Arsenic Poisoning (forensic medicine)

Arsenic Poison

Arsenic poisoning occurs due to the ingestion, inhalation, or absorption of arsenic compounds, which are highly toxic. Arsenic is a naturally occurring element found in various forms, commonly in groundwater, industrial chemicals, and pesticides.

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Mechanism of Action
Arsenic primarily exerts its toxic effects by:
1. Inhibition of Enzymes: Arsenic binds to sulfhydryl groups in enzymes, particularly those involved in cellular respiration (e.g., pyruvate dehydrogenase).
2. Disruption of ATP Synthesis:Arsenic interferes with oxidative phosphorylation, leading to decreased energy production.
3. Oxidative Stress:It induces the generation of reactive oxygen species (ROS), causing cellular damage.
4. Genotoxicity:Arsenic damages DNA, leading to carcinogenic effects.

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Properties
1. Physical:
Exists in gray, yellow, and black allotropes.
Soluble in water, particularly arsenic trioxide.

2. Chemical:
Stable under normal conditions.
Reacts with oxidizing agents and acids to form toxic compounds.

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Forms of Arsenic
1. Inorganic Arsenic:
Arsenic trioxide (As₂O₃): Commonly used in pesticides.
Arsenates and arsenites.

2. Organic Arsenic:
Found in seafood and less toxic.

3. Elemental Arsenic:
Less common in poisoning cases.

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Medicolegal Importance
1. Common Poison:Historically, arsenic was known as the "king of poisons" due to its use in homicides and suicides.
2. Chronic Exposure: Occupational exposure and contaminated groundwater are significant public health concerns.
3. Biomarker for Forensic Investigation: Detected in hair, nails, urine, and tissues during forensic analysis.

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Postmortem Findings
1. External Findings:
Cyanosis and pallor.
Skin lesions (in chronic cases).
Mees’ lines on nails (chronic poisoning).

2. Internal Findings:
Inflammation and erosion of the gastrointestinal mucosa.
Congested organs, particularly liver and kidneys.
Fatty degeneration of liver and myocardium.
Hemorrhagic patches in the stomach and intestines.
Persistent presence in hair and nails.

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Arsenic Imbibition
In cases of arsenic poisoning, the body tissues absorb arsenic, leading to a "preservation effect" by preventing putrefaction. Arsenic imbibition is noted during postmortem examination when arsenic compounds penetrate surrounding tissues, altering their color and consistency.

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*Signs and Symptoms*
#### *Acute Poisoning:*
1. Gastrointestinal: Severe abdominal pain, vomiting, diarrhea (rice-water stools).
2. Cardiovascular: Hypotension, tachycardia, and shock.
3. Neurological: Headache, dizziness, seizures, and coma.
4. Other: Garlic-like odor in breath and urine.

#### *Chronic Poisoning:*
1. *Skin:* Hyperpigmentation, hyperkeratosis, and skin cancers.
2. *Nails:* Mees' lines (white lines on nails).
3. *Neurological:* Peripheral neuropathy, numbness, and tingling.
4. *Hematological:* Anemia and leukopenia.
5. *Systemic Effects:* Fatigue, weight loss, and hair loss.


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