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How. You can be poisoned by different narcotics
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Some information about the substance include:- The name of the drug, medical uses, dependence ( physical & psychological), tolerance, duration, methods of usual administration, possible effects, effects of overdose, withdrawal syndromes, schedules, trade or other names.
Opium & morphine Titles Morphine derivatives, Action of morphine, Fatal dose, Poisoning (acute, chronic), Picture of poisoning (acute, chronic), Differential diagnosis (pontine haemorrhage) , treatment of acute poisoning, Chronic morphine poisoning (dependence), Withdrawal manifestations, Treatment of morphine dependent, Post-mortem findings.
Morphine derivatives Apomorphine which is a central emetic. Diacetyl morphine (Heroin) is used by dependents only. Ethyl morphine HCl (Dionine) is used in ophthalmology in the treatment of corneal ulcers. Nalorphine, Levallorphine, Naloxone are morphine competitive antidotes.
Poisoning (acute) Occurring accidentally in dependents taking a massive dose or swallowing by peddlers when arrested by authorities. Picture of poisoning (acute) transient euphoria, drowsiness. Vomiting may occur. Miosis (pin point pupils). Itching (histamine release). Coma with slow pulse. Smell of opium in breath. Signs of i.v. needle injections. Cyanotic cold clammy skin. Hypotonia & hyperflexia. Irregular respiration & death from central asphyxia in 12 hours.
Differential diagnosis should be differentiated from pontine hemorrhage in which there is coma &pin point pupils but with hyperthermia & quadriplegia. Also should be differentiated from all types of coma. Treatment of acute poisoning: - Gastric lavage with alkaloidal antidotes as for ingested opium and ingested morphine because it is excreted in the stomach and duodenum. Saline purge. General care of coma & respiration. The competitive narcotic antidotes are administered preferably naloxone i.v., nalorphine or levallorphine. The antidote of choice is naloxone, the drug can be repeated to achieve good response. Atropine 1gm i.v.
Withdrawal manifestations: - Occur 12 hours after stopping the drug or after injection of morphine antagonists. Withdrawal manifestations include yawning, salivation, lacrimation, running nose, sweating, vomiting, colic & diarrhea, shivering, goose skin, sense of cold tachycardia & tachyopnea. Mydrias, insomnia, irritability, sense of severe pain all over the body and mania. The patient may commit a crime to obtain the drug. In old dependents cardiovascular collapse which endangers life may occur. The withdrawal symptoms are severe for 3 days then gradually decrease. They are stopped by the administration of morphine.
Treatment of morphine dependents: - Hospitalization. Psychological care, health care and adequate nutrition & vitamins. Gradual withdrawal by decreasing the doe of morphine and giving codeine 10 mg dose till the patient becomes an addict to codeine then the dose of codeine is decreased gradually over three weeks. Methadone is a derivative less addicting than morphine and is given orally I 5 to 10 mg dose then the dose of methadone is decreased gradually over three weeks
Plant poisons alkaloids They are similar to alkalies. Plus acids they give salts and plants plus acids give salts also. But they are not true alkalies as they don’t turn litmus paper blue. They have remote action only. Local antidotes are charcoal, hydrogen peroxide or potassium permanganate (1/5000) or tannic acid or sodium bicarbonate to cause adsorption, oxidation, precipitation respectively. Opium ( morphine, heroin). The source is Papaver somniferum plant. Opium contains more than twenty alkaloids such as morphine & codeine. Opium is ingested or smoked and has a smell of meconic acid. While morphine is injected only and has no smell. Uses of morphine It is a pain killer for poisoning by: e.g. burns, metals & corrosives. Treatment of opium dependents (gradual withdrawal). The condition of poisoning is accidental: children, therapeutic, addicts overdose. Suicidal in dependents. The action & C/P: opiate receptor agonists, mixture of CNS depression & stimulation but mainly depression. Stimulation of the vagal centre (decrease in pulse rate, respiration & blood pressure as P/C), vomiting center (vomiting) & pupiloconstrictor center (Miosis, P.P.P. & fixed). Depression of: Sensory cortex (analgesia) which results in euphoria the dysphoria distress& fear; sleep, stupor & coma. Cough center (antitussive) which results in pulmonary oedema (dyspnea & cyanosis). Intestinal motility which leads to constipation. Respiratory center which results in respiratory depression with cyanosis and characteristic breath smell (if opium). Heat regulating center which leads to hypothermia. The cause of death is respiratory depression which is the result of central asphyxia.
The investigation is as usual, chemical analysis for morphine & meconic acid. D.D. ( Differential Diagnosis) Patients with classic opioid toxidrome (3 Cs): coma, cyanosis & constricted pupils may be due to: morphine ( Needle pricks & smell of meconic acid if opium), phenol ( green urine & characteristic smell), pontine haemorrhage ( tetraplegia & hyperpyrexia) & organophosphorous ( intestinal sounds & garlic smell). Treatment: - Supportive measures (ABCs). Mainly care for respiratory depression. GIT decontamination by: gastric lavage use cuffed endotracheal tube even if alert. Even if the toxicity is by morphine which is injected! Local antidotes: Use one of alkaloidal antidotes. Physiological antidotes: Antagonists (Atropine 1 ml i.v. vagus). Competitors. Agonist antagonists In absence of opiates, they act as agonists on receptors, but in presence of opiates, they act as agonists. Levallorphine 1 mg. Nalorphine 10 mg. Pure antagonists: They are antagonists only, having no agonistic actions. Naloxone (Narcan), short half life = 1 hour. Nalmefen (Revel) , long half life = 8 hours. Naltrexone ( longer half life = 72 hours ).
Barbiturates are sedatives & hypnotics which are very poisonous to cerebral cortex. Their medical uses are sedatives, hypnotics, anaesthetics, antiepileptic & in psychotic disorders. They are classified into four types depending on their time of onset of action. 1.Long acting (1to 12) hours e.g. Phenobarbiturate, barbitone, etc. 2.Intermediate acting (1/2 to 8) hours e.g. amylobarbitone. 3.Short acting (1/4 to 4)hours e.g. hexabaritone.
