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Place in Classification
Identification features
Uses
Mechanism of action
Poisoning
Fatal Dose
Treatment
Postmortem appearance
Medicolegal importance
Irritant Inorganic Non metallic
Waxy translucent pliable soft sticks
Exposure to light changes into yellow
Insoluble in water
Exposure to air oxidised
Emits white fumes of phosphorus trioxide on
oxidation
Phosphorus trioxide
Luminous in dark
Strong garlic odour
At 34 degree Celsius, ignites in air emitting
greenish white flame
Hence preserved in water or kerosene oil
Taken out by forceps (body heat ignition)
Prepared by heating yellow phosphorus at
240 degree Celsius in an atmosphere of
nitrogen and carbon dioxide
Not poisonous
Not luminous in dark
No odour
Not oxidised in air no preservation
Red phosphorus
Preparation of safety matches
Commercially available contains 0.6% yellow
phosphorus poisonous
Yellow phosphorus
Vermin pastes 1-4% yellow phosphorus with
arsenic, flour, oil, sugar etc
Fire works
Gun powder & incendiary ammunition
Tracer bullets
Fertilizers and rodenticides
Matchstick end
Potassium chlorate
Antimony sulphide
Striking surface
Red phosphorus
Powdered glass or coarse sand particles
To deliberately set fire on something
Molotov cocktail
Hepatotoxic and protoplasmic poison
Locally irritant
After absorption
Protoplasmic poison
Disturbs cellular oxidation metabolism
Widespread fatty degeneration and tissue destruction
Chronic absorption
Bone formation in epiphyseal cartilage and haversian
and marrow canals
Impaired blood flow
Necrosis and sequestration of bones
Spontaneous fracture
FATAL DOSE
60 to 120 mg for adult
10 to 25 mg for child
FATAL PERIOD
Within 24 hours in fulminating poisoning
2 to 8 days
> 1 gm ingestion
Thirst, nausea, vomiting and retching occur
Delirious and maniacal behaviour
Shock and cardiovascular collapse
Direct action on heart and blood vessels
Death within 12 hours
First stage (8 hours to 3 days)
Garlic taste and smell
Burning pain in upper GIT
Intense thirst
Profuse and persistent vomiting
Vomitus luminous in dark with garlic smell
Stools ? darks and offensive, garlic smell
Symptoms gradually subside and passes to
second stage
Second stage (2 to 3 days)
Apparent improvement
Merges into third stage
Third stage (Systemic toxicity)
N/V/D reappear with more intensity
Vomitus and stool blood and mucous
Jaundice sets in and deepens
Liver enlarged, softened and tender
Haemorrhagic spots over body
Epitasis, haematemesis, malaena, haematuria,
menorrhagia
Abortion in pregnant
Restlessness, insomnia, tinnitus, vertigo,
impaired vision, delirium, priapism etc
Hepatic and renal insufficiency jaundice
and oliguria acidosis fall in blood
pressure and pulmonary odema cyanosis,
dyspnoea with subnormal temperature
coma and death
SKIN BURNS by yellow phosphorus
Second or third degree
Surrounded by blister
Slow to heal
Gastric lavage with 0.5% KMnO4
Oxidise into harmless phosphoric acid and
phosphates
Manganese dioxide produced itself act as
chemical antidote
Copper sulphate ? 250 gm solution in water
orally every 5 minutes till vomiting
Precipitated as copper phosphide
Coating over phosphorus particles
Charcoal
Emetics
No oils, fats or milk promotes absorption
Liquid paraffin retards absorption
Purgatives for bowel evacuation
Glucose and alkaline drinks to protect liver
High carbohydrate, protein diet and low fat diet
Treatment of shock
i.v. 5% glucose saline with Vit C 500 mg
Calcium gluconate 10% 10 ml
Inj. Vit. K i.v. Or i.m
Skin ? irrigation with 1% CuSO4 for at least 15
minutes and remove yellow phosphorus by
forceps
Hemodialysis
Fulminating case
Slight icterus tings
Mucosa inflammed
Corrosion and ulceration sometime
Luminous stomach content
Death after few days
Yellow colour skin
Petechial haemorrhages
Garlic odour from cavity and stomach
Contents of stomach luminous in dark
Altered blood and detached shreds of mucous
membrane
Petechial haemorrhagic spots over serous and
submucous surfaces
Lemon yellow tint
Doughy consistency
Soft and greasy to touch
Histology
Cloudy sweeling
Fatty degeneration
Later necrosis
Fat in Kuffer's cells ? earliest manifestation of
necrobiosis
Kidney,
Soft, greasy and yellow in colour
Petechial spots on surface
Tubules filled with debris, fatty casts, albumen
etc
Heart
Soft, flabby and dilated
Fatty degeneration
Subendocardial haemorrhages
Blood tarry or blackish in colour
Low coagulability
Homicide ? NOT COMMON
However, if given with alcohol and coffee
Delay in onset of signs and symptoms
Long time between ingestion and death
Signs and symptoms simulate hepatotoxic drugs or
diseases
Oxidation in body if patient survives long
Suicide - Vermin pastes, rat killers etc
Accidental
Criminal abortion
Children eating rat poisons and fireworks
Projectiles with phosphorus in body
Inhaling hydrogen phosphide in cargo ships
Workers
Rare
Inhalation of fumes for long time
Workers
Match factory
Fireworks
Ammunitions
Inhalation of phosphorated hydrogen
in preparation of acetylene gas from carbide
Escape of gas from ferrosilicon
After months and years
N/V/D
Garlic smelling eructation
General wasting and weakness
Joint pains, anaemia and jaundice
Abortion
Death from infections
Phosphorus burns with dermatitis
Tooth and gums
Lower jaw affected
Through decayed teeth or raw interspace
between missing teeth
Osteomyelitis and periostitis of lower jaw
Loosening and falling of teeth
Toothache f/b swelling of jaw, loosening of
teeth, sloughing of gums, necrosis and
sequestration of affected part of mandible with
multiple sinuses, discharging foul smelling pus
Differential diagnosis ? Actinomyces = lumpy jaw
Cleanliness of factories
Ventilation
Saturation of air by turpentine in workrooms
Better oral hygiene
Treatment of dental problems
Surgical intervention of jaw necrosis if
already present
This post was last modified on 12 August 2021