What is Neurotic poisoning?

Classification of neurotic poisoning:
• Ethyl alcohol
• General anesthetics
• Opioid analgesics
• Sedatives & hypnotics.


OPIUM:
 Opium is derived from papaver somniferum, an annual plant with culiate or red flowers growing on a central bulbous pod.


MECHANISM OF ACTION:
1. Opiates exert their effects because of their chemical similarity  of natural substances called endorphins .
2. The opiate drugs activate receptor sites normally occupied by the natural opiates or endorphins
3. Opium depresses all the centers except. Oculomotor, vomiting, and sweating. It is a peripherally acting analgesics.
4. It stimulates non-propulsive rhythmic contraction of the small intestine.Opium and its derivatives act synergistically with alcohol and barbiturates.

Signs and symptoms:
1. The contact of morphine with the skin of sensitive persons ma cause erythema, urticaria and itching dermatitis
2. When opium taken by mouth- symptoms begin within 1/2  hr. If the drug is infected its action is noted within 3 or 4 mins. It first stimulated, then depresses and finally paralysis the nerve centers.


1. Stage of excitement:
• Short duration & maybe absent when taken in larger doses
• Increased sense of well being.
• Increased mental activity
• Freedom from anxiety
• Talkativeness.
• Restlessness or even hallucinations, flushing of face and greatly excited or maniacal condition maybe seen
2. Stage of stupor:
• Headache, nausea, vomiting
• Incapacity for exertion
• Sense of weight in limbs
• Giddiness, drowsiness
• Motionless, eyes closed as if in sound sleep from which he may be aroused at first but soon passes into stupor or coma
•  contraction of pupils
• Face and lips cyanosed
•  itching sensation
• Pulse respiration normal
3. Stage of coma:
• Muscles become flaccid and relaxed and all reflexes abolished.
• Face- pale & conjunctiva congested
• Pupils- pinpoint size and do not react to light
•  all the secretion are suspended except sweat
• The skin - cold often converted with perspiration
• Temperature decreased
• BP Lowered, pulse lowered.
• Breathing is slow and strenuous & may be reduced to 4 to 5 /min
• The odor of opium is present in the breath
Fatal termination:
• Lividity of the surface increases,  pulse becomes slow, irregular and imperceptible, the respiration becomes chegne-stokes in types and finally death occurs in deep coma from asphyxia.
• Skin blistering


POSTMORTEM APPEARANCES:
• They are not characteristics but signs of asphyxia are present.
• Face and nails are cyanosed. Froth is seen at the mouth & nostrils.
• Post mortem staining is well marked and cyanotic. The smell of opium is noticed on opening the chest, but it disappears if  putrefaction has set in.
• Stomach may contain small lumps of opium
• The trachea and bronchi are congested and covered with froth
•  Lungs are oedematous and  congested
•  Brain, meninges & abdominal organs are congested
• Blood usually dark and fluid. Opium disappears rapidly from the cadavers.
MANAGEMENT:
• Wash the stomach, thoroughly and frequently with a solution of 1: 5000 potassium permanganate leaving some of the solution in the stomach   for oxidizing the alkaloid.
• The intestines should be cleared out by enema twice daily for 2 days to prevent reabsorption
• Atropine is not recommended as it will cause death by  paralyzing the motor and sensory nerves.

                      What is a coma cocktail?

• Coma cocktail: In comatose  patient in whom the type of poison is unknown 100ml of 50% glucose,100ml of thiamin and 2mg naloxone should be given I.V
anesthetics