Chapter 43: Non-metallic Irritants

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Questions and Answers

What is a notable external postmortem finding associated with yellow phosphorus poisoning?

Corroded oral mucosa and gums (correct)

Presence of cyanosis in extremities

Presence of blisters on the skin

Bright red discoloration of the fingertips

Which internal organ exhibits yellowish discoloration and swelling in yellow phosphorus poisoning?

Heart

Lungs

Liver (correct)

Pancreas

What unusual odor may be associated with the stomach contents in cases of yellow phosphorus poisoning?

Pungent odor of ammonia

Sweet scent similar to candy

Foul smell of sulfur

Smell of garlic (correct)

Which of the following best describes the histopathological finding in yellow phosphorus poisoning?

Necrosis with ballooning degeneration Signup and view all the answers

What type of poisoning is considered more common in children involving yellow phosphorus?

Accidental poisoning from consuming food Signup and view all the answers

The symptoms of yellow phosphorus poisoning can often resemble which condition?

Acute liver disease Signup and view all the answers

What characteristic finding is observed in the kidneys during postmortem examination for yellow phosphorus poisoning?

Enlarged, greasy, and yellow in color Signup and view all the answers

Which method is mentioned as a potential use of yellow phosphorus in illicit activities?

Administering to horses disguised with coffee Signup and view all the answers

What symptom did the patient NOT exhibit upon her initial hospital admission?

Hypotension Signup and view all the answers

What treatment was administered to the patient after ingestion of yellow phosphorus?

Activated charcoal Signup and view all the answers

What was noted about the patient on her 4th day readmission to the hospital?

Presence of icterus Signup and view all the answers

What was the provisional diagnosis on the patient's 4th day in the hospital?

Acute yellow phosphorus poisoning Signup and view all the answers

What finding was noted during the autopsy of the patient?

Petechial hemorrhages Signup and view all the answers

What is a common outcome of chronic phosphorus poisoning?

Necrosis of the lower jaw Signup and view all the answers

What is a primary characteristic symptom of iodine poisoning upon ingestion?

Brownish discoloration of lips Signup and view all the answers

What is one of the clinical effects observed within the first stage of white phosphorus ingestion?

Garlic-like odor in breath, vomitus, and feces Signup and view all the answers

What treatment should be administered immediately after iodine poisoning?

Gastric lavage with starch solution Signup and view all the answers

During which stage do liver enzyme levels become elevated in cases of acute phosphorus ingestion?

Second Stage Signup and view all the answers

What condition may result from chronic phosphorus poisoning affecting the jaw?

Osteomyelitis Signup and view all the answers

Which of the following is a common use of iodine?

Disinfectant and antiseptic Signup and view all the answers

What is a common renal symptom in the third stage of phosphorus toxicity?

Oliguria Signup and view all the answers

What is the treatment for managing acute phosphorus poisoning generally focused on?

Preventing acute hepatic failure Signup and view all the answers

What is a common postmortem finding in cases of iodine poisoning?

Characteristic iodine odor Signup and view all the answers

What symptom could indicate respiratory distress in iodine poisoning?

Edema of glottis Signup and view all the answers

What is a recommended treatment method for reducing absorption after phosphorus ingestion?

Activated charcoal Signup and view all the answers

What is a distinguishing feature of 'phossy jaw' caused by phosphorus poisoning?

Multiple sinuses discharging foul-smelling pus Signup and view all the answers

What postmortem finding is associated with the liver after phosphorus poisoning?

Marked hyperemia with fatty degeneration Signup and view all the answers

Which of the following is a key clinical feature in the third stage of phosphorus toxicity?

Encephalopathy Signup and view all the answers

In cases of phosphorus ingestion, what is a vital sign of coagulopathy in the third stage?

Hemorrhage in mucous membranes Signup and view all the answers

What complication is likely to occur within 24 hours of ingesting a fatal dose of white phosphorus?

Acute renal failure Signup and view all the answers

Which of the following is a recommended treatment to help protect the liver after phosphorus exposure?

Ursodeoxycholic acid Signup and view all the answers

What is 'phossy jaw' associated with?

Chronic phosphorus poisoning Signup and view all the answers

Which of the following is a symptom of iodine poisoning upon ingestion?

Brownish discoloration of lips Signup and view all the answers

What initial treatment should be done in cases of iodine poisoning?

Gastric lavage with starch solution Signup and view all the answers

What characteristic odor is associated with iodine poisoning postmortem?

Characteristic iodine odor Signup and view all the answers

Which treatment is NOT typically necessary for iodine poisoning?

Surgical removal of the stomach Signup and view all the answers

What is a common outcome in chronic phosphorus poisoning?

Osteomyelitis of the jaw Signup and view all the answers

What is a characteristic symptom of white phosphorus exposure?

Strong garlic-like odor Signup and view all the answers

During the case of the 29-year-old female patient, what symptom indicated worsening condition upon readmission?

Drowsiness Signup and view all the answers

What transformation occurs to white phosphorus when it is exposed to heat and light?

It transforms into red phosphorus Signup and view all the answers

What is the primary effect of phosphorus as a protoplasmic poison?

Affects cellular metabolism leading to necrobiosis Signup and view all the answers

What type of poisoning is most commonly seen in children due to accidental ingestion?

Iodine poisoning Signup and view all the answers

What can cause respiratory distress in iodine poisoning cases?

Tracheostomy Signup and view all the answers

How does white phosphorus typically present on the skin upon contact?

It causes painful burns with a yellowish necrotic appearance Signup and view all the answers

What is the ignitability characteristic of red phosphorus?

Requires heat greater than 260°C for ignition Signup and view all the answers

What effect does iodine have on cells when toxicity occurs?

Precipitates proteins and damages cells Signup and view all the answers

Which of the following describes the solubility of white phosphorus in organic solvents?

Soluble Signup and view all the answers

What distinguishes red phosphorus from white phosphorus in terms of toxicity?

Low toxicity in comparison to white phosphorus Signup and view all the answers

What is one of the uses of white phosphorus?

Insecticides and incendiary bombs Signup and view all the answers

Study Notes

Phosphorus Overview

Phosphorus has two common allotropes: white (or yellow) and red phosphorus.
White phosphorus is crystalline, waxy, and emits a garlicky odor; it is highly toxic, while red phosphorus is less toxic, amorphous, and odorless.
White phosphorus is lipid-soluble, leading to rapid dermal penetration and delayed wound healing.

Signs and Symptoms of Acute Phosphorus Poisoning

First Stage: Burning pain in throat and abdomen, intense nausea, vomiting, diarrhea, and a garlic-like odor in breath and vomitus within 3-6 hours.
Second Stage: Symptom-free period lasting 1-4 days; however, liver enzymes begin to rise.
Third Stage: Signs of multi-organ failure, including jaundice, acute liver and renal failure, and CNS symptoms like confusion and convulsions.

Fatal Dose and Diagnosis

The fatal dose of white phosphorus is 60-120 mg, with symptoms potentially delayed for up to 10 days.
Diagnosis includes oral and skin burns alongside severe gastrointestinal damage.

Treatment of Phosphorus Poisoning

Management aims to prevent acute hepatic failure; treatments include activated charcoal, IV vitamin K, fluid maintenance, and possible dialysis for metabolic imbalances.
Supportive measures involve washing burns with mild disinfectant soap and water, and administering glucose-saline solution.

Post-mortem Findings

External: Signs of emaciation, purpura, extensive burns, and corrosion of oral mucosa.
Internal: Liver hyperemia with fatty degeneration, hemorrhage in tissues, corroded mucous membranes in the GI tract, and yellow discoloration of organs.

Medico-Legal Aspects of Phosphorus Poisoning

Accidental poisoning can occur in children; phosphorus is rarely chosen for suicides due to painful symptoms.
Potential uses for poisoning include stealthy horseicide intentions mixed with alcohol or coffee.

Chronic Phosphorus Poisoning: Phossy Jaw

Necrosis of the lower jaw occurs from prolonged inhalation of phosphorus fumes, leading to severe dental and gum issues.
Symptoms include jaw swelling, necrosis, nausea, and general malaise.

Iodine Poisoning Overview

Iodine appears as black crystals with a metallic taste and is used predominantly as a disinfectant and in the chemical industry.
Toxicity arises from ingestion, inhalation, or skin contact, causing corrosive effects on cells.

Signs and Symptoms of Iodine Poisoning

Upon ingestion, symptoms include brown discoloration of lips and oral mucosa, intense thirst, abdominal pain, vomiting, and diarrhea.

Treatment and Post-mortem Findings for Iodine Poisoning

Treatment includes gastric lavage with starch or sodium bicarbonate, IV hydrocortisone, and symptomatic care.
Postmortem may reveal characteristic iodine odor, brownish stains on skin and mucosa, and congestion of internal organs.

Interesting Case of Phosphorus Poisoning

A 30-year-old woman displayed symptoms of phosphorus poisoning after ingesting rat poison, presenting with nausea and garlicky vomit.
Despite symptomatic improvement, she later returned with signs indicating hepatic encephalopathy and multiorgan failure, leading to death after bradycardia onset.

Key Insights

Phosphorus is highly toxic, particularly in its white form, with significant effects on organs and metabolic function.
Medico-legal implications of phosphorus and iodine poisoning highlight risks in children and the roles of these substances in potential foul play or industrial hazards.

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Description

This quiz focuses on Chapter 43, where you will explore critical information about non-metallic irritants, particularly phosphorus poisoning. You will learn about signs, symptoms, treatments, and the medicolegal implications associated with phosphorus and iodine poisoning. Prepare to enhance your understanding of this essential topic in toxicology.