Notes On Poisons And Poisoning

Table Of Contents


Poison is a substance that puts people’s lives at risk because of its poisonous reaction/poisoning on the body’s vital functions. Very high dosages of drugs, industrial chemicals/gases, and household chemicals such as insecticides (DDT, BHC, etc.) are some examples of dangerous substances.

Antidotes are substances that counteract the effects of poisons and toxins. Antidotes work by stopping the toxin from being absorbed, binding and neutralising the poison, antagonizing the poison’s end-organ impact, or inhibiting the toxin’s conversion to more dangerous metabolites.

Poisons are commonly noticed in killings, suicides, and accidents cases. They play an important function as the silent weapon that destroys life in a strange and covert manner.

Poisons can be divided into two categories according to their action and Use.

Criminal Offences

The administration of a poison is a criminal offence whenever:

(1) It is with intent to kill,

(2) With intent to cause serious injury,

(3) Used recklessly even though there is no intent to kill,

(4) For stupefying to facilitate a crime, e.g., robbery or rape,

(5) To procure an abortion,

(6) To annoy the victim,

(7) To throw poison on another person with intention to injure him.

Categories of Poison

Poisoning is also categorized in 4 sub-category on the basis of their uses, activity and circumstances.

  • Accidental Poisoning
  • Homicidal Poisoning
  • Suicidal Poisoning
  • Miscellaneous Poisoning

Accidental Poisoning

The accidental poisoning commonly takes place as A result of the negligence and carelessness. The common accidental poisoning cases are:

A.) Coal is allowed to burn in A room giving rise to the production of poisonous carbon monoxide gas.

B.) There is A lots of cases of negligence, where workers go into untended well or gutters and die due to the presence of poisonous gases.

C.) Use of insecticides in large amount, many times may cause the death of farmers or workers due to the accidental inhalation.

D.) Overdose Of Medicines / Overdose Of Barbiturates / Duplicate Medicine

G.) Allergic Conditions.

H.) Bites By Poisonous Snakes And Insects.

I.) Accidental Cattle Or Animal Poisoning Cases.

Homicidal Poisoning

  • Tasteless and odorless properties.
  • Miscible with liquid.

Some poisons are mainly used for homicidal purposes, such as;

  • Arsenic Salts,
  • Mercury Salts,
  • Cyanides,
  • Sodium Nitrite,
  • Methyl Alcohol,
  • Dhatura Seeds,
  • Phosphides, etc.

In certain parts of the world, opium is used as infanticidal poison.

An perfect homicidal poison should have the following features:

▪It should be inexpensive,

▪It should be readily available,

▪It should be colourless, odourless, and very poisonous.

▪There should be no residual left,

▪And, Signs and Symptoms resembles natural illnesses.

▪There should be no antidote.

▪There should be no post-mortem modifications or signs.

Suicidal Poisoning

Some poisons are mainly popular for suicidal purposes because of their common availability in house or the working place like;

  • Cyanide in electroplating units.
  • Insecticidal  compounds mostly available with farming communities.
  • Sodium nitrite in dyeing industries.
  • Barbiturates are normally used by the people.

By injecting anaesthetic agents like Thiopental.

For an Ideal Suicide Poison Following Characteristics Should be present:

▪It should be readily available.
▪It shouldn’t taste bad.
▪It should be Tasteless or Pleasant to taste buds.
▪It shouldn’t Cause pain or Discomfort.
▪It should be cheap.
▪It should be highly toxic.
▪It should be able to be consumed with food or drink.

Miscellaneous Poisoning

Cases of poisoning other than the explained before, are prevalent all over India which are caused by shocking agents. The intention behind this is to stupefy the person and commit robbery or other crimes.

However, many times person dies because of overdose. These poisons are:

Cigarettes containing Dhatura, Cannabis, drugs, arsenic etc.; sweets containing phenobarbitone or other psychotropic substances like lorazepam, etc.

Some times, chloral hydrate mixed with drinks is also similarly used.

Medicolegal Classification of Poison

1. Homicidal poison:
Arsenic, Aconite

2. Suicidal poison:
Opium, Barbiturates, Organophosphorus compounds, Endrin

3. Stupefying:
Datura, Cannabis indica, Chloral hydrate

4. Abortion (Abortifacients):
Oleanders seed, Calotropis, Ergot, Arsenic, Aconite, Lead, Mercury, croton, semecarpus, cantharides, potassium permanganate, etc.

5. Accidental:
Snake venom, OPC poisoning, Kerosene

6. Cattle Poison:
Oleanders, calotropis, arsenic, aconite, organophosphorus, Abrus precatorius, strychnine, zinc phosphide, nitrate

7. Infanticides:
Opium, Madar, Tobacco

Classification According to the Site and Mode of Action

There are four categories of action of poison according to their site and mode of action

Also Read: Forensic Toxicology

1. Local Action

Local Action means direct action on the affected site of the body. This can be divided into three categories:

A.) Corrosive

1) Strong acids:
Sulphuric, nitric, hydrochloric, Carbolic acid, oxalic acid, acetic acid, salicylic acid

2) Strong alkalis:
Hydrates and carbonates of sodium, potassium, and ammonia

3) Metallic salts:
Zinc chloride, ferric chloride, copper sulphate, silver nitrate, potassium cyanide, chromates, and bichromates

B.) Irritant

1) Agricultural:
Organophosphorous compound (OPC) Poisoning

2) Inorganic:
a) Non-metallic: Phosphorus, iodine, chlorine, bromine
b) Metallic: Arsenic, antimony, copper, lead, mercury, silver, zinc.
c) Mechanical: Powdered glass, diamond dust, hair, etc.

3) Organic:
a) Vegetable: Castor oil, Croton oil, Calotropis, aloes, Abrus precatorius
b) Animal: Snake and insect venom, cantharides, ptomaine

C.) Chemical

Inorganic: Weak Acid, Weak Alkalies, Inorganic Non-Metals, And Inorganic Metals.

Organic: Chemical preparations, Animal and Vegetable Origin

2.  Remote Action

Remote action affects the person due to absorption of that poison into the system of that person. This can be divided into following categories:


• C.N.S. Poisons

i. Somniferous – These types of drugs induce sleep (Such as; Opium and its alkaloids, Barbiturates)

ii. Intoxicant – A substance that causes intoxication or inebriation. (Alcohol, ether, and chloroform, for example)

iii. Stimulant – A type of medication that speeds up the transmission of signals between the brain and the body. (Amphetamines, Cocaine, Ecstasy, Nicotine, Caffeine, and so on)

iv. Deliriant – These types of substances causes delirium (Such as; Dhatura, Belladona, Hyocyamus, Cannabia Indica)

v. Hallucinogens – Affects perception, thinking, and emotion. (LSD, Mescaline, Psilocybin, and Mescaline, for example)

vi. Convulsant – Causes convulsions and/or epileptic seizures.

vii. Stupefying Poison – Causes a person to lose their ability to think clearly or be attentive to their environment.

• Spinal toxins (Convulsant) (Strychnos Nux Vomica)

• Peripheral Nerves

a. Local Anaesthetics: Cocaine, Procaine.

b. Relaxants.

• Cardiac Poisons

Cardiac Poisons have a detrimental effect on the heart’s function.

(Such as; KCN, NaCN, Digitalis, Aconite, Nicotine, Quinine, Oleander)


These causes Oxygen deprivation. Oxygen deprivation can cause unconsciousness and, in severe cases, death.

(Such as; Carbon Dioxide, Carbon monoxide, Hydrogen Sulphide)

• Nephrotoxic

Kidney damage or harm as a result of poisoning.

(Such as; Oxalic Acid, Mercury, Cantherides)

• Hepatotoxic

Due to toxicity, the liver is damaged or injured.

(Such as; Phosphorus, Carbon tetrachloride, Chloroform)

Miscellaneous Poison

Food Poisons.

3. Local and Remotes action

Some toxins have the ability to harm both local and remote organs.

(Such as; Oxalic Acid)

4. General Action

Some poisons have the ability to harm many body organs.

(Such as; Mercury, Arsenic, and other heavy metals, for example.)

Classification of Poison According to Motive or Nature of Use

√ Homicidal: Arsenic, Aconite, Digitalis, Abrus Precatorius, Strychnos nux vomica.

√ Accidental: Aspirin, Organophosphorus, Copper Sulphate, Snakes Bite, Ergot, CO, CO2, H2S.

√ Suicidal: Opium, Barbiturate, Organophosphorus, Carbolic Acid, Copper Sulphate.

Abortifacient: Ergot, Quinine, Calotropis, Plumbago.

√ Stupefying Agent: Dhatura, Cannabis, chloral hybrate.

√ Agents used to cause Bodily Injury: Corrosive acids and Alkalies.

√ Cattle Poison: Abrus precatorius, Calotropis, Plumbago.

√ Used for Malingering: Semicarpus Anacardium

Sources of Poison

There are variety of ways that might be source of poisoning. These includes:

  • Domestic Sources: Poisoning can occur from a variety of sources in the home, including detergents, disinfectants, cleaning agents, antiseptics, insecticides, rodenticides, and other pesticides.
  • Industrial Sources: Poisons are manufactured or created as by-products in industries.
  • Agricultural and Horticultural Sources: Insecticides, pesticides, fungicides, and weed killers from agricultural and horticultural sources.
  • Contamination of food and drink by the use of preservatives in food grains or other food materials, additives such as colouring and odouring agents, or other methods of unintentional contamination of food and drink.
  • Commercial Sources: warehouses, distribution centers, and retail establishments.
  • Drug and Medicine Abuse – As a result of incorrect medication, overmedication, and drug abuse.
  • Miscellaneous Sources – Snakes bite poisoning, City smoke, Sewage gas poisoning etc.

Odors of Poison

Bitter AlmondsCyanide

Garlic or horseradish

Organophosphate Toxicity
Arsenic Poisoning
Sulfur Mustard
Dimethyl Sulfoxide (DMSO)
PeanutsVacor (PNU)
CarrotsWater hemlock
Rotten Eggs Hydrogen Sulfide

Sulfur Dioxide

WintergreenMethyl Salicylates
FruityDiabetic Ketoacidosis (DKA)
PearsChloral Hydrate
Freshly Mown HeyPhosgene

Actions and Administrations of Poison

The action of all poison is almost same. Commonly they either stop the supply of oxygen to the body tissues or inhibit the enzymes associated with the respiration mechanism and the person dies due to stoppage of oxygen availability. The site of action is said to be at the myoneural junctions and synapses of the ganglions.

The mode of stoppage varies for example insecticides and pesticides are powerful inhibitors of cholinesterase. In poisoning by insecticides and accumulates and results in hyper excitation of the voluntary and involuntary muscles.

A drop in the activity of cholinesterase to 3 percent of normal or lower is associated with toxic symptoms and leads to death resulting from respiratory failure or circulatory arrest.

In carbon monoxide poisoning, the gas having greater affinity combines easily with haemoglobin and make the unable to carry oxygen to various tissues of the body.

Opiates, alcohols, barbiturates, dhatura etc. paralyze the respiratory centers of the brain resulting in respiratory failure.

The glycosides poisons affect the heart muscles and the pumping of blood is stopped.

Action of Poison

The action of poison may be

  • Local Action
  • Remote Action
  • Local & Remote Actions
  • General Actions

Local Action

The local action means its direct action on the tissues and cause corrosion e.g. strong mineral acids and alkalis, irritation and inflammation in cantharides or some nervous effects as in the case of dilation of the pupil by atropine.

Remote Action

Remote action results from the absorption of the poison into the system e.g. alcohol, alkaloids or other drugs affect the organs after being absorbed into the system.

Local And Remote Actions

Some poisons produce both local and remote actions. In such cases, there is destructive action on the tissue with which they come in contact and there is also a toxic affect after absorption e.g. oxalic acid.

General Action

General action results when the absorbed poison evokes response from a wide variety of tissues beyond one or two systems e.g. arsenic, mercury insecticidal compounds etc.

Administration of Poison

■ Most of the poison affects the person immediately, if not, the poison is eliminated from the body by excretions or gets metabolized or detoxified into non-toxic metabolite which is eliminated slowly.

■ Some poisons have tendency to get accumulated in the body tissues and when a fatal level is reached, the person dies.

■ Arsenic and DDT as among such poisons, which have been reportedly used as slow poison since ages for homicidal purposes.

■ The absorption of DDT through skin and accumulation behavior may result into accidental death.

Routes of Administration

The majority of poisons are ingested. Poison is derived from the Latin word “potare“, which means “to drink.” Poisons, on the other hand, can enter the body in a variety of ways:

  • By inhaling
  • Through the skin
  • By IV injection
  • Due to radiation exposure
  • Snake venom or insect bite venom

In order of rapidity of action:

1. Inhaled in gaseous or vapourous form.
2. Injection into blood vessels.
3. Intramuscular, subcutaneous, and intradermal injection.
4. Application to a wound.
5. Application to a serous surface
6. Application to a bronchotracheal mucous membrane.
7. Introduction into the stomach
8. Introduction into the natural orifices, e.g. rectum, vagina, urethra, etc.
9. Application to unbroken skin.

Routes of Elimination

The absorbed portion of poison is mainly excreted by the kidneys and to some extent by the skin. Other routes are bile, milk, saliva, mucous and serous secretions. The unabsorbed portion is excreted in the vomit and feces.

Factors Modifying Actions of Poison

The resultant of poisoning depends on many factors.

There are number of reasons which can affect intensity of poisoning are further explained, such as:

  • Dose.
  • Time of intake
  • Way of taking
  • Environmental factors, etc.


Amount of the poison is determine the affect of it on the body. Smaller the dose, lighter the effect and larger the dose, severe the effect.


After doing continuous use of some drugs, such as opiates, tobacco, alcohol, etc. person develop a resistance towards some drugs.

Incompatible Combination of Drugs

Ingestion of some incompatible combination of Medicines may be fatal. Such As; Prozac and Tramadol, Thyroid medication and proton pump inhibitors, Nonsteroidal anti-inflammatory drugs and antihypertensive, etc.


Some of persons show abnormal response (idiosyncrasy) to a drug like morphine, quinine, aspirin etc. due to inherent personal hypersensitivity.


Some persons are allergic (acquired hypersensitivity) towards certain drugs like penicillin, sulpha, etc.

Incompatible Combinations

Ingestion of certain medications like anti – ulcerous gels with aspirin may lead to fatal effects.


People develop a marked tolerance in the case of opium, alcohol, strychnine, tobacco, arsenic and some other narcotic drugs by repeated and continued use.


Some poisonous drugs can be toxic when taken together may cause lethal effect. Such as; Alcohol and Benzodiazepines, Heroine and Cocaine, Benzodiazepines and Opioids, Alcohol and Opioids.

Slow Poisons

The continuous small amount of poison ingestion like arsenic, strychnine, lead, etc. accumulate in body and may cause death.

Conditions of The Body

  • Conditions of the body, i.e. age, health, etc. also affect the action of the poison.
  • Generally old persons, weaker persons and children severly affected by low dose of poison then young and healthy person.

Cumulative Action

The repeated small doses of cumulative poisons like arsenic, lead, mercury, strychnine, digitalis etc. may cause death or chronic poisoning by cumulative action.


Some times, a large dose of a poison acts differently from a small dose, for example; a large dose of arsenic may cause death by shock while a small dose results in diarrhoea.

Forms of Poison

  • Gases/Vapours Poisons
  • Liquid Poisons
  • Powder Poisons
  • Chemical Combination
  • Mechanical Combination

Gases / Vapours Poisons

These types of poison absorbed immediately and act quickly.

Liquid Poisons

These act better than solids.

Powder Poisons

Fine powdered poison act fast than coarse powdered poison.

Chemical Combination

Some substances in combination act like lethal, such as; acids and alkali’s, strychnine and tannic acid, etc.

Mechanical Combination

The action of a poison is altered when combined mechanically with inert substances, such as; when alkaloid when taken with charcoal, it does not act.

Types of Poisoning

1) Acute poisoning

It is caused by an excessive single dose or several smaller doses of a poison taken over a short interval of time.

2) Chronic poisoning

It is caused by smaller doses over a period of time, resulting in gradual worsening. The poisons which are commonly used for the purpose of chronic poisoning are arsenic, antimony, phosphorus, and opium.

3) Subacute poisoning

It shows features of both acute and chronic poisoning.

4) Fulminant poisoning

It is produced by a massive dose. In this death occurs rapidly, sometimes without preceding symptoms.

Failure to Detect Poison

In the following situations, it may be difficult or impossible to detect poison.

  • Eliminated by vomiting and diarrhea, e.g, in irritant poisons.
  • From the lungs by evaporation or oxidation.
  • After absorption may be detoxified, conjugated, and eliminated from the system.
  • Some vegetable alkaloidal poisons cannot be definitely detected by chemical methods.
  • Some drugs are rapidly metabolized, making extraction difficult.
  • Some organic poisons especially alkaloids and glucosides may by oxidation during life or due to faulty preservation, or a long interval of time, or from the decomposition of the body, may deteriorate and cannot be detected chemically.
  • Biological toxins and venoms which may be protein in nature cannot be separated from body tissues.
  • If the poison acts slowly and death is delayed following the production of irreversible organic changes
  • Sometimes, decomposition products make the detection difficult or impossible.
  • Treatment may alter the poisonous substance.
  • Many drugs may be present in very small amounts and these may require a considerable amount of viscera for their identification.
  • The wrong or insufficient material may have been sent for analysis.

Principle of Treatment of Poisoning

In case of Poisoning following treatment can be followed by medical professionals.

1. Removal of the patient from the source of exposure

2. Initial ABCD resuscitation
A – Airway
B – Breathing
C – Circulation (IV fluid administration)
D – Depression of CNS should be corrected.

An unconscious patient should be turned to lie on one side to stop the tongue from blocking the throat and to allow fluid to come out of the mouth (recovery position).

3. Removal of Unabsorbed Poison from the Body

► If the poison is inhaled as a gas, the patient must be removed into the fresh air, artificial respiration and oxygen should be given. The air passages should be kept free from mucus by postural drainage or by aspiration.

► If the poison has been injected subcutaneously from a bite or an injection, a tight ligature should be applied immediately above the wound, which must be loosened for one minute after every ten minutes, to prevent gangrene

► The patient’s contaminated clothes, contact lenses, and jewelry should be removed immediately. If poison is applied to the skin or wound or is inserted into the vagina, rectum, or urinary bladder, it should be removed by washing with water for 30 minutes or should be neutralized by a specific chemical.

► Removed from the stomach by emesis or by use of stomach tube

4. Diluting the poison & delaying its absorption

The poison in the stomach is to be diluted by giving water to drink. Bulky bland food also helps. Fat delays the process of absorption and also protects the stomach wall from the corrosive action of the poison.

5. Elimination of absorbed poison

► Purging: Elimination of poison from GIT by excretion

► Diuresis: For increased urination

► Diaphoresis: Increased perspiration can be tried with the help of neostigmine/pilocarpine

► Dialysis: Hemodialysis, urinary dialysis, peritoneal dialysis

► Use of chelating agents

6. Administration Of Specific Antidotes:

► For OPC: Atropine

► For Dautra: Physostigmine

► For morphine/Opium: Naloxone

► Barbiturate: For strychnine

► Atropine: Physostigmine

7. Symptomatic Treatment

► Control of convulsion: Diazepam

► Control of vomiting: Ondansetron

8. Follow-up

Contraindications of Stomach Wash

Absolute Contraindication

The only absolute contraindication is corrosive poisoning (except carbolic acid), owing to the danger of perforation.

Relative Contraindication

1) Convulsant poisons, as it may lead to convulsions. Lavage should be done after controlling the convulsions.

2) Comatose patients, because of the risk of aspiration of fluid into the air passages.

3) Volatile poisons, which may be inhaled.

4) Upper alimentary disease, e.g. oesophageal varices.

5) In patients with marked hypothermia and hemorrhagic diathesis.

Complications of Gastric lavage

• Laryngeal spasm
• Aspiration pneumonitis
• Perforation of the stomach
• Sinus bradycardia


► Syrup of ipecac contains cephaeline and emetine. It induces vomiting by local activation of peripheral sensory receptors in the GIT, and stimulation of the vomiting center. This is the only and best method of producing vomiting.

► Ingestion of an excessive amount of saltwater may cause fatal hypernatremia.
Household emetics, i.e. mustard powder (one teaspoon) and common salt are not effective and can lead to complications.

Tickling throat

Make the patient lie face down or sit well forward with the head lower than the chest, and ask the patient to touch the back of the throat with his fingers or with your own finger or a blunt object, such as a spoon handle or a wooden tongue depressor. This is usually ineffective.


Antidotes are substances that counteract or neutralize the effects of poisons.

Common modes of action of antidotes are:

• Inert complex formation e.g. chelating agents for heavy metals,

• Receptor site blockade, e.g. naloxone for opiates; atropine for organophosphates at muscarinic receptor sites.

Antidotes are agents that neutralise the effects of poison. They are classified as:

  1. Mechanical Antidote
  2. Chemical Antidote
  3. Physiological Antidotes
  4. Universal Antidotes.

Mechanical Antidote:

Physical or Mechanical antidote inhibits the action of a poison mechanically, without eliminating or neutralising the poison’s harmful effects. Adsorbents such as activated charcoal, demulcents such as egg albumin, starch, or milk, diluents such as water or milk, and bulky foods such as cooked rice or vegetables are examples.

Chemical Antidote:

  • Chemical antidotes are compounds that dissolve and inactivate toxins through a chemical process. Weak acids and alkalis, common salt, egg albumin, and KMNO4 are a few examples.
  • They counteract the action of poison by forming harmless or insoluble compounds or by oxidizing poison when brought into contact with them.Alkalis neutralize acids by direct chemical action. It is safer to give the little weak solution of an alkaline hydroxide, magnesia, or ammonia. Bicarbonate should not be given, because of the possible risk of rupturing the stomach due to liberated CO2.
  • 1) Alkalis neutralize acids by direct chemical action. It is safer to give the little weak solution of an alkaline hydroxide, magnesia, or ammonia. Bicarbonate should not be given, because of the possible risk of rupturing the stomach due to liberated CO2.
  • Acids neutralize alkalis by direct chemical action. Only those substances which are by themselves harmless should be given, e.g. vinegar, lemon juice, canned fruit juice.
  • Potassium permanganate has oxidizing properties. 1:5000 solution is used in poisoning for opium and its derivatives, strychnine, phosphorus, hydrocyanic acid, cyanides, barbituric acid and its derivatives, atropine, and other alkalis.
  • When it reacts with the poison in the stomach, it loses its pink color. The wash must be continued till the solution coming out of the stomach is of the same pink color as the solution put in.
  • Tannic acid 4%, or tannin in the form of a strong tea or one teaspoonful of tannic acid in water tends to precipitate apomorphine, cinchona, strychnine, nicotine, cocaine, aconite, pilocarpine, lead, silver, aluminum, cobalt, copper, mercury, nickel, and zinc.
  • Common salt decomposes silver nitrate by direct chemical action, forming the insoluble silver chloride.
  • Dialyzed iron is used to neutralize arsenic.
  • A solution of tincture iodine or Lugol’s iodine 15 drops to half a glass of warm water precipitates most alkaloids, lead, mercury, silver, quinine and strychnine.

Physiological Antidote:

Physiological antidotes have their own effect, causing indications and symptoms that are opposite to those caused by the toxin. For instance, Naloxone for morphine, Neostigmine for datura or the hyoscin group, and Barbiturate for strychnine.

Universal Antidote:

The term “universal antidote” refers to a cocktail of physical and chemical antidotes. When the precise nature of the poison is unknown, a universal antidote that is effective against a wide spectrum of poisons is applied.


Activated charcoal2 Parts
Magnesium oxide1 Parts
Tannic acid1 Parts

▪ Activated charcoal acts as an adsorbent,

▪ Magnesium oxide neutralises acids and toxins, and,

▪ Tannic acid precipitates alkaloids.

Other Antidotes

Household Antidotes:

Antidotes found at home are known as household antidotes. Some of them are given below:

  • Alkaloid and metallic poisons are precipitated by strong liquid tea (which contains tannic acid).
  • Starch for iodine.
  • Milk and raw eggs for mercury, arsenic, and heavy metals.
  • Flour suspension and mashed potatoes can be substituted for activated charcoal.
  • For acid poisoning, use milk of magnesia or a soap solution.
  • For alkali poisoning, use orange juice, lemon juice, or vinegar.

Serological Antidote:

Anti-snake venom serum is a serological antidote for snake bite poisoning.

Snake venom has just one distinct antidote: antivenom.

Antivenom is an immunoglobulin extracted from the serum or plasma of a horse or sheep immunised against the venoms of one or more snake species. Antivenom should be administered intravenously. For any suspected anaphylactic responses, adrenaline should always be prepared before antivenom is delivered.

Chelating Agents:

Chelating agents are compounds that act on metal toxins that have been ingested. When compared to indigenous enzymes, they have a higher affinity for metals. Because the complex of agent and metal is more water soluble than the metal itself, the complex is excreted more efficiently by the kidneys. Eg: British anti-lewisite (B.A.L., dimercaprol), E.D.T.A. (ethylene diamine acetic acid), Penicillamine (Cuprimine), Desferroxamine etc.

a.) British Anti-Lewisite (B.A.L., 2-3 dimercaptopropanol) has two unsaturated SH radicals that react with metal in circulation, sparing tissue enzymes. Useful in situations of arsenic, mercury, copper, bismuth, gold, and other heavy metals.

b.) E.D.T.A. (Ethylene diamine tetra-acetic acid) reacts with sodium to generate sodium salt, then with calcium to form disodium calcium edentate, which reacts with free metal and physiologically inactivates it. It is the most effective chelate for lead. Adults should take 1 gm twice daily at a 12-hour interval, using a slow I.V. injection mixed with 5% glucose saline.

c.) D-Penicillamine is used to treat copper, mercury, and lead toxicity, as well as Wilson’s disease, cystinuria, scleroderma, and rheumatoid arthritis.

d) Calcium Disodium Edetate – This medicine is used to treat lead poisoning. It helps with iron, zinc, copper, manganese, and radioactive metal poisoning, but not mercury poisoning.

e) Deferiprone is an iron chelator that can be taken orally. It can help with acute iron poisoning, cirrhosis iron overload, and thalassemia patients’ transfusion siderosis.

f) Desferrioxamine – This chelator is used to treat acute iron poisoning as well as chronic iron overload in individuals with thalassemia who require multiple transfusions. Desferrioxamine is a specific antidote for iron. Orally, take 8-12 gm. 2 gm iron absorbed I.V. in a 50 percent laevulose solution.

Disulfiram (Esperal)

Disulfiram is a medication that is used to treat chronic alcoholism. When even modest amounts of alcohol are drunk, it has adverse affects.

a) Leucovorin- It is utilised as a calcium leucovorin (calcium folinate). It’s a tetrahydrofolic acid derivative that works as an antidote to folic acid antagonists like methotrexate and pyrimethamine, which stop the enzyme dihydrofolate reductase from working.

b) Pralidoxime- It is used as an antidote for organophosphorus poisoning caused by substances such as malathion, TEPP, and parathion.

c) Nicotine- Nicotine is used to treat nicotine addiction and as a smoking cessation aid.

Read Also: Forensic Toxicology (Poisoning)

d) Bupropion— It’s used to help people quit smoking.


Sr. No.Drug / PoisonAntidote
1.Acetaminophen N-Acetylcycteine
2. BarbituratesActivated Charcoal
3.BotulinumBotulinum antitoxin
4.Beta blockersGlucagon
6.CaffeineEsmolol and Activated Charcoal
7.Cholinesterase inhibitorsAtropine
8. Cobra bite Snake anti-venin
9. CurarePhysostigmine
10.Cyanide Hydroxocobalamin, Sodium nitrite, and Sodium thiosulfate
12.Fluoride ingestion Calcium Salts
13. Ethylene glycol Sodium bicarbonate, Ethanol and Fomepizole
14. HeparineProtamine Sulfate
15.Heavy metal poisoning BAL (Dimercaprol), Calcium EDTA (Calcium Disodium Versenate) and Penicillamine.
16. Insulin reactionGlucose (Dextrose 50%)
17.IronDeferoxamine (Desferal)
18.IsoniazidPyridoxine hydrochloride (vitamin B6)
19.LeadEDTA, BAL
20.Magnesium SulphateCalcium gluconate
21.MestinonAtropine Sulfate
22. MethemoglobinemiaMethylene blue
24.Morphine SulphateNaloxone hydrochloride
25.NarcoticsNaloxone (Narcan)
26.NeostigmineAtropine and Pralidoxime


Non-specific poisons except cyanide, iron, lithium, caustics and alcohol Activated charcoal
28.Opioid analgesicsNalmefene or Naloxone


31. VincristineHyaluronidase
32. Tylenol/ Paracetamol Acetylcysteine


33.Warfarin (Coumadin)Vitamin K (phytonadione, Aquamephyton)
34. Tricyclic antidepressant toxicity, urine alkalization

for salicylate toxicity, cocaine toxicity

Sodium bicarbonate
35.Thallium or Cesium toxicityPrussian blue


● It is the process of elimination of poison from GIT by excretion.

● 30 gm sodium sulphate with large amounts of water, hastens the elimination of poison in the stool.

● Magnesium sulphate should be avoided, since sufficient may be absorbed to produce central nervous system depression in cases of renal failure.

● To remove unabsorbed material from the intestinal tract, poorly absorbable material, such as liquid petroleum which is a solvent for fat-soluble agents is effective.

● Sorbitol 50 ml of 70% solution is a better purgative, but in young children, it may cause fluid and electrolyte imbalance.


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