure to air and the taste is pungent. Action:

Make simplified notes

Make simplified notes CARDIAC POISONS NICOTIANA TABACUM All parts are poisonous except the ripe seeds. The dried leaves unlala) contain 1 to 8% of nicotine and are used in the Ma redestor deed, the nes conti act real, mich, Boricotine (less foxic. Nicotine is a colourless, volatile, bitter, ABSORPTION AND EXCRETION: Each cigarette contains about 15 to 20 mg of nicotine of which 1 to 2 mg. is absorbed by smoking; exc dar contains 15 to 40 mg. Nicotine is rapidly absorbed from all sacos membranes, lungs and the skin. 80 to 90 percent is metabolised by deliver, bat some may be metabolised in the kidneys and the lungs. tis excreted by the kidneys. ACTION: It acts on the autonomic ganglia which are stimulated aal, bet are depressed and blocked at later stage. It also acts on ibe somatic neuromuscular junction, and afferent fibres from sensory ACUTE POISONING: G.I.T. Burning acid sensation, nausea, eating, abdominal pain, hypersalivation. CARDIOPULMONARY: Tacbycardia, hypertension, tachypnoea (carly); bradycardia, Sypoteasion, respiratory depression (late). Cardiac arrhythmias may screr. C.N.S.: Miosis, confusion, headache, sweating, ataxia, agitation, redesess, hyperthermia (early); mydriasis, lethargy, convulsions, sou (late). Death may occur from respiratory failure. CHRONIC POISONING: Symptoms are cough, wheezing, eypaoca, anorexia, vomiting, diarrhoca, anaemia, faintness, tremors, Inpaired memory, amblyopia, blindness, irregularity of the heart with estrasstoles and occasionally attacks of pain suggesting angina pectoris. WITHDRAWAL SYMPTOMS: Intense urge to smoke, anxiety, spaired concentration and memory, depression or hostility, headache, ascle cramps, sicep disturbances, increased appetite and weight gain, dapboresis and rapid respirations. A short period (6 to 12 weeks) of malatenance often followed by a gradual reduction in 6 to 12 weeks is Nicotine replacement therapy (NRT) includes use of nicotine reducts including gum, transdermal patch, nasal spray, lozenge and Labaler. Bupropion can be used in those who are motivated to quit. Clonidine and nortryptyline can be used as second line of treatment. FATAL DOSE: 50 to 100 mg. of nicotine. It rivals cyanide as a poison capable of producing rapid death; 15 to 30g. of crude tobacco. FATAL PERIOD: 5 to 15 minutes. TREATMENT: (1 Wash the stomach with warm water containing charcoal, tannin or potassium permanganate. (2) A purge and colonic wash-out. (3) Mccamvlamine (Inversine) Is a specific antidote giver rally. (4) Protect airway. In mild to moderate poisoning, atropine sulphate 1 to 2 mg. i.m. and hexamethonium chloride 25 to 50 mg. s.c. to counteract peripheral autonomic disturbances and as respiratory stimulant. (5) Vasodilators can be given. (6) Oxygen. (7) Symptomatic. THE CIRCUMSTANCES OF POISONING: (I) Accidental poisoning results due to ingestion, excessive smoking and application of Icaves or juice to wound or skin. (2) For malingering tobacco leaves are soaked in water for some hours and placed in axillae at bed time, which is held in position by a bandage. Poisonous symptoms are seen the next morning. (3) Suicidal and homicidal poisoning is rare. DIGITALIS PURPUREA Entire plant is toxic, containing over thirty cardiac and steroidal glucosides Fig. (35-1). The root, leaves and seeds of digitalis contain digitoxin, digoxin, digitalin and digitonin (glycosides). SIGNS AND SYMPTOMS: GIT: Anorexia, nausea, vomiting, diarrhoea. CARDIAC: Arrhythmias: extrasystoles, ventricular tachycardia and fibrillation, atrial flutter and fibrillation, SA block, AV block. ENDOCRINE: Gynaecomastia. VISUAL: Transient amblyopia, photophobia, diplopia, blurring, scotomata, colour aberration, halos. SKIN: Urticaria. CNS: Headache, fatigue, muscle weakness, neuro-psychiatrie disorders, confusion, anxiety, depression, disorientation, drowsiness, delirium, hallucinations, trigeminal neuralgia. Death occurs from cardiovascular collapse. FATALDOSE: 15 to 30 mg. of digitalin: 4 mg. of digitoxin; digoxin FATAL PERIOD: 1 to 24 hours. TREATMENT: (I) Stomach wash with a solution of tannie acid. (2) The bowels should be evacuated. (3) Activated charcoal in repeated doses. (4) Digoxin-specific antibody fragments (Fab) one vial İ.v. in 30 minutes. Each vial, contains 38 mg Fab fragments. Total 10 to 20 vials. (5) In the absence of Fab fragments, ventricular irritability can be treated with phenytoin 50 mg/min. i.v. up to 1 g, followed by 300 to 400 mg. daily. Specific antidote for digitalis induced cardiac arrhythmias are: 100 mg. lignocaine i.v. or dilantin or propranolol. (6) Trisodium EDTA may help to lower the serum calcium. (7) Potassium salts to reduce extrasystoles and tachyarrhythmias. (8) Bradycardia should be treated with atropine sulphate 0.6 mg. i.v. repeated as necessary up to four days. (9) Symptomatic. Poisoning is accidental, due to therapeutic overdose. NERIUM ODORUM Characteristies: Nerium odorum (white oleander, kaner) grows wild in India. Flowers usually fragrant, are borne in terminal clusters. They are white, pink, dark-red or rarely pale-yellow. They are two-and-half to five cm. wide and have five petals or in double blooms, many petals. The leaves are narrow, lanceolate, leathery, dark-green on upper surface, lighter beneath, and 10 to 25 cm. long. Seed pod is slim, cylindrical, ribbed, up to 15 cm. long, turns brown, dries and splits, releasing small seeds tipped with brown hairs Fig. (35-2). Active Principles: All parts of the plant, including nectar are poisonous, containing several cardiac glycosides, primarily oleandroside (oleandrin), and nerioside (nerin), which resemble digitalis in action and folinerin and rosagenin. The nector yields poisonous honey. Signs and Symptoms: The plant is occasionally a source of contact dermatitis. Emanations from flowers, especially when fading cause headache, dizziness, respiratory difficulty and nausea. Ingestion causes difficulty in swallowing and articulation, abdominal pain, vomiting, profuse frothy salivation and diarrhoea. Pulse is first slow and later rapid and weak, blood pressure falls, fibrillation, AV block, respirations are increased, pupils are dilated, muscular twitchings, tetanic spasms, lock-jaw, drowsiness, coma, respiratory paralysis and death occurs. Death usually results from cardiac failure. Fatal Dose: 15 to 20 g. of the root; 5 to 15 leaves. 8 to 10 seeds. Fatal Period: 20 to 36 hours. Treatment: (1) Stomach wash. Activated charcoal. (2) Digoxin immune Fab. Postmortem Appearances: They are not characteristic. Congestion of organs is seen. It can be detected long after death. The Circumstances of Poisoning: (1) The root, leaves or fruit are often used as a paste or decoction for suicidal purposes. (2) Homicide is rare. (3) As an abortifacient, root is used either locally or taken internally. (4) Root is taken internally for treating venereal diseases. (5) Root is used for treating cancers and ulcers in the form of paste. (6) The decoction of leaves is applied externally to reduce swelling. (7) As a cattle poison, the juice of root is applied on piece of cloth and inserted into the anus of the animal. (8) Smoke from the burning plant is toxic. When plant material is used to roast food over a fire, the poisonous sap transferred to the food may be lethal. CERBERA THEVETIA CHARACTERISTICS: All parts of cerbera thevetia (yellow oleander; pila kaner) are poisonous. The Rowers are large, bell-shaped and yellow, to to cm. long and five cm. wide, the five lobes spirally twisted and spreading, and the leaves are lanceolate. The fruit is globular, light-green, about 4 to 5cm. in diameter and contains a single nut which is triangular with a deep groove along the edge. Each nut contains five pale yellow seeds Figs. (35-3 and 35-4). Active Principles: The seeds contain 4% of the cardiac glycoside thevetin, which is one-eighth as potent as ouabain and similar to digitalis in action; thevetoxin is similar to but less toxic than thevetin; nerifolin (more potent than thevetin); peruvoside, ruvoside, cerberin and also a bitter principle that acts on the (AS, and produces tetanoid convulsions. All active principles are masides. Milky juice exudes from all parts of the plant. Signs and Symptoms: The sap of the plant may cause mation in sensitive individuals. Chewing the bark or seed nelcanses aslight numbing sensation and feeling of heat in the muth and purging. Ingestion causes burning pain in the mouth, toss of throat, tingling and numbness of tongue, vomiting, bartoc, headache, giddiness, dilated pupils, loss of muscular par and fainting. Pulse is rapid, weak and irregular, blood mure ow. Heart block, collapse and death from peripheral arculatory failure occurs. Fatal Dose: 8 to 10 seeds; 15 to 20 g. of root; 5 to 10 leaves. Fatal Period: 2 to 3 hours. Treatment: (1) Wash out the stomach. (2) Digoxin immune Eb (vine) is effective in poisoning from digitalis, cerbera beretia, erbera odallam, nerium odorum, etc. Each vial contains Ng Fab which should be dissolved in 4 ml of sterile water and frien . 10 to 20 vials can be given through a membrane filter i.v. naute poisoning. Sodium molar lactate transfusion with glucose sd1 mg. atropine, 2 ml. adrenaline and 2 mg. noradrenaline is beeficial. (3) Symptomatic. Postmortem Appearances: They are not specific. The Circumstances of Poisoning: (1) The root and seeds are sed sometimes for suicide or homicide. (2) Root and seeds are aken for criminal abortion. (3) For cattle poisoning, the seeds are crushed and fed to the animal with corn or bread.