Renal Toxicology

Opium and its derivatives

● Types of neurotic poisons — induce sleep and lessen pain
● Include opium and pethidine
● Action characterised by two sets of sx — ​excitement and narcosis​ (narcosis
predominates)
● Opium ​= dry juice of unripe capsules of a plant called Papaver somniferum — appears
dark brown or grey and has a bitter taste
○ Contains alkaloid​s like morphine, codeine, noscapine, and papaverine
○ Natural opium derivatives are called ​opiates ​(like heroin) and synthetic
derivatives are called ​opioids (​ like methadone)
○ MOA — ​occupy endorphin/enkephalin receptors in the brain​. Most act as
analgesics but the CNS and respiration are depressed as well. Vomiting center is
stimulated.
○ Absorption of opium derivatives is maximal by parenteral routes (IM or IV)
○ Acute poisoning — euphoria, hallucinations, constipation, miosis, stupor,
respiratory depression (Cheyne Stokes: slow, sighing, and irregular breaths),
froth from mouth, death from respiratory failure.
○ Dx — ​blue color with ferric chloride; yellow color with nitric acid
■ Marquis’ Test —​ sulfuric acid + formalin = purple color that changes
to blue if morphine present
○ Chronic poisoning — tolerance is seen; dermal scars from injections, miosis,
constipation, anorexia, confusion/hallucinations
○ Tx of acute poisoning
■ Secure the airway
■ Wash stomach if ingested
■ Give dextrose and thiamine
■ Antidote: naloxone or nalorphine
■ If ​respiratory depression​ is severe ​physostigmine ​can be given to
raise ACh content in the brain
○ Tx of chronic poisoning
■ Withdraw drug progressively to avoid withdrawal symptoms and provide
methadone ​(weaker opioid), which can then be weaned off too
○ Abstinence syndrome — 6-8 hours after drug withdrawal — sx include sweating,
lacrimation, rhinorrhea, and yawning
○ PM findings — injection marks on the body; smell of opium around the mouth;
congestion and edema of lungs with froth in airways​; take body fluid samples
for analysis
○ Opium derivatives are the most common drug of abuse — and frequently abused
by medics
○ Prone personality — people who abuse opium/morphine/heroin usually display
■ Dysphoria — life looks much better when high
■ Problems of sexual identification
 ■ Poor interpersonal relationships
● Pethidine ​— colorless, crystalline powder; it’s a synthetic analgesic given IV/IM and
carries risk of addiction.
○ Sx of OD are ​atropine-like​ — dilated pupils, tachy, dry mouth, raised
temperature. This may be followed by coma and ​respiratory depression,
leading to death.
○ Tx — gastric lavage — ​IV coramine
○ Medics are most likely people to abuse it

Petroleum distillates​ (cerebral inebriants)

● Petroleum — a mixture of hydrocarbons
● Kerosene — refined oil — products lighter than kerosene are known as gasoline (like
ether, pentane, octane, petrol) and those heavier include paraffin, lubricating oil, and
vaseline. All are petroleum distillates.
● The lighter the product, the higher its toxicity.
● MOA — ​dissolve in fat and act as irritants; depress the CNS
● Sx of ingestion — sensation of burning; shallow and slow respiration; cyanosis; lung
inflammation; CNS depression; coma and death after respiratory failure
● Sx of inhalation — N/V, lung complications; hallucinations and convulsions
● Tx: ​gastric lavage with sodium bicarbonate​ containing warm water with ​sealed
glottis ​to prevent aspiration into the lungs; antibiotics to prevent lung infections
(kerosene is excreted via lungs); liquid paraffin to slow kerosene absorption
○ If inhaled — remove exposure and start artificial respiration
● PM findings — signs of asphyxia; froth at mouth and nose; pulmonary edema and
bronchoPNA signs; hypoplasia of BM after prolonged inhalation; preserve viscera in
saturated saline ‘
● Young children can mistake kerosene for ​water
● In all cases of petroleum ingestion, CXR and abdomen X-rays are ​essential​.
○ Abdominal X ray​ will show a ​double gastric bubble​ to confirm ingestion