Modern Medical Toxicology

CONTENTS
1. Introduction
SECTION 1: GENERAL PRINCIPLES
Epidemiology of Poisoning 3
Historical Overview 3 Poison information/Control Centers &
Mortality from Poisoning 6
Poisoning Severity Score 7
2. Diagnosis of Poisoning
3. General Management of Poisoning
Evaluation 19
Decontamination 23
Stabilization 11 Antidote Administration 35
Nursing and Psychiatric Care 37
Elimination 28
Special Precautions in Poisoned Pregnant Patient 38
4. Medicolegal Aspects of Poisoning
> Medicolegal Duties of a Doctor in Suspected/Actual Poisoning 41
Indian Statutes on Drugs/Poisons 42 Toxicology and the Criminal Law 47
Medicolegal Problems Involving Consent 48
Toxicology and the Workmen's Compensation A
Postmortem Examination in a Case of Poisoning 49 Homicidal Poisoning 52
Stupefying Poisons 53
SECTION 2: CORROSIVE (CAUSTIC) POISONS
5. Mineral Acids (Inorganic Acids)
Caustics 59
6. Organic Acids
7. Alkalies and Other Caustics
Alkalies (Alkalis) 81
Other Caustics 83
SECTION 3: CHEMICAL POISONS
8. Nonmetallic Chemical Poisons
- Phosphorus 91
Phosphine 96
Aluminum Phosphide 98
Zinc Phosphide 100
- Halogens 101
9. Heavy Metals
Arsenic 108
Lead 116
Mercury 126
Iron 134
Copper 139
Other Metals and Metallic Elements (in Alphabetical Order)
144
Metal Fume Fever
vi
10. Irritant Plants Classification 173
SECTION 4: ORGANIC POISONS (TOXINS)
Oropharyngeal initanant Plants 189
Gastric iritant Plants 175
Intestinal Irritant Plants 189
Dermal Irritant Plants 189
11. Plants of Special Importance
Hepatotoxic Plants 192
Other Plants 193
12. Venomous Bites and Stings
Snakes 201 Classification of Snakes 203 identification of Venomous Snakes 205 Common Indian Venomous Snakes 205 Snake Venom 214 Snakebite 216
Venomous Insects 232 Venomous Arachnids 236 Miscellaneous Venomous Creatures 244
Marine Venomous Creatures 247
SECTION 5: NEUROTOXIC POISONS
13. Somniferous Drugs
Somniferous Drugs (Narcotics) 253
14. Inebriants
Alcohols 270
Barbiturates 296
Benzodiazepines 298
Chloral Hydrate 302
Other Sedative-Hypnotics 303
15. Deliriants
Datura 308
Cannabis 313
16. Stimulants
> Amphetamines 321
Designer Amphetamines 327
Cocaine 330
17. Anticonvulsants and Antiparkinsonian Drugs
> Anticonvulsants (Antiepileptics) 342
Antiparkinsonian Drugs 354
18. Anesthetics and Muscle Relaxants
➤ Anesthetics 360
Inhalational Anesthetics 360
Intravenous Anesthetics 364
Local Anesthetics 367
Muscle Relaxants 371
Central Skeletal Muscle Relaxants 371
Neuromuscular Blocking Agents 374
Other Central Muscle Relaxants 373
Miscellaneous Muscle Relaxants 378
Antipsychotics 383
Antidepressants 394
Antimanic Drugs 409
19. Drugs Used in Psychiatry
Anti-migraine Drugs 413
Drugs Used in Alzheimer's Disease 416
20. Spinal and Peripheral Neurotoxic Agents
Strychnine 420
Poison Hemlock 423
Water Hemlock
SECTION 6: CARDIOVASCULAR POISONS
21. Diuretics, Antihypertensives and Antiarrhythmics
429
Diuretics 429
Antihypertensives 433
Antiarrhythmics 451
22. Cardiac Drugs and Lipid-lowering Agents
467
Cardiac Drugs 467
Lipoprotein-lowering Drugs 479
23. Anticoagulants and Related Drugs
48
Anticoagulants 485
Antifibrinolytics 492
Thrombolytics 494
Antiplatelet Drugs 495
Hematopoietic Growth Factors 496
24. Cardiotoxic Plants
50
Aconite 500
Oleander 503
SECTION 7: ASPHYXIANT POISONS
25. Toxic Gases
Simple Asphyxiants 511
Respiratory Irritants 513
Systemic Asphyxiants 524
26. Hydrocarbons
SECTION 8: HYDROCARBONS AND PESTICIDES
Classification 545
Aliphatic Hydrocarbons 545
Aromatic Hydrocarbons 549
Halogenated Hydrocarbons 555
27. Pesticides
Definition 560 Classification 560
Organophosphates (Organophosphorus Compounds] 560
- Carbamates (Carbamate Insecticides) 573 Organochlorines (Organochlorides) 575 > Diethyltoluamide (Diethylmethylbenzamide) 582 Pyrethrins and Pyrethroids 583
Alpha-naphthylthiourea 586 Cholecalciferol (Vitamin D,) and Ergocalciferol (Vitamin D,) 586
Bromethalin 587 Red Squill 587
Paraquat and Diquat 587
Chloroacetanilide Compounds 593 Chlorophenoxy Compounds 593
Glyphosate 596
Thiocarbamates (Carbamate Fungicides) 597
Tridemorph 598
Captan and Captafol 598
Metaldehyde 599
Dinitrophenol and Related Compounds 600
Fipronil 601
Neonicotinoid Insecticides 601
Ryanoid (Diamide) Insecticides 602
> Dioxins 603
Forensic Significance (for All Pesticides) 604
SECTION 9: MISCELLANEOUS DRUGS AND POISONS
28. Analgesic-antipyretics: Nonsteroidal Anti-inflammatory Drugs and Antihistamines
> Analgesic-Antipyretics 613
Nonsteroidal Anti-inflammatory Drugs 628
Antihistamines 632
29. Anti-infectives
Antimicrobial Agents 640
Antiprotozoal Agents 674
Antihelminthic Agents (Anthelmintics)
Autopsy Features in Anti-Infective Overdose Deaths 685
Forensic Significance of Anti-Infective Drug Poisoning 685
30. Gastrointestinal and Endocrinal Drugs
xviii
> Gastrointestinal Drugs 688
Endocrinal Drugs 704
31. Other Drugs
> Antiasthmatic Drugs 726
Catecholamines 739
> Immunomodulators 741
Antineoplastic Agents 748
> Drugs Acting on the Uterus 777
Radiocontrast Agents 778
> Drugs Used in the Treatment of Sexual Arousal Disorders 782
32. Food Poisoning
SECTION 10: FOOD POISONS
➤ Causes 793
Diagnosis 793
General Treatment Measures 793
➤ Prevention of Food Poisoning 793
Microbial Food Poisoning 794
➤ Food Poisoning due to Parasites 815 ➤ Food Poisoning caused by Plants 832
Food Poisoning due to Fungi 816
➤ Food Poisoning due to Fish (Marine Food Poisoning) 840
➤ Food Poisoning due to Chemicals 849
SECTION 11: SUBSTANCE ABUSE
33. Substances of Dependence and Abuse
➤ Definitions 857
Classification 858
Tobacco 858
➤Cocaine 865
➤Cannabis 874
➤ Amphetamines 879
Designer Drugs 886
➤ Methcathinone 888
Hallucinogens 889
Classification of Hallucinogens 891
➤ Inhalants ("Glue Sniffing", Volatile Substance Abuse, Inhalant-related Disorders) 897
➤ Emerging Substances of Abuse 899
SECTION 12: ANALYTICAL TOXICOLOGY
34. Methods of Toxicological Analysis
➤ Biochemical and Hematological Tests Useful in Toxicology 914
➤ Analytical Methods Used in Toxicology 915