Domestic Poisons Chapter Notes | Forensic Medicine and Toxicology (FMT) - NEET PG PDF Download

Introduction

The poisons that are frequently encountered in everyday life can be categorized into three main types: domestic or household poisons, poisoning from medications, and food poisoning.

DOMESTIC/HOUSEHOLD POISONS

In India, typical household poisons are commonly classified into the following groups:

Common Household Poisons

• Hydrocarbons
• Dishwashing powders and granules
• Dishwashing liquids
• Household detergents
• Disinfectants
• Metal polishes
• Cosmetics

Hydrocarbons

Hydrocarbons are a vast category of organic compounds consisting solely of carbon and hydrogen atoms. They are classified into three main types:

• Aliphatic hydrocarbons, which have a straight-chain structure.
• Aromatic hydrocarbons, characterized by the presence of a benzene ring.
• Halogenated hydrocarbons, which have been discussed earlier.

Aliphatic Hydrocarbons

Aliphatic hydrocarbons are petroleum distillates commonly found in various industrial and household products. However, they pose a risk of accidental poisoning, especially in young children. Reports indicate that approximately 28,000 children under the age of 5 ingest petroleum distillates each year, contributing to 12 to 25 percent of all poison-related fatalities in this age group. Aliphatic hydrocarbons can be further categorized into low molecular weight and high molecular weight types.

Low Molecular Weight Hydrocarbons

Gaseous Forms

Gaseous forms of low molecular weight hydrocarbons include:

• Methane (CH4)
• Ethane (CH3CH3)
• Propane (CH3CH2CH3)
• Butane (CH3(CH2)2CH3)

All of these gases are flammable. Natural gas primarily consists of methane and ethane, while liquefied petroleum gas (LPG), commonly known as 'bottled gas,' contains propane and butane.

Liquid Forms

Liquid forms of low molecular weight hydrocarbons include petroleum distillates and by-products resulting from crude oil processing. Examples are:

• Kerosene
• Diesel oil
• Gasoline (petrol)
• Mineral seal oil
• Naphtha

Kerosene, diesel oil, and petrol are types of cerebral poisons and are separated through distillation at different boiling points. Petrol and naphtha are obtained at temperatures between 50-100°C, while kerosene is derived at temperatures ranging from 150-300°C.

High Molecular Weight Hydrocarbons

High molecular weight hydrocarbons are derived from petroleum distillates and include products such as:

• Petroleum jelly (commonly known as Vaseline)
• Paraffin wax

These substances are obtained at boiling points exceeding 300°C. Notably, the toxicity of these hydrocarbons decreases as the boiling point increases, making them relatively nontoxic.

Hydrocarbons of Non-Petroleum Distillate Origin

• Hydrocarbons can be sourced from materials other than petroleum distillates.
• For instance, turpentine and carbon tetrachloride are examples of hydrocarbons that are not derived from petroleum.
• Turpentine, often used as a paint thinner or remover, is produced from pine oil.
• Although turpentine is classified as an aromatic hydrocarbon, it behaves more like an aliphatic hydrocarbon.
• Rectified turpentine has medicinal applications as a counter irritant.

It is crucial to understand the toxicity ratings of these hydrocarbons for their safe handling and use.

• Vaseline and paraffin are non-toxic substances used for medicinal purposes.
• Petrol, naphtha, and kerosene are highly toxic if ingested or inhaled.

Mode of Action

• Low molecular weight hydrocarbons have low viscosity, and their toxicity primarily results from aspiration into the lungs.
• Once aspirated, these liquid hydrocarbons can rapidly spread in the lungs, leading to severe conditions such as pulmonary edema and bronchopneumonia.
• Aspiration can occur, for example, during vomiting.
• Gaseous hydrocarbons can cause asphyxiation directly.
• Some high molecular weight hydrocarbons can also cause respiratory problems when aspirated, but the resulting pneumonia is usually more localized and less inflammatory.

Toxicity Rating and Uses of Aliphatic Hydrocarbons

Toxic petroleum distillates can cause irritation and are absorbed both orally and nasally. They dissolve in fat, which may impact nervous tissues, leading to depression of the central nervous system and potential damage to the liver, kidneys, and bone marrow. Symptoms typically involve:

• Pulmonary system
• Central nervous system
• Gastrointestinal system
• Other affected systems may include the cardiovascular system, kidneys, liver, spleen, and blood.

Signs and Symptoms of Poisoning

Poisoning can manifest in two ways: Acute Poisoning and Chronic Poisoning.

Acute Poisoning

When harmful doses are ingested, acute poisoning can lead to a variety of symptoms affecting different body systems.

• Odour:. distinct smell associated with the ingested hydrocarbon may be noticed near the patient.
• Pulmonary System:. strange smell is often detected in the breath and vomit. Cyanosis may occur due to conditions like bronchopneumonia. Aspiration can result in coughing, choking, gasping, bronchospasm, and hypoxia. In severe cases, hemoptysis (coughing up blood) may occur, and haemorrhagic pulmonary oedema can produce pink, frothy sputum, leading to shock and cardiac arrest.
• Central Nervous System: Depression of the central nervous system can cause symptoms such as vertigo, dizziness, drowsiness, headaches, tremors, and convulsions. Individuals who inhale toluene may appear intoxicated. Initially, pupils may be constricted, but they may dilate later if coma occurs.
• Gastrointestinal Tract: Ingestion of the poison can lead to symptoms like pain, a burning sensation in the throat, nausea, vomiting, abdominal cramps, and diarrhoea.
• Cardiovascular System: Problems such as cardiomyopathy (disease of the heart muscle) and arrhythmias (irregular heartbeats) may develop.
• Renal and Hepatic System: These systems are less frequently affected but can show signs of toxicity in severe cases.
• Haemopoietic System: Blood tests may reveal conditions like aplastic anaemia (failure of the bone marrow to produce blood cells) and agranulocytosis (severe reduction in white blood cells).

In fatal cases of acute poisoning:

• Drowsiness can progress to coma, leading to death from respiratory failure.
• Symptoms may include intense excitement, hallucinations, convulsions, cyanosis, unconsciousness, profound coma, and death.

Chronic Poisoning

Causes: Chronic poisoning is commonly observed in individuals working within the petroleum industry who are regularly exposed to petroleum products. This prolonged exposure can result in various health issues, including:

• Skin Conditions: Chronic eczematoid dermatitis, which is characterized by symptoms such as redness, itching, and inflammation of the skin. Additionally, contact with substances like gasoline and other hydrocarbons can lead to second-degree burns.
• Systemic Symptoms: Other potential symptoms of chronic poisoning may include dizziness, weakness, weight loss, anemia, nervousness, pain in the limbs, peripheral numbness, and paraesthesias (tingling or prickling sensations).

Fatal Dose: The lethal dose of kerosene can vary, with estimates ranging from 10 to 15 ml for adults, depending on individual factors. It's important to note that even a small amount, if aspirated, can lead to serious toxicity.

Fatal Period: The time frame for fatality can range from a few hours to one day following exposure.

Treatment for Kerosene Ingestion

• Skin Decontamination: Wash the affected skin thoroughly with soap and water to remove any residual kerosene.
• Oral Administration of Liquid Paraffin: Administer 250 ml of liquid paraffin orally. This helps dissolve kerosene and reduce its absorption in the body.
• Activated Charcoal: Large doses of activated charcoal may be recommended, although it is not effective against all types of petroleum distillates.
• Saline Purgatives: Saline purgatives might also be beneficial in this situation.
• Gastric Lavage: Avoid gastric lavage due to the risk of aspiration. However, if a large amount of kerosene (more than 4 ml/kg body weight) has been consumed, gastric lavage with warm water containing 5 per cent sodium bicarbonate can be considered, but it must be done with extreme care to prevent aspiration into the lungs.
• Intravenous Fluids: Be cautious with intravenous fluid administration to prevent fluid overload, which could lead to pulmonary edema.
• Symptomatic Management: Focus on managing symptoms to alleviate patient discomfort. The treatment aims to isolate and stop further absorption of the poison.

Postmortem Observations

• Frothy fluid coming from the mouth and nostrils, with a specific smell related to the hydrocarbon ingested.
• Other findings might indicate asphyxia.

Table 37.2: Aromatic hydrocarbons: Uses, Signs, Symptoms, and Treatment of Toxicity

• UFD. Usual Fatal Dose
• TR. Toxicity Rating

Signs and Symptoms

• Benzene
• Usual Fatal Dose: 15–20 ml
• Uses: Solvent and degreaser
• Symptoms:
• CNS: Vertigo, lethargy, convulsions, coma
• GI Tract: Abdominal pain, vomiting, diarrhoea
• RS: Pulmonary oedema, pneumonia
• CVS: Cardiac arrhythmias, blood disorders
• Possible renal and liver damage
• Chronic Exposure: Anaemia, leukaemia, CNS damage
• Toluene Poisoning: Metabolic acidosis
• Treatment: Similar to aliphatic hydrocarbons
• Stomach Wash: Cautiously after cuffed endotracheal intubation
• Xylene
• Uses: Solvent for rubber, manufacture of terylene, histological procedures in laboratories

Table 37.3: Domestic Poisons Other than Hydrocarbons

• Powders and Granules
• Irritant/Corrosive: Causes irritation of the mouth, throat, oesophagus, and stomach, particularly in children.
• Management: Stomach need not be emptied. Offer milk, water, or fruit juice. Endoscopy may be useful in uncertain cases.
• Irritant/Caustic: Symptoms from swallowing may include choking, retching, and coughing.
• Management: Stomach wash and simple fluids to drink may be administered.
• Detergents and Soaps: Vomiting after ingestion may occur; simple fluids are usually sufficient.
• Dettol and Lysol (Chlorinated Phenols): These chemicals may be mixed with isopropyl alcohol. Low toxicity, but can act like ethanol if swallowed with isopropyl alcohol.
• Management: Stomach wash and treatment for any sequelae should follow guidelines for ethanol overdose. Avoid stomach wash.
• Cosmetics (e.g., Hair Dyes, Conditioners, Shampoos, Bath Oils, Soaps): Generally considered non-toxic in practical scenarios. Palliative measures only.

Table 37.4: Common Domestic Poisons with Toxic Substances

• Toxic Substances:
• 1. Babies and Children:
  • (a) Baby Powder - Boric acid
  • (b) Crayons (Chalk) - Coloured with copper, arsenic, lead
  • (c) Crayon (Wax) - Paranitroaniline, azo dyes
  • (d) Fireworks - Arsenic, antimony, lead, thiocyanate, phosphorus
  • (e) Toys (Paints) - Lead, chromium, copper, etc.
• 2. Cosmetics:
  • (a) Cuticle Remover - Potassium hydroxide, trisodium phosphate
  • (b) Depilatories - Barium sulphide
  • (c) Nail Polish Removers - Acetone, ethyl acetate
  • (d) Sun Tan Lotions - Denatured alcohol, methyl salicylate
• 3. Kitchen:
  • (a) Baking Powder - Tartaric acid (mild irritant)
  • (b) Baking Soda - Sodium bicarbonate (can cause alkalosis over 5 gm/kg)
  • (c) Dishwashing Compounds (Machine) - Sodium polyphosphates, sodium carbonate
  • (d) Domestic Fuel
  • (e) Domestic Gas
  • (f) Fire Extinguishing Fluids - Carbon tetrachloride, methyl bromide
  • (g) Matches - Antimony, phosphorus sesquisulfide, potassium chlorate
• 4. Rat Poisons:
  • (a) Rat Paste - Phosphorus, zinc/aluminium phosphide
  • (b) Rodine (Brown Bran Paste) - Barium carbonate, thallium acetate
  • (c) Warfarin - Yellow phosphorus; a 4-hydroxy coumarin.
• 5. Sanitary:
  • (a) Deodorants - Formaldehyde, naphthalene
  • (b) Drain Cleaners - Sodium hydroxide
  • (c) Lysol - Phenol
• 6. Miscellaneous:
  • (a) Anti-Rust Products - Ammonium sulfide, naphtha, oxalic acid
  • (b) Cleaning Solvents (Flammable) - Petroleum hydrocarbons
  • (c) Cleaning Solvents (Non-Flammable) - Carbon tetrachloride, trichloroethylene
  • (d) Dentifrices, Mouthwashes - Hydrogen peroxide
  • (e) Furniture Polish - Ordinary denatured spirit, resins, sodium hypochlorite (5%), oxalic acid
  • (f) Insecticide (Spray) - Organochloro, organophosphorus, and carbamate insecticides
  • (g) Lavatory Cleaners - Mineral acids
  • (h) Marking Ink - Aniline
  • (i) Mothballs - Naphthalene
  • (j) Paint Removers - Sodium hydroxide, acetone
  • (k) Shoe Polish - Aniline, nitrobenzene
  • (l) Straw Hat Cleaner - Oxalic acid

The gastrointestinal tract may exhibit signs of acute gastroenteritis. The stomach may appear congested, and its contents can emit a smell specific to the type of hydrocarbon ingested.

Lungs. The lungs smell like kerosene and show signs of pulmonary edema (fluid in the lungs) and bronchopneumonia (lung infection that includes areas of solidification in the lung tissue and air pocket changes).

Liver and Kidneys. Both organs show signs of degenerative changes, indicating damage or deterioration.

Bone Marrow. The bone marrow appears hypoplastic, meaning it is underdeveloped or not producing enough blood cells.

Organ Preservation. The brain and other organs should be preserved for chemical examination to investigate further.

Preservative Used. Saturated saline solution is used as a preservative for the organs.

Medicolegal Importance

• Most cases are accidental, often due to industrial exposure or domestic accidents involving children.
• Some hydrocarbons are easily accessible and may be ingested for suicide or used to soak cloth for self-immolation.
• The high flammability of these fluids makes them a choice for homicidal burning, such as in dowry deaths.
• Homicide by oral route is very rare.
• However, most incidents are accidental, leading to poisoning or burning, for example:
  • Sucking petrol from tanks with rubber tubing can cause choking from sudden petrol gushing into the mouth and throat.
  • Inhalation of petrol fumes occurs in petroleum industries.

Aromatic Hydrocarbons

• Aromatic hydrocarbons, including substances like benzene, toluene, xylene, and styrene, play a significant role in various industrial applications due to their unique properties.
• These compounds are characterized by their distinct odors and can enter the human body through different routes, such as inhalation, ingestion, and direct skin contact.
• Among these hydrocarbons, benzene and toluene are highly toxic, posing serious health risks, while xylene is considered relatively non-toxic.
• Table 37.2 provides detailed information on the uses, signs, symptoms, and treatments associated with the toxicity of each aromatic hydrocarbon.
• While domestic poisoning incidents involving these compounds are rare, industrial exposure is quite common, necessitating strict safety measures.
• Workers handling benzene in industrial settings require regular blood checks to monitor for potential health effects.
• Toluene is often associated with the practice of "glue sniffing,". dangerous activity where individuals inhale the vapors of toluene-containing products for recreational purposes.

Introduction

Dishwashing Products

• Powders and Granules: These are solid forms of dishwashing detergent.
• Liquids: Liquid dishwashing detergents are popular for their ease of use and effectiveness.
• Disinfectants: These products not only clean but also kill germs and bacteria.
• Metal Polishes: Used to clean and shine metal surfaces, these products are often used on appliances and cookware.
• Cosmetics: While not directly related to dishwashing, some cosmetic products may contain ingredients similar to those found in dishwashing detergents.

Household Poisons

• Antiseptics: Products like iodine, benzoin, and phenol are used for their antiseptic properties but can be toxic in large amounts.
• Cough Remedies: Cough syrups containing codeine can be harmful if ingested inappropriately.
• Headache Remedies: Common pain relievers like aspirin, phenacetin, and analgin can be toxic in high doses.
• Pep Tablets: Tablets containing benzodrine are used for their stimulating effects but can be dangerous in excess.
• Sleeping Preparations: Barbiturates, used for sleep disorders, can be lethal in high doses.
• Throat Tablets: Tablets containing potassium chlorate can be harmful if swallowed in large quantities.
• Tonic Syrup: Easton’s syrup, which contains strychnine, is used as a tonic but can be toxic.
• Others: Various medications like antidepressants, tranquilizers, antibiotics, and analgesics can be toxic if misused.

Garden Poisons

• Fungicides: Substances like lead arsenate, copper compounds, organic mercurials, and lime are used to kill fungi but can be toxic to humans and animals.
• Insecticides and Pesticides: Products containing nicotine, tar oils, organochloro and organophosphorus compounds, carbamates, and cyanides are used to kill pests but can be harmful if ingested.
• Weed Killers (Herbicides): Chemicals like sodium chlorate, arsenious oxide and arsenites, dinitrocresol, and paraquat are used to kill weeds but can be toxic to humans and animals.

Household Poisons: Medical

 Common household items can pose serious poisoning risks if ingested, inhaled, or absorbed through the skin. Here are some key points about medical household poisons: 

•  Acetaminophen: Overdose can lead to liver failure. Symptoms may not appear immediately. 
•  Antidepressants: Can cause drowsiness, confusion, and in severe cases, seizures. 
•  Spoons and Forks: Ingestion of metal utensils can cause gastrointestinal obstruction or perforation. 
•  Hand Sanitizers: High alcohol content can lead to alcohol poisoning, especially in children. 
•  Batteries: Ingestion can cause chemical burns and heavy metal poisoning. 
•  Laundry Detergent Pods: Can cause respiratory distress, vomiting, and lethargy. 
•  Mouthwash: Ingestion of large amounts can lead to alcohol poisoning and gastrointestinal irritation. 
•  Baby Oil: Ingestion can cause aspiration pneumonia and gastrointestinal irritation. 
•  Rubbing Alcohol: Ingestion can lead to alcohol poisoning and gastrointestinal irritation. 
•  Essential Oils: Can cause respiratory distress, gastrointestinal irritation, and skin burns. 
•  Electric Toothbrushes: Ingestion of parts can cause gastrointestinal obstruction or perforation. 
•  Pain Relief Creams: Overuse can cause skin irritation and systemic effects. 
•  Pet Flea Treatments: Can cause neurological symptoms in pets and humans if ingested. 

 Always store potentially harmful substances out of reach of children and follow safety guidelines for use. 

Garden Poisons

 Introduction:   The garden contains various plants and substances that can be toxic if ingested or improperly handled. 

•  Plants: Some common garden plants are known to be poisonous, including: 
  •  Oleander: All parts of the plant are toxic. 
  •  Foxglove: Contains compounds that can be harmful. 
  •  Yew: The berries and foliage are poisonous. 
  •  Azalea: Ingestion can cause serious health issues. 
•  Chemicals: Garden chemicals such as pesticides, herbicides, and fertilizers can also pose poisoning risks. Always follow the manufacturer’s instructions and keep these substances out of reach of children and pets.