International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525

Trends of Poisons and its Toxicity

Devarakonda Vishal Vardhan21 Yasmine valentina V22 Mohana Lakshmi P23

ABSTRACT The review focuses on suicidal and accidental poisoning in India, which estimates and describes the prevalence and effects of motivations behind, and risk factors for consumption of insecticides, hair dyes, rat poison and other poisons. In this, different poisons have been studied along with their fatal doses and harmful effects. According to reports published by the National Crime Record Bureau (NCRB) India, every year, the number of suicides are continuously increasing, The means adopted for committing suicide are classified by over alcoholism, by drowning, by self/fire immolation, by fire arms, by hanging, by consuming poisons (household, plant, animal, synthetic poisons), by self- infliction of injury, by overdose of sleeping pills, by touching electric wires, by coming under running trains and by other means.

Keywords: Poison, Insecticides, pesticides, rat-poison, consumption, peer-reviewed, fatal dosages and NCRB

INTRODUCTION Poison is a substance that is capable of causing the illness or death of a living organism when introduced or absorbed. Poisoning is the one of the common means of suicidal and accidental deaths. The most common means of taking poisons are by ingestion, injection and inhalation. Commonly used poisons are household poisons, plant, animal, synthetic poisons, poisonous gases and etc due to easily available and cheap of cost. It is usually ingested to suicide, homicide, and to threaten family members. The causes for suicides are bankruptcy, marriage related issues, extra marital affairs, divorce, failure in examination, death of dear person, drug abuse/addiction, poverty, unemployment, love affairs etc. The review focuses on different types of poisons, its toxicity, fatal doses, clinical symptoms and death factors that are caused. Super vasmol-33 is an emulsion Based hair dye, it is cheap and easily available and it is the major cause for suicidal and accidental poisoning. The composition of super vasmol-33 is paraphenylenediamine (PPD), resorcinol, ethylene diamine tetra acetic acid (EDTA),

21 B.Sc. (Hons) Forensic Science, School of Sciences, Jain university, Bangalore 22 B.Sc. (Hons) Forensic Science, School of Sciences, Jain university, Bangalore 23 B.Sc. (Hons) Forensic Science, School of Sciences, Jain university, Bangalore

212 Legal Desire Media & Insights www.legaldesire.com/forensics International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525 propylene glycol, liquid paraffin, cetostearyl alcohol, sodium louryl sulphate liquid, herbal extracts, preservatives, almond protein and perfume. The active ingredient of vasmol-33 is paraphenylenediamine which is a derivative of aniline which is a white solid and it darkens due to oxidation. PPD is more toxic when consumed orally and low toxic by dermal route. Even though the label of super vasmol-33 is showing that 4% of PPD, but the exact concentration has not been mentioned. The fatal dose for PPD is 0.3%-7% when consumed orally and fatal period is within 24 hours of consumption. It has high mortality rate of 47%. The large amount of ingestion produces a wide range of acute health problems such as pain in throat, cough, dyspnoea, oedema of tongue, pharynx and neck. It also shows the chronic symptoms such as severe cervico-facial inflammatory oedema, rhabdomyolysis, intravascular haemolysis, renal failure, hepatic injury, metabolic acidosis, hypo calcemia, seizure and death. Death occurs due to respiratory obstruction, angioneurotic oedema of larynx, oedema of floor of the mouth and base of tongue and renal failure. Super vasmol-33 contains various combinations of substances that are potentially dangerous toxins which can result in multiorgan dysfunction and death. Rat poison is used to kill rats, mice and other rodent pests, but commonly used for suicides due to easy availability and low cost. Rat poison contains mixture of anticoagulant, metal phosphide and some various forms of vitamin-D. Red squill is the first rodenticide used for many years, but due to its low effectivity it is not used now-a-days. zinc phosphide, bromethalin, cholecalciferol, strychnine are commonly used rodenticides. Zinc phosphide is a crystalline, dark grey powder and also used as insecticide which is registered as highly potent rodenticide in 1947. Ingestion of zinc phosphide reacts with moisture such as gastric fluid and releases phosphine gas, which is very toxic and it leads to death. Clinical symptom includes headache, dizziness, vomiting and difficulty in breathing. Fatal dosage is 10mg-20mg and the fatal period is 24 hrs -72hrs and the mortality rate is 37%-100%. when intake of rodenticide is in fatal dosage can lead to seizure, respiratory distress, heart attack, internal bleeding, liver failure, shock, coma and death. Phenyl is a fluid antiseptic agent, strong deodorant and caustic germicide, that destroys pathogenic organisms. It is an emulsion of light creosote oil and soap water. Since it is easily available household reagent it is a vital cause for suicidal and accidental poisoning. Ingestion of phenyl causes extensive local corrosions, pain, nausea, vomiting, sweating, diarrhea, respiratory tract irritation, burning pain from mouth to stomach, and pneumonia. The fatal dosage is 3-30grams and fatal period is 3-4hrs. Post-ingestion of phenyl in fatal dosage produces systemic manifestations within 5-30 mins that causes lethargy or coma, convulsions, hypotension, tachycardia or bradycardia, dysrhythmias, seizure, acidosis, hemolysis,

213 Legal Desire Media & Insights www.legaldesire.com/forensics International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525 methemoglobinemia, shock and death. Good night liquid is a mosquito repellent, which is generally used to control mosquitoes in household. It contains prallethrin which is extracted from flower chrysanthemum cinerarilifolium and it is a pyrethroid insecticide. Prallethrin poison acts on sodium channels in the heart which can lead to cardiac conduction. All-out liquid contains 1.6% w/w prallethrin and each bottle contains 35%ml. Different types of mosquito repellent includes good night, all- out, mortein, etc. The fatal dosage is 500mg and the fatal period is 4-48hrs. In case of consumption the minor problems include sore throat, nausea, dizziness, headache, fatigue, vomiting and abdominal pain within minutes. Systemic manifestations such as mouth ulceration, increase secretions or dysphagia, chest tightness, blurred vision, stomach ulcer, allergic reactions and cause high liver toxicity which can lead to coma and death. Harpic is a toilet cleaning agent used to kill germs which is also used to shine surface, dirt removal and pleasant fragrance. Harpic contains 10% of hydrochloric acid as an active ingredient along with butyl oleylamine and other aqueous solutions. Mostly abused acid is hydrochloric acid which is present in higher percentage (more than 50%) in sanitary cleaning agents. When hydrochloric acid is consumed orally it effects body tissues and transforms haemoglobin into haematin and tissue proteins into acid proteins resulting in coagulation necrosis. These cleaning agents are commonly used in India and Taiwan. Consumption of harpic leads to gastric stenosis and oesophageal stenosis, it affects the gastro intestinal tract. The fatal dosage is 10-50ml. The systemic complications include nausea, vomiting, burning sensation and pain in throat and mouth, retro sternal pain and epigastric pain, hypersalivation, difficulty in swallowing, ulcerations and whitish plaques in pharynx, palate and oral cavity. The death may be due to toxicity of the internal body that can leads to multiorgan disfunction and death. Organophosphorous (OP) insecticide is a man-made poison that used to kill insects and mammals. OP is widely used insecticide for agriculture, home gardens, and veterinary practice. Commonly types organophosphorous compounds are diazinon, diethomate(N=33), chloropyrifos(N=15), acetamide(N=1), dicofal(N=1) etc. OP is colourless-brown at room temperature, some are odourless, while other have fruit like smell. Insecticides are commonly consumed orally than intramuscular route. The fatal dose is 175mg by oral administration and 80mg by intra muscular route. Consumption of insecticides can lead to clinical manifestations like bradycardia, hypotension, tachycardia, increases salivation, abdominal pain, excessive sweating, nausea, vomiting, urinary and faecal incontinence. OP affects central nervous system (CNS) that includes anxiety, restlessness, convulsions, miosis, insomnia, coma and cardio

214 Legal Desire Media & Insights www.legaldesire.com/forensics International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525 vascular failure. Death occurs due to cardiovascular and respiratory failure. Insecticides are commonly used by farmers for cultivation purpose hence they are major victims for suicidal and accidental insecticide poisoning. Inert gases are not toxic and they do not explode or burn but, they can cause injury and death when inhaled in high concentrations. Inhalation of inert gases such as helium, neon, argon are major causes for suicidal and accidental poisoning. Inhalation of inert gases in large concentration can lead to suffocation, since it displaces the oxygen by which vapour possess mild anaesthetic effects. The fatal dose is 75% of its normal percentage. Inhalation of mixture of air and gas can lead to simple Asphyxia, and if it exceeds beyond the limit of 50% it leads to clinical manifestations. Commonly used inert gases are helium, argon etc. The helium gas displaces oxygen and carbon dioxide, which leads to asphyxia. The fatal period is within minutes of inhalation. Inert gases are very toxic when inhaled in fatal dosage can lead to rapid respiration, dizziness, nausea, loss of consciousness, confusions, airway obstructions also lead to death. Pesticide poisoning are major cause for suicides in developing countries. Pesticides are used for agricultural purposes, where it is the common method for self-poisoning and most frequently used agents. High suicide deaths with less suicide intent among the individuals are due to pesticide ingestion, which is very toxic. Highly hazardous pesticides (HHPs) have high fatality rate of poisoning compared to other agents. Aluminium phosphide is most commonly used pesticide when compare to organochlorines, organophosphates, fungicides and herbicides. Aluminium phosphide is solid fumigant and toxic pesticide which is used for grain preservation. Due to easy availability in markets it is misused for committing suicides. The fatal dose is 150-500 mg/70kg and mortality rate is high ranging from 37%-100%. Ingestion of aluminium phosphide reacts with moisture and releases phosphine gas which is very toxic. Early symptoms of acute poisoning are headache, fatigue, dizziness, restlessness, nervousness, nausea, perspiration and acute problems include fever, intense thirst, increased rate of breathing, vomiting, pinpoint pupils, convulsions, inability to breath, unconsciousness. Aluminium phosphide liberates phosphine gas, which causes hypoxia due to oxidative phosphorylation leading to circulatory failure. Datura (wild shrub) and oleander (garden plant) are poisons plants which are causes for accidental and suicidal poisonings. These plants are most commonly encountered in all parts of India. Oleander is a cardiotoxic plant and datura is a neurotoxic plant. Commonly two types of oleander are found in India such as pink oleander (Nerium oleander) and yellow oleander. All parts of the plant are toxic especially leaves, stem, seeds, and root. The fatal dose is 15g or

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5-15 leaves or 15-20g of root or 8-10 seeds can be fatal if consumed. Pink oleander is less toxic than yellow oleander. clinical symptoms include bradycardia, hypotension, lethargy, dizziness, convulsions, electrolyte disturbances, hypertension, and coma. Datura is a wild shrub which grows country side, belongs to Solanaceae family and grows to a height of 3-5 feet. All the parts of the plant are toxic especially seeds are highly poisonous. Usually fatal dose comprises of 50-100 seeds or 10-100mg of atropine. Clinical symptoms include dryness of mouth, diplopia, dry hot skin, hyperreflexia, convulsions, amnesia, respiratory depression, coma and death. Datura is commonly mixed with food/drinks, adulteration in tobacco and exposing to fumes. Suicidal cases are common and instances of murder are also reported. Medicinal and Recreational drugs Drugs are the major causes for suicidal and accidental deaths. Addiction or misuse of drugs is majorly associated with suicidal thoughts, suicidal attempts, and suicides. The drugs include sleeping pills, medicines, heroine, recreational drugs, etc. METHODOLOGY Databases and peer-reviewed articles were searched and articles demonstrating suicidal and accidental poisonings were characterized as taken intentionally as well as unintentionally. All the studies related to poison were considered; the effects, changes, toxicity, dosage, mode of administration, cases etc. were extracted. The poisons are studied fully along with cases that are occurred. RESULTS AND CONCLUSION Prevalence of suicidal poisoning in general population was reported to be 26.0% in 2014 to 27.9% in 2015 (NCRB). An array on subjective experiences reminiscent of poisons such as hair dyes, rat poison, were reported over a range of doses, including those with clinical recommendations. Insecticides, pesticides, rat poison, sleeping pills are primarily misused for self-harm and was misused alone or in combinations with other substances, especially soft drinks, cakes, alcohol. Individuals with family problems and illness, bankruptcy and love affairs, drug abuse/alcoholic addiction, failure in examination and unemployment, property dispute, poverty and professional/career problem were the causes of suicides. Epidemiological and case report evidence suggests that consumption of household, plant, animal and synthetic poisons etc, can lead to special risk and death since its consumed in fatal dosages.

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DISCUSSION This study was done to analyse the trends and toxicity of poisons that are causes for suicidal and accidental poisoning. Suicidal poisoning is common mode of deaths in this study. Poisoning is majorly increasing due to which ‘the victims are used for no pain death”. Poisons such as hair dye (super vasmol-33), rat poison, phenyl, good night, harpic, insecticides, inert gases, pesticides, datura and oleander and medicinal and recreational drugs are studied along with their fatal doses, toxicity, clinical symptoms, risk factors and causes for death. In this, poisons are studied which are easily available and cheap of cost. The poisons that are studied are commonly consumed by rural areas in the country due to easy availability.

REFERENCES

1. oxford_dictionary. (2021, january 30). google. Retrieved from www.google.com: https://www.google.com/search?q=poison+meaning&rlz=1C1CHBF_enIN868IN868 &oq=poison+meaig&aqs=chrome.1.69i57j0i13l5j0i13i395l2.6330j1j15&sourceid=ch rome&ie=UTF-8 2. National Crime Records Bureau. (n.d.). Retrieved January 19, 2021, from https://ncrb.gov.in/en/accidental-deaths-suicides-india-adsi 3. An analysis of the trend of rising in poisoning due to hair dye brand (super vasmol 33 Keshkala). (n.d.). Retrieved January 19, 2021, from https://www.thefreelibrary.com/An+analysis+of+the+trend+of+rising+in+poisoning+ due+to+hair+dye+brand...-a0362850004 4. A. Chrispal, A., MB. Abdelraheem, M., SM. Suliman, M., SA. Shalaby, M., & PK. Jain, N. (1970, January 01). Hair dye poisoning [paraphenylenediamine, super vasamol 33]. Retrieved January 19, 2021, from https://link.springer.com/article/10.1007/s13312-013-0076-2 5. (PDF) Hair dye poisoning: An overview - ResearchGate. (n.d.). Retrieved January 20, 2021, from https://www.researchgate.net/publication/263654792_Hair_dye_poisoning_An_overv iew 6. Anugrah Chrispal, A. (n.d.). Hair dye poisoning – an emerging problem in the tropics: An experience from a tertiary care hospital in South India - Anugrah Chrispal, Anisa Begum, I Ramya, Anand Zachariah, 2010. Retrieved January 20, 2021, from https://journals.sagepub.com/doi/10.1258/td.2010.090367 7. Brodifacoum. (2021, January 13). Retrieved January 19, 2021, from https://en.wikipedia.org/wiki/Brodifacoum 8. Lin, C., Yen, T., Juang, Y., Lee, C., & Lee, S. (2018, August 29). Distinct psychopathology of patients who attempted suicide with rodent: PRBM. Retrieved January 19, 2021, from https://www.dovepress.com/distinct-psychopathology-of- patients-who-attempted-suicide-with-rodent-peer-reviewed-article-PRBM 9. Rodenticide poisoning. (n.d.). Retrieved February 3, 2021, from https://www.researchgate.net/publication/338720866_Rodenticide_Poisoning 10. C=AU; o=The State of Queensland; ou=Queensland Health; ou=Online Services;. (n.d.). Rat poison contamination. Retrieved January 19, 2021, from http://conditions.health.qld.gov.au/HealthCondition/condition/1/173/538/rat-poison- contamination

217 Legal Desire Media & Insights www.legaldesire.com/forensics International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525

11. Rod Brouhard, E. M. T.-P. (2019, November 25). Learn the Symptoms of Rat Poisoning and How to Treat Them. Verywell Health. https://www.verywellhealth.com/rat-poison- first-aid-1298860. 12. Overview of Rodenticide Poisoning By Safdar A. Khan, By, Khan, S., Schell, M., & Last full review/revision Oct 2014 | Content last modified Nov 2014. (n.d.). Overview of Rodenticide Poisoning - Toxicology. Retrieved January 20, 2021, from https://www.merckvetmanual.com/toxicology/rodenticide-poisoning/overview-of- rodenticide-poisoning 13. Admin. (2017, January 05). Rodenticide Toxicity. Retrieved January 19, 2021, from https://cwhl.vet.cornell.edu/disease/rodenticide-toxicity 14. Successful Management of Rodenticide Induced Acute Liver ... (n.d.). Retrieved January 20, 2021, from https://www.researchgate.net/publication/275582039_Successful_Management_of_R odenticide_Induced_Acute_Liver_Failure_in_a_Patient 15. All about rodent poison in pets with emphasis on anticoagulant rodenticides. (n.d.). Retrieved January 20, 2021, from http://www.pet-informed-veterinary-advice- online.com/rodent-poison.html 16. Doğan, E., Güzel, A., Çiftçi, T., Aycan, İ, Çelik, F., Çetin, B., & Kavak, G. (2014, June 30). Zinc Phosphide Poisoning. Retrieved January 19, 2021, from https://www.hindawi.com/journals/cricc/2014/589712/ 17. Doğan E;Güzel A;Ciftçi T;Aycan I;Celik F;Cetin B;Kavak GÖ;. (n.d.). Zinc phosphide poisoning. Retrieved January 20, 2021, from https://pubmed.ncbi.nlm.nih.gov/25101186/ 18. Richard, D., Schiavi, B., & Joullié, M. (2004, August 17). Synthetic studies of roquefortine C: Synthesis of isoroquefortine C and a heterocycle. Retrieved January 19, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514418/ 19. What would happen if someone drinks good knight liquid? - Embibe. (n.d.). Retrieved January 19, 2021, from https://www.embibe.com/ask/question/what-would-happen-if- someone-drinks-good-knight-liquid 20. 1,2-Diphenylhydrazine. (n.d.). Retrieved January 19, 2021, from https://pubchem.ncbi.nlm.nih.gov/compound/1_2-Diphenylhydrazine 21. V;, T. (n.d.). [Acute phenol poisoning]. Retrieved January 19, 2021, from https://pubmed.ncbi.nlm.nih.gov/15510912/ 22. Fukuda, T., Sato, T., Ohashi, N., Hayase, N., Gunshin, M., Matsubara, T., … Yahagi, N. (2020, February 6). Management of Acid Toilet Bowl Detergent-Induced Chemical Injuries. Journal of Clinical Toxicology. https://www.longdom.org/abstract/management-of-acid-toilet-bowl-detergentinduced- chemical-injuries-48615.html. 23. How dangerous is mosquito liquid to children if they drink ... (n.d.). Retrieved January 19, 2021, from https://www.quora.com/How-dangerous-is-mosquito-liquid-to- children-if-they-drink-it 24. Chandra, A., Dixit, M. B., & Banavaliker, J. N. (2013). Prallethrin poisoning: A diagnostic dilemma. Journal of anaesthesiology, clinical pharmacology, 29(1), 121– 122. https://doi.org/10.4103/0970-9185.105820 25. Harpic (Hydrochloric acid) ingestion causing 'isolated ... (n.d.). Retrieved January 19, 2021, from https://eprints.manipal.edu/139680/ 26. (PDF) Undereporting of acute pesticide poisoning in ... (n.d.). Retrieved January 19, 2021, from https://www.researchgate.net/publication/311166899_Undereporting_of_acute_pestici de_poisoning_in_Tanzania_Modelling_results_from_two_cross-sectional_studies

218 Legal Desire Media & Insights www.legaldesire.com/forensics International Medico-Legal Reporter Journal February 2021 ISSN: 2347 - 3525

27. EJ. Mew, P., D. Gunnell, M., A. Bose, C., M. Weerasinghe, M., M. Eddleston, A., AN. Chowdhury, S., . . . DM. Roberts, A. (1970, January 01). Suicide by pesticide poisoning in India: A review of pesticide regulations and their impact on suicide trends. Retrieved January 19, 2021, from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-8339-z 28. (PDF) Predictors of Morbidity and Mortality in ... (n.d.). Retrieved January 19, 2021, from https://www.researchgate.net/publication/280328742_Predictors_of_Morbidity_and_ Mortality_in_Organophosphorus_Poisoning_A_Case_Study_in_Rural_Hospital_in_K arnataka_India 29. M. Wiergowski, M., A. Smędra, S., T. Konopka, M., A. Borowska-Solonyko, A., D. Gunnell, C., KE. Hondel, M., . . . V. Varlet, F. (1970, January 01). Suicidal deaths due to helium inhalation. Retrieved January 19, 2021, from https://link.springer.com/article/10.1007/s11419-019-00473-2 30. Srinivas Rao Ch;Venkateswarlu V;Surender T;Eddleston M;Buckley NA;. (n.d.). Pesticide poisoning in south India: Opportunities for prevention and improved medical management. Retrieved January 19, 2021, from https://pubmed.ncbi.nlm.nih.gov/15941422/ 31. Symptoms of Pesticide Poisoning. (n.d.). Retrieved January 19, 2021, from https://psep.cce.cornell.edu/Tutorials/core-tutorial/module09/index.aspx 32. (PDF) Acute poisoning due to ingestion of Datura ... (n.d.). Retrieved January 19, 2021, from https://www.researchgate.net/publication/316430294_Acute_poisoning_due_to_inges tion_of_Datura_stramonium_-_A_case_report 33. Case Report Death Due to Datura Consumption-A Case Report. (n.d.). Retrieved January 19, 2021, from https://www.researchgate.net/publication/322143998_Case_Report_Death_Due_to_D atura_Consumption-A_Case_Report 34. Neale, G., & Smith, A. (2007, May 01). Self-harm and suicide associated with benzodiazepine usage. Retrieved January 19, 2021, from https://bjgp.org/content/57/538/407 35. Diphenhydramine overdose: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved January 19, 2021, from https://medlineplus.gov/ency/article/002636.htm 36. T., G. (2020, March 10). Diphenhydramine Overdose: Recognize It & How to Treat It. Retrieved January 19, 2021, from https://www.serenityatsummit.com/diphenhydramine/overdose/ 37. First Aid for Toilet Bowl Cleaner Poisoning. (n.d.). Retrieved January 19, 2021, from https://www.dovemed.com/healthy-living/first-aid/first-aid-toilet-bowl-cleaner- poisoning/ 38. The link between substance abuse, violence, and suicide. (n.d.). Retrieved February 05, 2021, from https://www.psychiatrictimes.com/view/link-between-substance-abuse- violence-and-suicide

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