poisons, cardiac, heart , treatment

1. Dr Gopisankar.M.G.

2. Nicotiana Tabacum
Digitalis Pupurea
Nerium Odorum
Cerebera thevetia
Cerebera Odallam
Cleistanthus Collinus
Qunine
Aconite

3. All parts are poisonous except ripe seeds
Dried leaves  1-8% of nicotine
Toxic alkaloids
1. Nicotine
2. Anabasine (equally toxic )
3. Nornicotine (less toxic)

4. Agricultural , horticultural works
Fumigation , spraying , insecticide , worm
powder
Each cigarette  15 – 20mg N
1-2 mg is absorbed by smoking
15 – 40 mg /cigar

5. Absorbed from  skin , mucous
membrane , lungs
90% is metabolised by liver
Some metabolised by lungs and kidneys
Excreted by kidneys

6. Acts on Autonomic ganglia stimulated
first and then depressed and blocked
Also acts on somatic neuromuscular
junction and afferent fibers from sensory
receptors

7. GIT
Cardiopulmonary  arrhythmias
CNS  mydriasis
Death  respiratory failure

8. Amblyopia

9. A short period of 6 to 12 weeks of
maintenance often followed by a gradual
reduction in 6 – 12 weeks is done
NRT
FD 50 – 100 mg of nicotine
15 – 30 mg of crude tobacco

10. Stomach wash
Colonic washout
Inversine /Mecamylamine  specific
antidote
Atropine / hexamethonium chloride
VD
Oxygen

11. Asphyxia

12. Entire plant is toxic
Over 30 cardiac and steroidal glucosides
Roots , leaves ,seeds
1. Digitoxin
2. Digoxin
3. Digitalin
4. Digitonin

13. GIT
Cardiac arrhythmias , block
Endocrine  gynaecomastia
Visual  transient amblyopia , scotomata,
colour aberration , halos
Skin  urticaria
CNS  nueropsychiatric , delerium ,
hallucinations , trigeminal nueralgia

14. Death occurs from cardiovascular collapse
FD 2 gm leaf
15 – 30 mg digitalin
10 mg digoxin
4 mg digitoxin
FP 1 – 24 hours

15. Stomach wash with tannic acid
Bowel wash
Activated charcoal
Digoxin specific antibody fragments (Fab)
one vial IV over 30 min
1 vial = 38 mg Fab
Total 10 – 20 vials
Phenytoin

16. Specific antidote for digitalis induced
cardiac arrhythmias  lignocaine 100 mg
,Dilantin , Propanalol
Trisodium EDTA  to lower s. calcium
Potassium suppliment
Atropine if brady

17. White oleander or kaner
All parts except roots , including nectar are
poisonous
Cardiac glycosides
1. Oleandroside(oleandrin)digitalis in
action
2. Nerioside(nerin) digitalis in action
3. Folinerin
4. Rosagenin

18.  Contact dermatitis
 Emenations Headache, dizziness,
respiratpry difficulty, Nausea
 Ingestion difficulty in swallowing and
articulation , V, profuse frothy salivation and
diarrhoea , abdominal pain
 Pulse is first slow and later rapid and weak
 Arrhythmias , block
 Mydriasis , tetanic spasm, lock jaw ,
 Death usually results from cardiac failure

19. FD 15 – 20 g of root
5 to 15 leaves
FP 20 – 36 hours
Treatment  symtpomatic
PMA -

20. Root  abortifacient , veneral disease
Cattle poison  into anus of cattle
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

21.  Yellow oliander / pila kaner
 All parts are poisonous
 Seeds (A) 4% thevetin  which is 1/8th as
potent as ouabain
 Similar to digitalis in action
 (B) thevetoxin
 ( C) nerifolin
 (D) Peruvoside
 (E) Ruvoside
 (F) Cereberin

22. And a bitter principle that act on CNS to
produce tetanic convulsions
All active principles are glycosides
Milky juice exudes from all parts of the
plant

23. Contact dermatitis
Chewing bark /seed numbing sensation ,
feeling of heat in the mouth
Mydriasis
Heart block
Death due to peripheral circulatory failure

24. FD 8 – 10 seeds
15 – 20 g of root
5 – 10 leaves
FP  2- 3 hours

25. Stomach wash
Sodium Molar lactate solution with glucose
and 1 mg atropine , 2 ml adrenaline, 2 mg
noradrenaline
PMA
Circumstances  criminal abortion , cattle
poison

26. Pilikirbir
Contains glycosides
1. Cerberin
2. Cerberoside
3. Odollin
4. Odolotoxin
5. Thevetin
6. Cerapain

27. Milky acrid juice (toxic) from all parts of the
plant

28. Within 1 hour
GI
Cardiac  3 hours  brady , AF ,
Irregular respiration
Death from heart failure
Hyperkalemia and depression of
transaminase activity are chief biochemical
changes

29. FD Kernal of 1 fruit
FP  1-2 days or more
PMA asphyxia
Sub epi, endo , plueral ptecheal bleed

30. Stomach wash
Atropine
Correct hyperkalemia
Circumstances

31. Odovan , karlajuri , karada, garari
All parts of the plant are poisonous
Toxic principle  Oduvin  glucoside
MOA blocks nueromuscular
transmission , and cardiac conductive
system

32. FD  200 – 400 gm of leaves
FP  1 – 3 days

33. Mydriasis
Hyperpyrexia
Cardiac conductive

34. Species of cinchona plants
Quinine
Cinchonidine
Alkaloids

35. It is a strong protoplasmic poison
Anaesthetic
Sclerosing action
It stimulates and depresses CNS

36. Starts in 15 – 30 min
Partial deafness, disorders of vision ,
pupils fixed dilated
Rash
Methhaemoglobinemia
Death occurs due to respiratory failure
Large doses cause hemolysis
Renal tubule block  uremia

37. Repeated therapeutic doses or over dose
Tinnitus, vertigo , deafness, diplopia ,
scotomata, blindness, skin rash ,
hypoglycemia , and cardiac arrhythmias

38. FD 8 – 15 g
FP  6 hours
Quinidine  4 – 6 g

39. Gastric lavage
Concentrated solution of magnesium
sulphate left in stomach for rapid
elimination of poison
Activated charcoal +MgSo4 until stool
looks black
Forced acid diuresis
Bilateral Stellate ganglion block cause
immediate return of vision

40. Hemolysis
Renal tubules blocked with Hb
Circumstances abortifacient

41. Monk’s hood
Blue rocket
Mitha zaher
Bish
Bikh

42. Aconitum napellus
Aconitum ferox
Roots are used
All varieties and all parts are poisonous
Most when seeds ripen and bloom

43.  Roots and seeds are most potent
 Contains
1. Aconitin
2. Pseudo aconitine
3. Indaconitine
4. Bikhaconitine
5. Picraconitine
6. Aconine
7. Mesaconitine
8. Jesaconitine

44. Contact  tingling and numbness
Odour has narcotic action
Pollen causes pain and swelling of the
eyes
Symptoms immediately or within min
GI
Salivation  dry and difficulty in
swallowing
Limbs weak , paraestheisa, ataxia, slurred
speech

45. The pupils alternate contract and dilate 
Hippus …but remain dilated in later stages
Diplopia
Dim vision
 cardiac arrhythmia , blocks
Mind clear =+/_ hallucinations
Death  paralysis of cardiac or respiratory
centres or both

46. FD 1 g root
2 – 5 mg Aconitine
250 mg extract
2 – 30 ml tincture
FP  2 – 6 hours

47. Gastric lavage
Weak solution of iodine , in KI , or tannic
acid to precipitate alkaloid
Animal charcoal
Cathartic
Atropine
Eliminated mainly by urine