copper, iron, thallium and manganese poisoning

1. COPPER / TAMBA

2. COPPER
• It is a brown colour metal
• As a metal it is non poisonous
• Important integral of enzymes
Action:
– high affinity for sulphhydryl and amino groups.
– May also target nucleic acids

3. Toxic compounds and its uses:
• Copper sulphate (CuSO4, blue vitriol, neela tutia):
– Large blue crystals, soluble in water and styptic taste
– Used in algaecides, fungicides, electroplating, leather
tanning, hide preservation to impart rich green colour and
for preservation of fruits and vegetables and also usedas
emetic except in arsenic.
– It is used as an antidote in phosphorus poisoning where it
forms cupric phosphide (non toxic substance).

4. Copper sulphate

5. • Copper subacetate (verdigris / zangal) :
– Bluish green powder formed by the action of
vegetable acids on improperly tined copper
cooking vessels.
– Used in arts and external medicine
• Copper carbonate
– fungicide

6. Exposure, Absorption and Excretion:
• Principal route of exposure is through
– Ingestion,
– Inhalation of fumes and dust and also
– Exposure of skin
• Maximum absorption occurs in stomach and GIT and
then transported to liver to bond with ceruloplasmin
• Excreted in feces, bile and urine

7. • F.D.: copper subacetate: 15 gm
copper sulphate: 20 gm
• F.P. : 1- 2 days.

8. Signs and symptoms: Acute
• GIT: Metallic taste, ptyalism, thirst, colicky
abdominal pain, nausea, eructation, repeated vomiting
(blue/green). Diarrhea (brown) with much straining
• Hemolytic tendencies due to increased concentration
of copper in the erythrocytes, resulting in
haemetemesis and Melaena.
• Hepatic: jaundice

9. – Renal: oliguria, haematuria, uraemia
– MS: cramps/spasm of legs, paralysis
– Inhalation of fumes: sore throat, cough;
conjunctivitis; perforation of nasal mucosa
– Skin exposure: contact dermatitis

10. Treatment :
– No need to use emetic as vomiting occurs in 5-10 min
– Gastric lavage 1% potassium ferrocyanide as it form
insoluble cupric ferrocyanide
– Demulcents: egg white or milk
– Castor oil
– Chelating agents: D-pencillamine (2 gm / day in four
divided doses orally), EDTA or BAL
– Morphine and diuretics
– Symptomatic
– For severe cases: cortisone 50- 100 mg thrice daily

11. Post mortem findings:
– Skin yellow d/t jaundice
– Greenish blue froth from mouth
– Greenish blue tinge in the mucus membrane of GIT.
– Liver : soft and fatty; shows centri-lobular necrosis
and biliary stasis
– Kidneys : degenerative changes in proximal tubules,
Hb casts

12. Chronic poisoning :
• Seen in factory workers
• It result from, preservation and cooking of food in
unclean copper utensils may result in poisoning as it
is contaminated with verdigris.
• Chronic consumption of fruits and vegetables
preserved and coloured with copper sulphate.

13. – Greenish or purple line on gums at its junction
with the teeth called Clapton’s line.
– Giddiness and headache
– laryngitis and bronchitis
– Metal fume fever
– Progressive emaciation with anemia malaise and
debility
– Conjunctivitis and corneal ulcers
– Bronze diabetes m/b present
• Treatment: Symptomatic management
Signs and symptoms:

15. PM findings
• Liver: fatty degeneration
• Kidneys: degeneration of epithelial cells

16. Medico Legal Aspects
– Suicide: common
– Accidental: eating food coked in copper utensils,
children
– Copper used in IUCDs and haemodailysis
equipment.
– Copper is used as antidote in phosphorus
poisoning and wound debridement
– Cattle poison
– Homicide is rare

17. IRON
– Incidence usually d/t overdose and in children less
than 6 yrs of age
– M O A: taken up by parenchymal cells of liver,
causes mitochondrial damage and cellular
dysfunction l/t
• Metabolic acidosis and Necrosis,
• Liver failure,
• Hypoglycemia,
• Coagulopathy and death.

18. Signs and symptoms ( 4 stages)
• Phase 1: (30 min to few hrs)
– vomiting, gastroenteritis, with grey or black vomitus and stool with
metallic odour l/t collapse and coma
• Phase 2: (6 - 24 hrs)
– s/s alleviate finally progressing to next stage
• Phase 3: (12 to 48 hrs)- hepatic stage
– severe lethargy, convulsions, shock, gastrointestinal hg, cv collapse,
metabolic acidosis, hepatic failure with hepatocellular necrosis, jaundice,
hypoglycemia, Coagulopathy, pulmonary edema and renal failure.
• Phase 4: (2- 5 wks)
– Formation of gastric strictures and pyloric stenosis, Hepatic cirrhosis

19. Diagnosis and Treatment
– X-ray abdomen show iron tablets
– Serum iron level more than 350 μg/dl
– Blood glucose : > 150 µg/dl
– Prothrombin time increased
– Fatal dose: 20-40 gm of ferrous sulphate/ 150 mg of iron
A 325-mg tablet of
ferrous sulfate has 65 mg of elemental iron
ferrous gluconate has 39 mg of elemental iron
ferrous fumarate has 107.25 mg of elemental iron

20. Treatment:
– GL with sodium bicarbonate
– Demulscents
– Antidote: desferoxamine: iv at the rate of 15- 80
mg /kg BW/hr

21. THALLIUM
– Heavy metal with lustrous colour on exposure to air form
thallous oxide
– It is a cumulative poison
– All salts as well as metal are poisonous.
• Toxic compounds and uses:
Thallium acetate: depillatory creams, fire works,
rodenticides and insecticides
Thallium sulphate: rodenticides and insecticides

22. Absorption and Excretion
• Abs through all routes
• Deposited in epididymis, liver, kidneys,
muscles and bones.
• Excreted through kidneys and in breast milk

23. Signs and symptoms
• Acute:
– Metallic taste, nausea vomiting, colic, diarrhoea,
– Conjunctivitis, scotoma, blindness,
– Polyneuritis, peripheral neuropathy- (burning feet
syndrome), ataxia coma, encephalopathy
– Loss of hair, mees lines and deafness,
– Maculo-papular skin eruptions on face with butterfly
distribution,
• F.D.: 1 gm
• F.P.: 2-3 days

24. Chronic Poisoning
• Alopecia
• Skin rashes
• Painful peripheral neuropathy
• Mental confusion with lethargy

25. Diagnosis and Treatment
• Eosinophilia
• Urine m/b green
• thallium > 40 μgm % in blood and > 150 μgm/l in urine
• Opacity in liver on X-ray
• Signs of gastric irritability and loss of hair.

26. Treatment:
– Stomach wash with 1% sodium or potassium
iodide
– Prussian blue (potassium ferric hexacyanoferrate)
orally 250 mg/kg/day in 2-4 divided doses
– BAL and EDTA are contraindicated
– Pilocarpine is physiological antidote
– Hemodialysis/ peritoneal dialysis
– Symptomatic

27. MLI:
• Ideal homicidal poison: more prevalent in European
countries.
• Chronic poisoning in industries.
• Accidental poisoning d/t therapeutic over usage.

28. MANGANESE
• Important compounds are Potassium
permanganate and manganese dioxide.
• Potassium permanganate :
• Dark purple slender crystals with astringent
taste. powerful antioxidant and disinfectant.
• MOA: causes coagulation necrosis and brown
discolouration of mucus mb., paralysis of heart

29. Signs And Symptoms:
– Burning pain from mouth to stomach, thirst,
colicky abdominal pain, nausea, eructation,
repeated vomiting, difficulty in swallowing,
dyspnoea , stridor, cough.
– Discolouration initially purple brown but later
changes to brown then coal black d/t formation of
manganese dioxide
– F.D.: 10- 20 gm
– F.P.: few hrs

30. Treatment:
• GL
• Demulscents
• Charcoal
• Symptomatic
PM appearance:
• necrosis , Hg and corrosion
• Liver and kidneys show degensrative changes

31. MLI:
– Usually suicidal poisoning
– M/b accidental in case of children
– Abortificient: inserted into vagina- causes
ulceration ( acute, localised, punched out with
raised edges and granular black base)
– Fictious injury: when applied to skin for 10 -20
min causes ulcer resembling syphilis.