Transcript File
SOMNIFEROUS POISONS (OPIOIDS)
Known as somniferous poisons or narcotics i.
ii.
Reduce pain Induce sleep Important poisons Excitement i. OPIUM Narcosis
ii.
HEROIN (Brown sugar)
Synthetic derivatives of opium (Diacetyl morphine) Strong analgesic
Narcotics Cause severe addiction iii . PETHIDINE (Meperidine)
Analgesia Euphoria
Very high addiction Difficult to treatment
OPIUM & MORPHINE
OPIUM (AFIM): Dried juice obtained by incision of unripe capsule of white poppy (Papaver somniferum)
There are two groups of alkaloids i.
ii.
Phenanthrene Isoquinoline
Phenathrene Group i.
Morphine about 10% ii.
Codeine about 0.5% iii.
Thebaine about 0.3% iv.
Dionin v.
Heroin (Diacetyl Morphine) Isoquinoline Group i.
Papaverine about 1% ii.
Narcotine about 6% (They are mild analgesic but no narcotic effect)
Ripe and dry capsule of poppy contain very little opium.
Poppy seeds (khaskhas) are creamish in colour and contain no opium.
Used as food and oil for cooking.
Alkaloids of opium used in medicine are i.
Morphine ii.
Codeine They act as narcotic and sedative iii.
Apomorphine: Used as emetics
SIGNS & SYMPTOMS
Acute poisoning , mainly acts on CNS in three stages i.
ii.
iii.
Excitement Stupor Narcosis
STAGE OF EXCITEMENT:
i.
ii.
iii.
iv.
v.
Sense of well being Laughter Hallucination Increase in H.Rate
Convulsions may occur in children
STAGE OF STUPOR
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
Headache Giddiness Diminished sensibility Strong tendency to sleep Awake only by painful stimuli.
Pupils are contracted Lips & face are cyanosed Pulse normal Respiration normal
i.
STAGE OF NARCOSIS
: ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
Deep coma Muscles relaxed Reflexes abolished.
Pupils contracted No reaction to light BP is low Skin is cold Profuse perspiration Temperature is low less than 35 o C
IN FATAL------
i.
ii.
iii.
iv.
v.
vi.
vii.
Cyanosis Fine froth for month.
Breathing is sighing & irregular (2-4/m) Pulse is imperceptible.
Pupils dilate terminally No reaction to light.
Coma deep & respiratory paralysis.
i.
DIAGNOSITC POINT:
Breath smells of opium(raw flesh) ii.
Pin point pupils with no reaction to light.
iii.
Moist perspiring skin ---------- iv.
Low temp < 35 o C v.
Cyanosis, froth at month & nose.
i.
D/D:
ii.
iii.
iv.
v.
vi.
CVA (elderly hypertensive,pontine hmg) Metabolic conditions a) Uraemic coma b) Diabetic coma Alcohol poisoning Organophosphorous poisoning Carbolic acid poisoning Epileptic ,hysterical coma and in barbiturate poisoning
TREATMENT
Emetics – ineffective – due to depression of vomiting centre.
2.
Stomach wash a.
with tepid water, initially & then b.
with KMNO 4 : 1: 5000 strength till the washed water returns with original pink colour c.
d.
Some KMNO 4 should be left in stomach to oxidize alkaloids that is secreted in stomach after absorption In the absence stomach with.
of KMNO 4 , wash
i.
Tea or tannic acid ii.
Mixture of powder Charcoal & water.
IMPORTANT:
Gastric lavage should be done if the drug is taken by Hypo dermic or S / C injection as alkaloid is resecreted into stomach after absorption.
SPECIFIC
: Nalorphine (Specific antidote to opium) 5 – 10 mg after every 15 minutes till
Pupils begin to dilate Response becomes normal
Patient is aroused Maximum dose 40 mg
Naloxone (pure antagonist):
0.4
– 0.8mg I/m or I/V to be repeated every 10 to 15 minutes
Maximum dose 10 mg i.
ii.
Antibiotic in case of prolonged coma.
Artificial respiration iii.
iv.
Keep the body warm Symptomatic treatment
MEDICOLEGAL ASPECTS
Mostly painless.
suicidal easily availability &
Homicidal rare due to bad smell and taste, mostly used in infanticide .
Accidental poisoning due to over dosage.
(death on the needle)
OPIUM ADDICTION
Chronic poisoning morphinism morphinomania 1.
Chronic poisoning is characterized by Physical 2.
3.
Mental Moral degeneration
SIGNS OF PHYSICAL DEGENERATION
1.
2.
Emaciation Infections 3.
4.
Anorexia Constipation 5.
Impotence 6.
Sterility, etc
SIGNS OF MENTAL DEGENERATION
1.
Loss of memory 2.
Irritability 3.
Depression 4.
Gradual dementia
SIGNS OF MORAL DEGENERATION
1.
Criminal attitude 2.
Distorted personality
HEROIN (BROWN SUGAR)
It’s a synthetic derivative
Most potent addictive drug
Smack,junk,dope & brown sugar
Can be smoked, inhaled or injected
SHOOTING GALLERY: Is the place where heroin activities are conducted.
BOOTING/ FOOLING: Is the process of injecting small amount of drug, withdrawing some blood to ensure that the needle is in the vein & to keep the lumen open, helps to asses the potency of drug & for intermittent injection.
Tolerance develops rapidly Withdrawl symptoms are: Sweating Malaise Anxiety Depression General feeling of heaviness Cramps in limbs In case of severe addiction there is also twitching & convulsions.
Heroin is rapidly metabolized, blood samples can be negative after 30 – 60 min.
Urine samples may show morphine alkaloids for hours or days even after a single dose