Do you know about Lead Poisoning?

আজকের ফরেনসিক ক্লাসে আমাদের পড়ানো হয়েছিলো Lead poisoning।
সন্ধ্যে বেলা চা খাচ্ছিলাম রুহি এসে বললো, “চল পড়াটা একবার রিভিউ করি”।
আমি বললাম, “হ্যাঁ চল। ক’দিন পরেই তো আইটেম নেবেন স্যার”।
প্রথমে বল, What type of poison it is?

রুহি: It is an irritant & metallic poison.

আমি: আর Identification point কী হবে?

রুহি: This is a clear glass bottle with stopper containing scarlet crystalline powder. It is lead tetra oxide ( Red lead, Vermilion, Sindur)
তুই বল তো Fatal dose কত?

আমি:
Fatal dose-
1) Lead acetate: 20gm
2) Lead carbonate: 40gm

রুহি: What are the toxic components of lead?

আমি:
Toxic components of lead are –
➡ Lead acetate
➡ Lead carbonate
➡ Lead chromate
➡ Lead monoxide
➡ Lead tetra-oxide
➡ Lead sulphide
তুই বল তো, Which one is least toxic?

রুহি: Lead sulphide।

আমি: আর Fatal period?

রুহি:
Fatal period-
➡ 1-2days
এইবার Properties আর Source গুলো বল দেখি।

আমি:
Properties-
1) Heavy steel-grey metal.
2) Always present in our body.
3) Pure metallic lead is absorbed through G.I.T. being soluble in the gastric juice.

Source-
1) Water pipes
2) Tin food container
3) Storage batteries
4) Paints
5) Hair dyes
6) Cosmetics
7) As vermilion
8) Petrol
9) Glass blowing
10) Electric cable insulations
11) On the surface of ceramic articles

আয়, এইবার Medico-legal aspects গুলো পড়ি।

রুহি:
Medico-legal aspects :
1) Acute poisoning is very rare. The victims are usually children who chew substance painted with lead paints.

2) Chronic poisoning is much more common & is regarded as an industrial disease.

3) Poisoning with lead mostly accidental. The sources of poisoning are extensive.

4) Suicidal poisoning: Very rare due to long painful sufferings before death.

5) Homicidal poisoning: Very rare due to chance of detection from the taste of the poison & other s/s as well as due to high fatal dose.

6) Daichylon paste ( Lead oelate) or red lead is used locally for abortion.

7) Red lead is sometimes used alone or mixed with arsenic as a cattle poison.

8) Lead missiles remaining embedded in the tissues due to gunshot injuries may produce poisonous symptoms in 12-48days.

আমি: এইবার আমরা পড়বো,
🔴 Mode of action of lead :

At the cellular level, lead interacts with sulphydryl groups
⬇
Interferes with action of enzymes necessary for haem synthesis, & for haemoglobin & cytochrome production
⬇
Haemolysis (breakdown of RBC)

রুহি: এখন আর বাকি রইলো Sign symptoms। শুন,

✴ S/S of acute lead poisoning:
1) An astringent & metallic taste.
2) Dry throat
3) Intense throat
4) Burning abdominal pain
5) Nausea
6) Vomiting
7) Diarrhoea
8) Peripheral circulatory collapse
9) Insomnia
11) Paraesthesia
12) Depression
13) Coma

আমি: Sign symptom বলা হলো যেহেতু Management/Treatment ও বলে ফেল?

রুহি:
✳ Management of acute lead poisoning-:
A) Removal of unabsorbed poison from the G.I.T. –
1) Emesis maybe tried first.
2) Gastric lavage with 1% solution of sodium/ magnesium sulphate.
3) Purgative: Sodium/magnesium sulphate.
4) Calcium gluconate: 2 gm I/V, cause deposition of lead in the skeleton from the blood.
5) Atropine.

B) Removal of the absorbed poison :

1) CaNa2 E.D.T.A, by slow I/V infusion in a dose of 10-15 mg/kg body wt. , twice in the first day. If therapy is tolerated well then, it is repeated in the same doses for the next four days.

2) Peritoneal dialysis : For rapid effect, it is given along with I/V E.D.T.A therapy

3) Combined B.A.L & E.D.T.A

4) Penicillamine

C) Symptomatic treatment.
এইবার Post mortem findings গুলো ও জেনে নিই?

আমি: হ্যাঁ, আমি বলছি-
✳ Post mortem of a case of acute lead poisoning:

External findings
1) Body – Emaciated
2) Rigor mortis – Appears early.

Internal findings
1) Stomach :
⬇ Signs of acute gastroenteritis
⬇ Mucosa maybe thickened & softened with eroded patches & may be covered with a grayish-white deposit.

2) Intestine: Inflamed.

3) Kidney: Renal tubular degeneration.

তাহলে আমাদের Acute lead poisoning জানা হলো, এখন বাকি রইলো Chronic lead poisoning।

রুহি: আজ আর না রে, খুব টায়ার্ড লাগছে।

আমি: ঠিক আছে, আগামীদিন আমরা Chronic lead poisoning নিয়ে পড়বো। Acute lead poisoning আরেকবার রিভাইস দিয়ে দিস কিন্তু।
আজ এখানেই সমাপ্তি।

Reference : Dr.K.S.Narayan Reddy & DR.O.P.Murty, The essential of forensic medicine and toxicology, 33rd edition.
DR.Apurba Nandy, Principles of forensic medicine including toxicology, 3rd edition.

Platform Academia/
Monadia chowdhury
Southern medical college
2017-2018.