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Phosphorus Poisoning - 5 Marks

Phosphorus is a protoplasmic poison that interferes with cellular oxidation. White/yellow phosphorus is highly toxic, unlike red phosphorus. It is found in rat poisons, fireworks, fertilizers, and incendiary materials.

Clinical features

  1. Fulminant poisoning
    After ingestion of more than 1 g, there is severe vomiting, thirst, shock, and cardiovascular collapse. Death may occur within 12 hours.
  2. Acute poisoning: three stages
    • First stage: Burning pain in throat and abdomen, intense thirst, nausea, vomiting, diarrhoea, and abdominal pain. Breath, vomitus, and stools have a garlic odour. Vomitus and faeces may be luminescent, which is characteristic.
    • Second stage: Symptom-free period for 2-3 days.
    • Third stage: Systemic toxicity with jaundice, hepatomegaly, liver failure, haematemesis, bleeding from skin/mucosa/viscera, renal failure, convulsions, delirium, coma, and death.

Fatal dose and period

  • Fatal dose: 60-120 mg
  • Fatal period: 2-8 days

Treatment

  • Gastric lavage with 1:5,000 potassium permanganate solution.
  • Activated charcoal.
  • Avoid oils and fats as they enhance absorption.
  • Correct shock and dehydration with IV fluids; give glucose-saline/plasma and supportive treatment.
  • Vitamin K and blood transfusion for bleeding due to hypoprothrombinaemia.
  • Magnesium sulphate for bowel evacuation.
  • Dialysis may be needed in severe renal failure.
  • Skin burns should be washed thoroughly.

Medicolegal importance

Poisoning is usually accidental or suicidal, commonly from rat poisons and fireworks-related products. Luminescent vomitus or gastric contents with garlic odour are important diagnostic clues.
The Essentials of Forensic Medicine and Toxicology, Gowtham Biswas, 36th ed., pp. 522-523.
Clinical safety note: Copper sulphate was historically mentioned in older forensic texts but is not used in modern practice because it can itself cause toxicity. Acute suspected ingestion needs emergency hospital/poison-centre management.
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