2 VISHA CHIKITSA

2.1 DIAGNOSIS OF POISONING IN

LIVING AND DEAD.
 IN LIVING.
 THE DOCTOR MUST BE FAMILIAR.
 SYMPTOMS APPEAR SUDDENLY SOON AFTER THE CONSUMPTION
OF SUSPECTED DRINK, FOOD ETC.
 RAPID INCREASE IN THE SEVERITY OF SYMPTOMS.
 THE GROUP OF PEOPLE WHO CONSUMED SAME FOOD WILL BE
SUFFERING FROM SAME SIGNS & SYMPTOMS.
 POISON CAN BE DETECTED FROM INGESTED FOOD.
 POISON CAN BE DETECTED FROM GASTRIC LAVAGE SUBSTANCE.
 POISON CAN BE DETECTED FROM BLOOD INVESTIGATION, URINE
ANALYSIS, STOOL ANALYSIS.
 POISON CAN BE DETECTED BY SUBJECTING THE FOOD INTO
VARIOUS CHEMICAL ANALYSIS.
SYMPTOMS IN ACUTE POISONING

 SUDDEN ONSET OF PAIN ABDOMEN, NAUSEA, VOMITING,

DIARRHOEA, & COLLAPSE.
 SUDDEN ONSET OF COMA WITH COSTRICTED PUPILS.
 SUDDEN ONSET OF CONVULSIONS.
 DELIRIUM WITH DILATED PUPILS.
 PARALYSIS SPECIFICALLY LOWER LIMBS.
 JAUNDICE & HEPATOCELLULAR FAILURE.
 OLIGURIA WITH PROEINURIA & HAEMATURIA.
 SUDDEN ONSET OF ANY NEUROLOGICAL,GI,RESPIRATORY
ILLNESS.
SYMPTOMS IN CHRONIC
POISONING
 THE SYMPTOMS EXAGGERATED AFTER ADMINISTRATION OF
SUSPECTED FOOD, DRINK, MEDICINE.
 MALAISE, CACHEXIA, DEPRESSION, GRADUAL DETERIORATION.
 REPEATED ATTACKS OF DIARRHOEA, VOMITTING.
 SYMPTOMS DISAPPEAR IF THE PATIENT IS MOVED OUT FROM
PRESENT SURROUNDING.
 TRACES OF POISON CAN BE DETECTED FROM BLOOD, URINE,
VOMIT, STOOLS.
DIAGNOSIS OF POISONING IN
DEAD
 COLLECT THE CHALLAN FROM POLICE.
 IF POSSIBLE VISIT CRIME SITE.
 MAKE A REPORT OF EVERY SMALL THING.
 POST MORTEM.
EXTERNAL FINDINGS

 THE SURFACE OF BODY & CLOTHES.

 COLOUR OF POST MORTEM STAINING.
 SMELL AT MOUTH AND NOSE.
 EXAMINATION OF NATURAL ORIFICES.
 INJECTION MARKS.
 EXAMINATION OF SKIN.
 MARKS OF VIOLENCE.
THE SURFACE OF BODY &
CLOTHES
 MARKS OR STAINS OF VOMIT, FAECES, OR POISON ITSELF.
 IN CORROSIVE POISONS IT BECOMES VERY NECESSARY

SUBSTANCE COLOUR CHANGE IN SKIN

AND MUCOUS MEMBRANE.
H2SO4,HCL, OXALLIC ACID GREY
HNO3 BROWN
HYDROFLOURIC ACID REDDISH BROWN
CARBOLIC ACID, ALKALIS GREYISH WHITE
CRESOLS BROWN LEATHREY
HGCL2 BLUISH WHITE
POTASSIUM CHROMATE ORANGE
COLOUR OF POST MORTEM STAINING

SUBSTANCE COLOUR CHANGES IN SKIN

COPPER, PHOPHORUS DARK BROWN TO YELLOW
CO CHERRY RED
NITRITES, ANILINE, NITROBENZENE, CHOCOLATE (FORMATION OF
BROMATES, CHLORATES METHAEMOGLOBIN)
SMELL AT MOUTH AND NOSE

ODOUR SUBSTANCE
GARLIC PHOSPHOURUS, ARSENIC, THALLIUM,
TELLURIUM, SELENIUM, OP POISONS.
SWEET OR FRUITY ETHANOL, CHLOROFORM, NITRITES.
KEROSENE OP POISONS.
ROTTEN EGGS HYDROGEN SULPHIDE, DISULFIRAM.
ACRID PARALDEHYDE, CHLORAL HYDRATE.
FISHY ZINC PHOSPHIDE.
EXAMINATION OF NATURAL
ORIFICES
 FOR PRESENCE OF ANY EVIDENCE.
EXAMINATION OF SKIN

 HELPFUL IN CHRONIC POISONING.

 HYPERKERATOSIS & PIGMENTATION CH. AS POISONING
 JAUNDICE POSPHORUS POISONING.
INTERNAL FINDINGS
1. SMELL
2. MOUTH & THROAT
3. OESOPHAGUS
4. UPPER RESPIRATORY TRACT
5. STOMACH
6. DUODENUM & INTESTINES
7. LIVER
8. RESPIRATORY SYSTEM
9. KIDNEYS
10. HEART
11. BLADDER & EXTERNAL GENITALS
1. SMELL
 SKULL MUST BE OPENED FIRST TO DETECT UNUSUAL ODOUURS IN THE
BRAIN.
 EX- CYANIDE, ALCOHOL, PHENOL, CRESOL, ETHER, CHLOROFORM,
CAMPHOR POISONING.
 2. MOUTH & THROAT

 IT INCLUDES EXAMINATION OF TONGUE MOUTH & THROAT.

 TO FIND OUT ANY EVIDENCE OF INFLAMMATION, EROSION, STAINING.

 IN CASES OF POISONING BY AMIDOPYRINE, THIOURACIL, DINITROPHENOL,

SULPHONAMIDES, BARBITURATES WE CAN SEE NECROSIS OF PHARYNX.
3 OESOPHAGUS

 IN CASES OF POISONING BY CORROSIVE ALKALIS WE

CAN SEE SOFTENING & DESQUAMATION OF MUCOUS
MEMBRANE.
 IN CANTHARIDIN POISONING MUCOUS MEMBRANE IS
SWOLLEN WITH ULCERATION.
 IN CASES OF POISONING BY PARAQUAT & FLUORIDES WE
CAN SEE PERFORATION.
4 UPPER RESPIRATORY TRACT

 EXAMINATION OF LARYNX TRACHEA & BRONCHI.

 FOR THE EVIDENCE OF VOLATILE IRRITANTS OR INHALED

POISONOUS MATTER.

 IN CORROSIVE ACID OR ALKALI POISONING WE CAN SEE OEDEMA

OF GLOTTIS & CONGESTION OF TRACHEA & BRONCHI.
 5 STOMACH
 TOXIC SUBSTANCES WILL BE HELD IN HIGH CONCENTRATIONS IN THE RUGAE
& CRYPTS OF THE MUCOUS.
 IN POISONING WE CAN SEE 4 KINDS OF CHANGE IN THE STOMACH.

1. HYPERAEMIA
2. SOFTENING
3. ULCERS
4. PERFORATION
 2 SOFTENING
1 HYPERAEMIA
COLOUR OTHER THAN RED
MUSCU
SUBSTANCE COLOUR
CORROS LAR
MERCURY, ACIDS BLACK
IVES CONTRA
ARSENIC, CARBOLIC WHITE CTION
ACID
CRESOL BROWN
NITRIC ACID YELLOW
COPPER BLUE OR GREEN
GLANDS
SPASM
OF
GET
PYLORUS PROTEC
TED
EXCESS
OF
MUCUS
SECRETE
D
 3 ULCERS
ULCERS ARE SEEN IN CASES OF CORROSIVE POISONING.
IT IS VERY THIN WITH FRIABLE MARGINS.

4 PERFORATION

PERFORATION IS SEEN VERY OCCASIONALLY.

IN CASES OF POISONING BY SULPHURIC ACID, AMMONIA.
ANALYSIS OF STOMACH
 STOMACH HAS TO BE TAKEN IN A CLEAN PORCELAIN DISH.

 OPENED ALONG ITS GREATER CURVATURE.

 A NOTE HAS TO BE PREPARED REGARDING COLOUR, CONTENTS,

FRAGMENTS, VOLUME etc.

 THEN IT IS LIGATURED SENT FOR FURTHER ANALYSIS.

6 THE DUODENUM AND INTESTINES

 ULCERATION BEYOND PYLOROUS IS NATURALLY DUE TO DISEASE.

 IN MERCURY POISONING WE CAN NOTICE THE CHANGES.

7 LIVER

 LIVER NECROSIS IN ARSPHENAMINE, PHOSPHORUS,

CHLOROFORM
 FATTY LIVER ARSENIC, FERROUS SULPHATE
 JAUNDICE POTASSIUM CHLORATE.
9 KIDNEYS

 DEGENERATIVE CHANGES SEEN IN METAL POISONING.

 NECROSIS SEEN IN PHENOL, CARBON TETRA CHLORIDE.
10 HEART

 IN ARSENIC POISONING SUBENDOCARDIAL HAEMORRHAGES.

 NO POISON KILLS WITHOUT PRODUCING SOME SYMPTOMS OF
ILLNESS.
 2.2 CHATURVIMSHATI UPAKRAMA
 Agada Tantra is a branch of Ayurveda. Toxicology that deals with
various type of poisons and its management.

 Intreatment of visha acharya Charaka has explained the

Chaturvimshati upakramas (24 treatment procedure).

 From this it is clear that, it was possible to treat visha with ayurveda
medicine alone.

 The Chaturvimshati upakramas are

 Mantra (Chanting hymns),  ANJANA (COLLYRIUM)
 Arishta bandhana (Tourniquet application),  Nasya (Nasal instillation),
 Uthkarthana (Incision),
 Dhoopa (Fumigation),
 Nishpeedana (Squeezing),

 Leha (linctus),
Chushana (sucking),
 Agni (Cauterization),  Aushadha (medicine),
 Parisheka (Sprinkling),  Prashamana (pacifying measure),
 Avagaha (Immersionbath),  Prathisarana (rubbing),
 Rakthamoshana (Bloodletting),
 Prathivisha (antidote),
 Vamana (Emesis),

 Sanjastapanam (regaining
Virechana (Purgation),
 Upadhana (Applying medicine over
consciousness)
incised scalp), , Lepa (oinments),
 Hrdayavarana (protection of hridaya),  Mrthasanjivani (revival)
 MANTRA (Chanting of Hymns) Mantra are nature of truth and penance delivered by Devarshi
and Brahmarshi.
 For the removal of visha mantra chikitsa is said to be the best treatment .
 So it is the first line of treatment in Chathurvimshathi Upakrama.
 According to Vagbhata, mantra is said as vishapaharani, Mantra has the capacity to destroy
visha and it is said to be Daiva sampat.
 Method of chanting mantra
 One who chant the Mantras should stay away from women, meat, wine; limited food should
be taken, should be clean, sleep in a bed prepared by Kusha (a type of grass) and worship of
Gods should be done by garlands, aroma sticks, sacrifices, etc.
 Mode of action of Mantra
 Chanting mantra in a specific rhythm creates confidence in person and helps in reducing
anxiety.
 It stimulates sympathetic nervous system and strengthens the peripheral blood vessels, which
help in maintaining the normal blood flow to vital organs.
 Thus mantra has a role in reassuring the victim. The energy level in the surrounding varies
 ARISHTA BANDHANA (Tourniquet application)
 Arishta bandhana is the one of the emergency line of treatment for Visha.
 It prevents spreading of the poison.
 If the Visha has not spread from site of bite the shareera dhaatu’s then arista bandhana
should be done 4 angula (4inches) above the bite site
 . Two types of tourniquet application are mentioned in classics namely; without mantra by
rajju (rope), etc and with mantra.
 Materials used for tourniquet
 application Cloth, skin of animals which is soft can be used for tourniquet application.
 The bandhana should be based on the Desha.
 It should not be too tight or too loose.
 If it is too tight it will cause swelling and putrid smell from the site of bite.
 If it is too loose it will cause fast spreading of visha.
UTHKARTHANA (Incision)
 It is the method of incision of the site of bite.
 According to Vagbhata, Visha will remain 100 matra kaala
(blinking of the eye is considered as one matra kala) in the
bite site.
 Then it spreads into circulation.
 One should go for utkartana karma during this time period.
NISHPEEDANA (Squeezing)

 Itis the method of expelling the poison by squeezing the

area of bite.

 Itis contra indicated in Marma (vital parts) and Sandhi

(joints).

 Ifit is done in marma sthana it will cause death, in joints it

will cause deformity of joints
CHUSHANA (Sucking)
 It is the method of sucking the poison from the site of bite.

 According to acharya Charaka, the mouth should be filled with yava curna
(Hordeum vulgare), before sucking

 It removes blood mixed with visha from the bite site.

 Acharya Sushrutha explained to suck the visha by filling the mouth with
cloth
AGNI KARMA (Cauterization
 It is indicated in Twak-Mamsagatha visha (Poison in skin & muscles)

 Dalhana opines that in viper bite agnikarma is contraindicated, it causes

pitta aggravation and leads quick spread of poison.

 Material used for agnikarma are metals and cloth.

 In modern it is known as Cauterization.

 It destroys affected tissues and minimizes infection

 PARISHEKA
 It is the method of sprinkling medicated decoction over the site of bite.
 Decoction prepared by Chandana (Santalum album) and Usheera (Vetivera zizanoides) is
used for parisheka.
 Visha vega is prevented by using cold decoction.
 After raktamokshana (bloodletting) the remaining rakta will attain leenata because of the
ushna guna of visha.
 For this cold lepa (Cold pack) and parisheka (Sprinkling) should be done.
 In Viper bite, the commonly practiced dhara is Panchavalkala kwatha dhara.
 In Cobra bite Grtha saindhava dhara is used.
 Condensation of blood helps to pacify the intensity of poison.
 Appropriate irrigation of the bite will decrease the rate of absorption of poison.
 Cold character of drug helps in reduction of further infection in the wound; contraction of
blood vessels, prevent further spread of poison.
AVAGAHA (Immersion bath)
 Avagaha means immersion or dipping the affected part in the medicated
decoction or oil.

 As per modern terminology it is known as immersion bath.

 They help in proper circulation and eliminates toxic matter from the body.
RAKTHAMOKSHANA (Bloodletting)
 Once the visha enters the body Rakthamokshana is said to be the parama chikitsa
(Prime treatment).
 In all cases of snake bite, the physician should puncture the vein in the upper or
lower limbs and in forehead region.
 By this visha will be eliminated from the body with blood and saves the life of
the person.
 If visualization of the vein is good then Raktamokshana can be done with
Shrunga and Jalouka.
 If blood does not come from the site of bite- pragarshana (rubbing) should be
done with Trikatu (Zingiber officianale, Piper nigram, Piper longum),
Grhadhuma, Rajani (Curcuma longa).
 As the poison spreads the patient will suffer from intoxication, depression, so
application of cold therapy will alleviate such complication.
 VAMANA (Emesis)
 It the method of inducing vomiting.

 In visha chikitsa, mainly sadhyo vamana should be done.

 It is indicated in Kaphaja bites, associated with excessive salivation.

 According to Sangrahakara, vamana should be done, if snake bite is

above the umbilical region
 VIRECHANA (Purgation)
 It is the method of inducing purgation.

 It is indicated in burning sensation, pain and obstruction of urine in pitta

prakrithi person.

 According to Ashtanga sangraha if a pitta prakrithi person is bitten by snake

of pitta predominance, if the bite is below the umbilical region, and is
localized in pakvasaya, then Virechana is to be done.

 Purgation is induced by giving Neelini choorna(Indigofera tinctoria) with

milk, Trivrit choorna(Operculina turpethum) along with Triphala kwatha
 HRIDAYAVARANA (Protection of heart)
 Hridayavarana is the method of protection of hridaya by using certain
medicines.
 Teekshnata of visha causes the karshana of hridaya.
 So for the protection of Heart Hridayaavarana is to be done.
House hold items Plant materials Animal materials Other products
MADHU, IKSHU RASA Majja (Bone marrow Gairika (Red ochre)
SARPI SHIREESHA Gomaya rasa (Cow Bhasma (Ash) OF
dung) HEMA, TAMRA
DUGDHA Kaaka niryasa
(Crow soup
Panchagavya Dadhi Raktha of chaga
(curd) (goat’s blood)
 ANJANA (Collyrium)
 Itis indicated in Shoonakshikuta (Swelling in the orbital margin), Nidrarta
(Excessive sleep), Vivarna avila lochana (Discoloured and turbid eyes),
Vivarnam pasyathi (perception of various colours).

 Ifthere is any obstruction in netra then Anjana should be done using Devadaaru
(Cedrus deodara), Shunthi (Zingiber officianale), Maricha,(Piper nigram)
Pippali (Piper longum), Haridra (Curcuma longa), Karaveera,(Nerium indicum)
Karanja (Pongamia pinnatta) Nimba flowers (Azadirachta indica) and Tulasi
(Ocimum santum) are made into pishti using goat’s urine.

 Commonly practiced yoga are Bilvadi gulika with Tulasi pathra swarasa in all
types of poison.
 NASYA (Nasal Therapy)
 It is the instillation of medicine in the nose.

 If poison enters the head, nasya is said to be the main line of treatment.

 According to Charaka if there is obstruction in nose, eyes, ear, tongue, throat,

nasya should be done. Different combinations are used for Nasya karma like
Bharngi mula (Clerodendrum serratum), Tulasi (Ocimum santum)
 DHOOPANA (Fumigation)
 Itis the procedure, wherein medicated smoke is used for the purpose of
fumigation and this helps to nullify the adverse effect of the poison.

 Ex. Nrikeshadhi dhoopana for Keeta visha(insect poisoning) 38 Anti-toxic

material that is emitted from the smoke enters the body and clears the channels
of circulation and nullify the toxic effects of poison
LEHA (Confectionary/ Linctus)
 It is the preparation of medicine in linctus form.

 .Lehyas are used, to prevent the drying of throat, palate by visha.

 Sharkara(Jaggery) and Madhu (Honey) should be given with Swarna

bhasma and is used as sarva visha prashamana leha4
 AUSHADA (Medicine)
 Internal medicine for the treatment of visha are explained.

 Some examples for aushadha yogas are mrthasanjivani agada, gandhahasthi

agada, dhumagada, kshara agada, pancha sirisha agada, etc.
 Commonly practiced aushada yogas:

 In cobra bite15 ml of Maha kalyanaka grtha, 10 ml honey, Vilvadi gutika

can be given.3-5 minute, later Jeevaraksha gutika along with milk is given.
 In viper bite decoction of Patoladhigana and Vilvadi gutika
are given as primary medication.
 Incase of haematuria, Taruna bhaskara gutika and tender
coconut is useful.
 In insect bite, Dasanga agada is usually prescribed
PRASHAMANA (Pacifying measures)

 Afterelimination therapy some doshas will remain in the

body. To remove this prashamana is to be done
 PRATHISARANA (Rubbing)
 It is a method by applying and rubbing with powders.
 It is indicated in Raktamokshana when blood fails to come out.

 Drugs used are Trikatu (Zingiber officinale, Piper longum, Piper nigrum)
Gruhadooma (soot), Haridra (Curcuma longa), etc.

 Prathisarana increases the flow of blood or body fluids.

 The medicated powder absorbs excess moisture, reduces itching, irritation,

cools the skin and also dries the oozing
 PRATHIVISHA (Antidotes)
 Substances used to treat poison is named as Prativisha.
 It is indicated if the visha vega in between 5th and 7th vega.
 Sthavara visha is similar to kaphaja guna, so the direction of visha is upward.
 Jangama visha is similar to pittaja guna, so the direction of visha is
downward.
 The guna of sthavara and jangama visha are opposite to each other.
 Hence it is Prativisha to each other and it nullifies the effect of visha.
 It is given after the administration of Ghritapana. After Vamana-
Virechanaadi karma in cold season or spring.
 It is contraindicated in rainy season, pregnant ladies and children
SAMJNASTHAPANAM (Regaining consciousness)
 It is the method of regaining consciousness.

 In 6th visha vega samjnasthapana chikitsa is to be done.

 It is attained by pana of gopitta along with haridra (Curcuma longa),

manjishta, (Rubia cordifolia), maricha (Piper nigrum), pippali churna.
(Piper longum)
 LEPA (Ointments)
 It is the method of applying medicated paste at the site of bite.
 If a pitta prakrithi person suffers from thirst, unconsciousness, then
sheethala lepa should done.
 After Raktamokshana for the removal of residual poison lepa should be
applied at the site of bite.
 Commonly practiced lepa is Sigru punarnavadi lepa in allergy caused by
viper bite.
 Bilvadigulika and Dasanga lepa is used in insect poisoning
 MRUTHASANJEEVANI
 Justas amrita gives life even to the dead person, in the same way
mrthasanjeevani can be used in all cases of visha.

 Charaka explains a formulation named as Mrthasanjeevani agada

which is in the form of gutika.

 This cures all types of visha

DISCUSSION
 The chathurvimshathi upakrama explained in classics have all the measures
needed in the management of poisons.

 Inchathurvimshathi upakrama, the pacifying measures are Anjana, Lepa,

Dhupana, Leha, Upadhana, Prashamana, Prathisarana.

 The measure that restrict entry of poison into systemic circulation are
Arishta, Uthkarthana, Nishpidana, Chushana, Agni, Parisheka, Avagaha.
 The Elimination therapy are Rakthamokshana, Vamana, Virechana, Nasya.
 DISCUSSION
 The Supportive symptomatic treatment are Hrdhayavarana, Sanjasthapana,
Mrthasanjivani.

 The counteracting medication are Mantra, Aushadha, Prathivisha.

 The Upakrama has to be selected according to condition of patient as per

the yukti of the physician
2.3 GENERAL PRINCIPLES OF MANAGEMENT OF POISONING
I . IMMEDIATE RESUSCITATIVE
 AIRWAY BREATHING CIRCULATION DEPRESSION
OF CNS

II . REMOVAL OF UNABSORBED POISON

 INHALED INJECTED CONTACT INJESTED
 INJ NIKETHAMIDE, INJ AMINOPHYLLINE, INJ HYDRO CAORTISONE etc.
 EMETICS (IPECAC POWDER)
 GASTRIC LAVAAGE

III . ADMINISTRATION OF ANTIDOTES

THE SUBSTANCE WHICH COUNTERACT THE ACTION OF A POISON
 ANTIDOTES
 PHYSICAL ANTIDOTES
 THEY NEUTRALISEPOISON BY THEIR MECHANICAL ACTION OR
PREVENT THEIR ABSORPTION.

 ACTIVATED CHARCOAL

 DEMULCENTS MILK, STARCH, EGG WHITE, MINERAL OIL etc.

 BULKY FOOD
 CHEMICAL ANTIDOTES
 THEY COUNTERACT THE ACTIONOF POISON BY FORMING
HARMLESS OR INSOLUBLE COMPOUNDS
 1. COMMON SALT + AGNO3 = AGCL2
 2. ALBUMEN + MERCURY = PRECIPITATION
 3. DIALYSED IRON + ARSENIC = FERRIC ARSENITE
 4.KMNO4 SOLUTION WIDELY USED IN MANY TYPES OF CASES OF
POISONING.
 PHYSIOLOGICAL ANTIDOTES
 THESE ACT ON THE TISSUES
OF THE BODY AND PRODUCE
SYMPTOMS EXACTLY OPPOSITE TO THOSE CAUSED BY POISON.
 ADMINISTERED WHEN SOME PORTION OF POISON IS ABSORBED
IN SYSTEMIC CIRCULATION.
 ATROPINE AND PHYSOSTIGMINE.
 CHELATING AGENTS.
 BAL 3-4MG/KG OF BODY WEIGHT
 EDTA 25-35MG/KG OF BODY WEIGHT
 PENICILLAMINE 30MG/KG OF BODY WEIGHT
 DESFERRIOXAMINE 8-12 GMS
 UNIVERSAL ANTIDOTE
 CHARCOAL +MGO+TANNIC ACID = 2:1:1
 IV. ELIMINATION OF POISON
 RENAL EXCRETION BY GIVING LARGE AMOUNTS OF ORAL
FLUIDS LIKE TEA, LEMONADE,
 PURGING 30GMS OF SODIUM SULPHATEWITH LARGE AMOUNT
OF WATER.
 WHOLE BOWEL IRRIGATION USE OF POLYTHYLENE GLYCOL
WITH ELECTROLYTE LAVAGE SOLUTION.
 2LITRES/HOUR UNTIL THE RECTAL EFFLUENT IS CLEAR.
 DIAPHORETICS ATTAING THE PERSPIRATION BY COVERING HOT
BLANKETS ORAL FLUIDS OR INJ PILOCARPINE 5MG S.C.
 FORCED ALKALINE DIURESIS ACHIEVING THE URINARY pH
7.5 – 9. promotes excretion of drugs. INJ SODIUM BICARBONATE 1
AMP WITH 1 LTR OF NS @ 250- 500ML /HR. + DIURETICS
 URINARY OUTPUT 2-3ML/KG/HR.
 HAEMODIALYSIS
 PERITONEAL DIALYSIS
 CHARCOAL HAEOPERFUSION

V. SYMPTOMATIC TREATMENT

 VI. FOLLOW UP
2.4 DUTIES OF A MEDICAL PRACTIONER IN
CASES OF SUSPECTED POISONING
 1 MEDICAL
 2 LEGAL
 NON COMPLIANACE S. 39 Cr P C S.201 IPC S.193 IPC