Place in Classification
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Identification featuresUses
Mechanism of action
Poisoning
Fatal Dose
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TreatmentPostmortem appearance
Medicolegal importance
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Irritant Inorganic Non metallicWaxy translucent pliable soft sticks
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Exposure to light changes into yellowInsoluble in water
Exposure to air oxidised
Emits white fumes of phosphorus trioxide on
oxidation
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Phosphorus trioxideLuminous in dark
Strong garlic odour
At 34 degree Celsius, ignites in air emitting
greenish white flame
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Hence preserved in water or kerosene oilTaken out by forceps (body heat ignition)
Prepared by heating yellow phosphorus at
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240 degree Celsius in an atmosphere ofnitrogen and carbon dioxide
Not poisonous
Not luminous in dark
No odour
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Not oxidised in air no preservationRed phosphorus
Preparation of safety matches
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Commercially available contains 0.6% yellowphosphorus poisonous
Yellow phosphorus
Vermin pastes 1-4% yellow phosphorus with
arsenic, flour, oil, sugar etc
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Fire worksGun powder & incendiary ammunition
Tracer bullets
Fertilizers and rodenticides
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Matchstick end
Potassium chlorate
Antimony sulphide
Striking surface
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Red phosphorusPowdered glass or coarse sand particles
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To deliberately set fire on something
Molotov cocktail
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Hepatotoxic and protoplasmic poisonLocally irritant
After absorption
Protoplasmic poison
Disturbs cellular oxidation metabolism
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Widespread fatty degeneration and tissue destructionChronic absorption
Bone formation in epiphyseal cartilage and haversian
and marrow canals
Impaired blood flow
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Necrosis and sequestration of bonesSpontaneous fracture
FATAL DOSE
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60 to 120 mg for adult10 to 25 mg for child
FATAL PERIOD
Within 24 hours in fulminating poisoning
2 to 8 days
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> 1 gm ingestion
Thirst, nausea, vomiting and retching occur
Delirious and maniacal behaviour
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Shock and cardiovascular collapseDirect action on heart and blood vessels
Death within 12 hours
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First stage (8 hours to 3 days)Garlic taste and smell
Burning pain in upper GIT
Intense thirst
Profuse and persistent vomiting
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Vomitus luminous in dark with garlic smellStools ? darks and offensive, garlic smell
Symptoms gradually subside and passes to
second stage
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Second stage (2 to 3 days)
Apparent improvement
Merges into third stage
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Third stage (Systemic toxicity)
N/V/D reappear with more intensity
Vomitus and stool blood and mucous
Jaundice sets in and deepens
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Liver enlarged, softened and tenderHaemorrhagic spots over body
Epitasis, haematemesis, malaena, haematuria,
menorrhagia
Abortion in pregnant
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Restlessness, insomnia, tinnitus, vertigo,
impaired vision, delirium, priapism etc
Hepatic and renal insufficiency jaundice
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and oliguria acidosis fall in bloodpressure and pulmonary odema cyanosis,
dyspnoea with subnormal temperature
coma and death
SKIN BURNS by yellow phosphorus
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Second or third degreeSurrounded by blister
Slow to heal
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Gastric lavage with 0.5% KMnO4Oxidise into harmless phosphoric acid and
phosphates
Manganese dioxide produced itself act as
chemical antidote
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Copper sulphate ? 250 gm solution in waterorally every 5 minutes till vomiting
Precipitated as copper phosphide
Coating over phosphorus particles
Charcoal
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EmeticsNo oils, fats or milk promotes absorption
Liquid paraffin retards absorption
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Purgatives for bowel evacuationGlucose 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
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Calcium gluconate 10% 10 mlInj. Vit. K i.v. Or i.m
Skin ? irrigation with 1% CuSO4 for at least 15
minutes and remove yellow phosphorus by
forceps
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HemodialysisFulminating case
Slight icterus tings
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Mucosa inflammedCorrosion and ulceration sometime
Luminous stomach content
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Death after few daysYellow colour skin
Petechial haemorrhages
Garlic odour from cavity and stomach
Contents of stomach luminous in dark
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Altered blood and detached shreds of mucousmembrane
Petechial haemorrhagic spots over serous and
submucous surfaces
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Lemon yellow tint
Doughy consistency
Soft and greasy to touch
Histology
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Cloudy sweelingFatty degeneration
Later necrosis
Fat in Kuffer's cells ? earliest manifestation of
necrobiosis
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Kidney,
Soft, greasy and yellow in colour
Petechial spots on surface
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Tubules filled with debris, fatty casts, albumenetc
Heart
Soft, flabby and dilated
Fatty degeneration
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Subendocardial haemorrhagesBlood tarry or blackish in colour
Low coagulability
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Homicide ? NOT COMMONHowever, 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
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diseasesOxidation in body if patient survives long
Suicide - Vermin pastes, rat killers etc
Accidental
Criminal abortion
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Children eating rat poisons and fireworksProjectiles with phosphorus in body
Inhaling hydrogen phosphide in cargo ships
Workers
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Rare
Inhalation of fumes for long time
Workers
Match factory
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FireworksAmmunitions
Inhalation of phosphorated hydrogen
in preparation of acetylene gas from carbide
Escape of gas from ferrosilicon
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After months and years
N/V/D
Garlic smelling eructation
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General wasting and weaknessJoint pains, anaemia and jaundice
Abortion
Death from infections
Phosphorus burns with dermatitis
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Tooth and gums
Lower jaw affected
Through decayed teeth or raw interspace
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between missing teethOsteomyelitis and periostitis of lower jaw
Loosening and falling of teeth
Toothache f/b swelling of jaw, loosening of
teeth, sloughing of gums, necrosis and
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sequestration of affected part of mandible withmultiple sinuses, discharging foul smelling pus
Differential diagnosis ? Actinomyces = lumpy jaw
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Cleanliness of factories
Ventilation
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Saturation of air by turpentine in workroomsBetter oral hygiene
Treatment of dental problems
Surgical intervention of jaw necrosis if
already present
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