27. Metal Poisons,Miscellaneous Poisons & CNS Depressant

Medico Macha

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00:00:00hello my dear friends so one of the very important metallic poison is arsenic arsenic

00:00:05now my dear friend by the name of the arsenic we can get many questions a for arsenic a for

00:00:10eldritch mese line which are also known as reynolds line and my dear friend these lines

00:00:20present over the nails eldritch mese line and my dear friend a you can remember arsenic is also

00:00:28aphrodisiac it is used for increasing the libido aphrodisiac r my dear friend two r are for red

00:00:40velvety mucosa

00:00:44and another r is rendrop pigmentation red velvety mucosa

00:00:52and another r is rendropigmentation and there are rashes and that's why the disease look like

00:01:01fading measles it's mimics like fading measles rendropigmentation and red velvety mucosa 2 r are done

00:01:07now s sub endocardial hemorrhage

00:01:10sub endocardial hemorrhage and my dear friend these hemorrhages are also known as sihan's hemorrhage

00:01:22sihan's hemorrhage now e e for excessive hyperpigmentation

00:01:29or you can say hyperkeratosis of palm and soul excessive hyperpigmentation or hyperkeratosis of

00:01:40palm and souls this is e and my dear friend it causes neuritis neuropathy

00:01:47and more common is sensory than motor it's a sensory motor but more common is sensory

00:01:52iron oxide i i is taken iron oxide the antidote the chemical antidote we use

00:01:59hydrated ferric oxide hydrated ferric oxide i is done now sir arsenic mimics a or resembles a

00:02:11arsenic resembles a disease or mimics a disease that is cholera so chemical antidote is hydrated

00:02:16ferric oxide i is done iron oxide is done okay so this is the way we can remember the the chelating

00:02:22agent we use bal and damsa that's a different thing now sir metallic arsenic i am coming to very

00:02:28very important sir metallic arsenic is non-poisonous it's non-poisonous metal is non-poisonous because

00:02:34it is not absorbed by git poisonous compound are and i am coming to the first poisonous compound which

00:02:39is known as arsenic trioxide or arsenic oxide and friends remember this is colorless odorless

00:02:47tasteless that's why that's why it can be used as a homicidal poison it can be used as a homicidal

00:02:55poison arsenic trioxide sir arsenic trioxide is also known as white arsenic

00:03:02it is known as white arsenic used as an inheritor powder inheritor powder it is also known as sankhya

00:03:13and it is also known as somalkar or somalkar sankhya somalkar white arsenic because it's a white crystal

00:03:24it is arsenic trioxide sir it is used in arsenic trioxide is used in aml type 3 that is acute

00:03:35promyelocytic leukemia acute promyelocytic you can remember it is apl acute promyelocytic leukemia

00:03:43okay use of this sir copper arsenite i already discussed this it is known as shillies green

00:03:52it is also known as shillies green copper arsenite copper aceto another age there it is also known as

00:04:01paris green both are green compound shillies green and paris green arsene my dear friend

00:04:07arsene is a gas arsene is a gas it is a gas arsene is a gas and the smell of the arsene is garlicky

00:04:16it is garlicky smell arsene just like other phosphorus compound it's a garlicky smell arsene

00:04:24so these are some very very important questions you can get in an exam these are important arsenic

00:04:29compound now mechanism of action of arsenic it combines with very potential word it combines

00:04:36with sulfhydryl groups it combined with sh group of the mitochondrial enzyme so my dear friend

00:04:46ultimately it inhibits respiratory chain it inhibits respiratory chain or respiratory chain enzyme like

00:04:54pyruvate oxidase or other enzyme which are very very important now sir very very important mcq comes

00:05:01its target is

00:05:02its target is vascular endothelium its target is vascular endothelium very very potential

00:05:13vascular endothelium and because of this target is vascular endothelium the consequence will be

00:05:22increased permeability of the vessels increase permeability of the vessels there will be edema

00:05:29and there will be gastrointestinal hemorrhage these are the consequence of arsenic toxicity

00:05:37because its main target issue is vascular endothelium there will be increased permeability edema

00:05:44and gi hemorrhages these are common consequence of the arsenic toxicity

00:05:48now my dear friend the sign and symptom of acute arsenic poisoning now one question comes in exam what

00:05:55is a fatal dose of arsenic in milligram we can write down 100 to 200 milligram 100 to 200 milligram but

00:06:03sir if you want to write down in gram it will be 0.1 to 0.2 gram this is the in gram fatal dose

00:06:11fatal period is 1 to 2 days if you want to go in detail fatal period is 1 to 2 days now sir in

00:06:19fulminant type what is fulminant type if the dose ingested is massive if the dose ingested is massive

00:06:28there is a fulminant type and observe here cause of death is shock so here it direct act on the heart

00:06:35muscles here it direct act on the heart muscle and the cause of death is shock

00:06:41or you can say the peripheral vascular collapse shock or peripheral vascular collapse peripheral

00:06:51vascular collapse leading shock so it is affecting the heart muscles that's a cause of death is shock

00:06:56peripheral vascular collapse this is fulminant type but sir the most common type is gastroenteritis type

00:07:04it causes gastroenteritis acute arsenic poisoning i'm talking about acute answer this disease

00:07:11resemble cholera this disease resemble cholera how do you remember the symptom of acute arsenic

00:07:19poisoning tvp t first will be t for throat pain

00:07:23second v for vomiting

00:07:26second v for vomiting

00:07:28and third p for purging tvp purging is a loose tool loose tool but sir in the symptom of cholera if you compare this

00:07:41with cholera the symptom will be pvt first will be purging then vomiting then there will be throat pain

00:07:51the last symptom will be throat pain so symptom sequence is different tvp arsenic tvp arsenic

00:07:57now sir along with this in arsenic poisoning acute arsenic poisoning tinasmus is present what is tinasmus

00:08:07inclination every time you feel like you are going to have some stool out and you want to defecate

00:08:11this inclination is known as tinasmus this tinasmus present in arsenic and this is absent in this one

00:08:17for arsenic you can use the blood sample and anyone you can use the urine sample but sir in cholera what

00:08:24you use tool for diagnosis for cholera you use tool for diagnosis so just remember tvp pvt tinasmus present

00:08:30tinasmus absent and lab investigation are also different we'll discuss arsenic in detail

00:08:35now sir the narcotic form of arsenic poisoning i discussed the this is the acute acute i discussed

00:08:41the fulminant type the second i discussed gastroenteritic type now the third is narcotic

00:08:48form if arsenic attacks on different part of this one giddiness formication tenderness of muscle with

00:08:56very less gi symptoms here i want to emphasize on this point either gi symptom would be absent or very

00:09:04less this is narcotic form of arsenic poisoning so we can see two types one was fulminant

00:09:11second was gastroenteritis third is narcotic now sir test what are the best sample my dear friend

00:09:18for arsenic the urine sample are the best sample these are more reliable than blood sample because

00:09:24if you compare with the lead blood sample are more reliable here urine sample are more and if you have

00:09:30this urine excretion of the arsenic that is 50 micron or more than 50 micron in 24 hours that means you

00:09:38are exposed to arsenic poisoning that's very very important and actually sir arsenic has a tendency

00:09:43to get deposited in those tissue which contain keratin and also if you see these tissue are bone

00:09:52like see the bone is a different example but main tissue are hair nail and skin so i am highlighting

00:09:59this my dear friend in chronic arsenic poisoning because these are having tendency to get deposited in

00:10:04hair and nail and sir the best hair to get sample for the arsenic poisoning are pubic hair

00:10:09pubic hair the reason is very simple because the scalp hair are contaminated by environment or climatic changes

00:10:16that's why the pubic hair are better to take for sampling now sir there were few tests

00:10:22which not done in arsenic these tests are murga what is murga m4 march test march test is not done nowadays

00:10:37r4 rinse test not done

00:10:42and g for gurga test not done march test rinse test gurga test but these are obsolete you can remember by murga now murga is not done for arsenic

00:10:54what is done for metallic poison most of the metallic poison we do now what is now neutron activation analysis

00:11:03neutron activation analysis and atomic absorption

00:11:15absorption spectroscopy

00:11:21neutron activation analysis atomic absorption spectroscopy these are two tests which are done for arsenic na or as nas nas nas are done for arsenic

00:11:31nas are done for arsenic murga is not done murga is not done nowadays now treatment my dear friend

00:11:37treatment we go for gastric lavash with warm saline yes my dear friend without any down

00:11:42this is done freshly prepared hydrated ferric oxide i told you the trick also

00:11:49hydrated ferric oxide that is freshly prepared hydrated ferric oxide is done

00:11:56it is used as a chemical antidote i told you the trick i i for iron

00:12:00and sir damsa damsa is a succimer

00:12:03a chelating agent it is a

00:12:08oral chelating agent damsa

00:12:10it is superior to baal

00:12:13it is superior to baal baal is dimercaprol

00:12:16baal is dimercaprol

00:12:20so it is superior to baal

00:12:22because baal is given as a deep intramuscular injection it's a painful condition that's why damsa is superior to baal

00:12:28so this is the treatment of arsenic poisoning now the post-martem findings sir rigermotis we are coming to very very important word rigermotis

00:12:35rigermotis i told you the trick all it comes

00:12:39late

00:12:41and it is for a long duration late and long comes late and long duration stomach mucosa sir stomach mucosa

00:12:48i already told you it's a red velvety mucosa

00:12:51or sometime we use a word strawberry mucosa

00:12:57red velvety mucosa

00:13:01sometime we use a word strawberry mucosa

00:13:03and multiple hemorrhages in the mucosa

00:13:06that gives flea bitten opinions

00:13:09multiple hemorrhages in the mucosa that gives flea bitten opinions

00:13:14white particle in the stomach because we have consumed is a white arsenic

00:13:18white particle in the stomach suggests that you consumed arsenic

00:13:20sub-cardial sub-endocardial hemorrhage i already told you it is known as sheehan's hemorrhage

00:13:26i already told you it is known as sheehan's hemorrhage

00:13:29so this these post-martem findings already been discussed

00:13:32now sir there are few people we are known as arsenophagists

00:13:35what what they take what they do

00:13:38they take arsenic as aphrodisiac

00:13:42they take arsenic as aphrodisiac to increase their libido

00:13:49so once they are taking a small dose small dose small dose

00:13:53then they start taking like a larger dose

00:13:55so they become tolerant

00:13:57they can tolerate

00:13:58almost 300 milligram arsenic

00:14:02i told you the fatal dose is 100 to 200 milligram

00:14:05but they are taking so they can tolerate up to 300 milligram

00:14:07means 0.3 gram they can tolerate

00:14:09now sir these people are known as arsenophagists

00:14:14arsenophagists

00:14:15so it's a very very important

00:14:17this is the tolerance

00:14:18to take arsenic to increase the libido

00:14:21it becomes tolerance

00:14:22this is known as arsenophagist

00:14:23now sir arsenic is good homicidal poison

00:14:27i won't say it's an ideal ideal i told you thallium

00:14:29the reason is

00:14:31the reason is only this advantage is

00:14:34it registers putrefaction

00:14:35arsenic registers putrefaction

00:14:40so it retards the rate of putrefaction

00:14:42so it can be detected

00:14:43after many years

00:14:45in bones

00:14:46hair

00:14:46nail

00:14:47skin

00:14:47it can be detected

00:14:48so as i told you

00:14:50it can be detected in your bones

00:14:52yes my dear friend

00:14:52it can be detected in your hair

00:14:56it can be detected in nail

00:15:00these are very very important

00:15:01now sir as i told you

00:15:02how it is used as a homicidal poison

00:15:04it is used as an inheritor powder

00:15:07inheritor powder

00:15:08very very potential mcq

00:15:10so in early stages

00:15:11it is found in liver

00:15:13kidney and spleen

00:15:14and my dear friend

00:15:15one very very important

00:15:15so sometime a question comes

00:15:17arsenic in acute toxicity

00:15:18it is metabolized in liver

00:15:19then kidney

00:15:20then spleen

00:15:21it doesn't cross

00:15:23bbb

00:15:24arsenic doesn't cross

00:15:26blood brain barrier

00:15:27this is another very potential mcq

00:15:28arsenic doesn't cross

00:15:30blood brain barrier

00:15:31okay

00:15:31now sir

00:15:32i am coming to a very very important topic

00:15:34the symptom of chronic arsenic poisoning

00:15:36sir

00:15:37the earliest symptom

00:15:38because i have seen this question

00:15:39many times in exam

00:15:40the earliest symptom is

00:15:42leukomelanosis

00:15:44what is leuko?

00:15:45leuko is a white

00:15:45white means depigmentation

00:15:47white means

00:15:50it is depigmentation

00:15:52depigmented over the malar area

00:15:56how would you remember

00:15:57leukomelanosis

00:15:58it is in malar area

00:15:59the earliest symptom

00:16:00of chronic arsenic poisoning

00:16:02is leukomelanosis

00:16:03randropigmentation

00:16:04i already told you

00:16:05randropigmentation

00:16:06endoxa

00:16:06because of this pigmentation

00:16:08i told you

00:16:08it mimics

00:16:09fading measles

00:16:11or it mimics

00:16:13addition disease

00:16:14addition disease

00:16:17fading measles

00:16:18or addition disease

00:16:19hyperkeratosis

00:16:20of palm and soul

00:16:21yes my dear friend

00:16:22and this remember sir

00:16:25it is bilateral

00:16:26it is bilateral

00:16:27hyperkeratosis

00:16:27of palm and soul

00:16:28rashes on the body

00:16:30yes my dear friend

00:16:30that's why

00:16:31it mimics measles

00:16:32rashes on the body

00:16:33because of the pigmentation

00:16:35it mimics addition disease

00:16:37because of the rashes

00:16:37it mimics measles

00:16:39so these are the arsenic

00:16:40chronic poisoning

00:16:41now sir

00:16:41this is very simple sir

00:16:43eldritch measline

00:16:44i told you

00:16:44this is known as

00:16:45reynolds line

00:16:46eldritch line

00:16:47or measline

00:16:47see

00:16:48tino

00:16:48ama lag lag

00:16:48word de sakte

00:16:49eldritch measline

00:16:50it is also seen in

00:16:53thallium toxicity

00:16:55chronic renal failure

00:16:58and chemotherapy

00:17:00thallium toxicity

00:17:01chronic renal failure

00:17:02and this chemotherapy

00:17:04these are the cases

00:17:06in which we can see

00:17:07the eldritch measline

00:17:07these are the transverse line

00:17:09these are the

00:17:12transverse line

00:17:13seen in arsenic poisoning

00:17:15eldritch measline

00:17:17now sir

00:17:18in hair

00:17:18in arsenic poisoning

00:17:19we have alopecia

00:17:20in hair

00:17:23we have alopecia

00:17:24hair are lost

00:17:25that can cause

00:17:26alopecia

00:17:26okay

00:17:27neuropathy sir

00:17:28this is a very potential

00:17:29mcq

00:17:29neuropathy

00:17:30the mainly neuropathy

00:17:32is sensory

00:17:33the second number

00:17:34is motor

00:17:34sensory is more common

00:17:35than motor

00:17:36sensory is more common

00:17:37it resembles

00:17:39gbs

00:17:39what is gbs

00:17:41gullenbare syndrome

00:17:42what is gbs

00:17:43gullenbare syndrome

00:17:45now sir

00:17:45another very very important

00:17:47blood vessels

00:17:48occlusion and sclerosis

00:17:49it causes occlusion and sclerosis

00:17:51of the blood vessels

00:17:51and that's why

00:17:52it causes

00:17:53ischemia

00:17:54peripheral ischemia

00:17:55so because of the

00:17:56peripheral ischemia

00:17:57there is a peripheral gangrene

00:17:59because of the

00:18:03peripheral ischemia

00:18:05we have peripheral gangrene

00:18:07and doctor

00:18:07this is known

00:18:08as a very very potential

00:18:10mcq

00:18:10black

00:18:11foot

00:18:13disease

00:18:14this is known

00:18:17as black foot disease

00:18:18peripheral ischemia

00:18:19causing

00:18:19this

00:18:20peripheral gangrene

00:18:21this is known

00:18:22as black foot disease

00:18:23okay

00:18:23now doctor

00:18:24arsenic can predispose

00:18:25to the malignancy

00:18:26also

00:18:26the more common

00:18:28malignancy

00:18:29is squamous cell carcinoma

00:18:30the second

00:18:33is bcc

00:18:33basal cell carcinoma

00:18:35and

00:18:36it can predispose

00:18:38to the

00:18:38boven disease

00:18:39and just remember

00:18:42boven disease

00:18:42is a predisposing factor

00:18:44of squamous cell carcinoma

00:18:45if you are confused

00:18:46that

00:18:46whether it more commonly

00:18:47causes squamous cell

00:18:48or bcc

00:18:49just remember

00:18:49arsenic has

00:18:50s

00:18:50s for squamous

00:18:52arsenic has

00:18:53s

00:18:53s for squamous

00:18:54so this is a trick

00:18:55you can remember

00:18:56so my dear friend

00:18:56this was a very very

00:18:57important poison

00:18:58that was arsenic

00:18:59i discussed

00:19:00everything in detail

00:19:01you can get a

00:19:02questions in arsenic

00:19:03and i told you

00:19:03the trick

00:19:04a r s e n i c

00:19:06arsenic

00:19:06sensory neuropathy

00:19:07is more common

00:19:08gb s

00:19:09gulin barry syndrome

00:19:10gulin barry syndrome

00:19:11now sir

00:19:12i am coming to

00:19:12the next very very

00:19:13important

00:19:14metallic poison

00:19:15which is lead

00:19:15actually

00:19:16and of sub

00:19:17i have made a

00:19:17very simple trick

00:19:18to remember

00:19:18the lead

00:19:19a b c d e

00:19:21f if you want

00:19:22to add

00:19:23a anemia

00:19:23yes

00:19:24b

00:19:25basophilic

00:19:27stapling

00:19:27and b

00:19:28if you want

00:19:28to add

00:19:29one more

00:19:29thing

00:19:30you can add

00:19:31bartonian line

00:19:32but bartonian line

00:19:32can be seen

00:19:33in other toxicity

00:19:34also

00:19:34so b is

00:19:35bartonian

00:19:35or basophilic

00:19:36stapling

00:19:36what is

00:19:37basophilic

00:19:37stapling

00:19:38bartonian line

00:19:38we will discuss

00:19:38don't worry

00:19:39c colic and

00:19:40constipation

00:19:41that is abdominal

00:19:42colic and

00:19:42constipation

00:19:43this question

00:19:43comes in exam

00:19:44no diarrhea

00:19:45it's a colic

00:19:45and constipation

00:19:46d drops

00:19:47wrist drop

00:19:48and foot drop

00:19:49because of

00:19:50involvement of the

00:19:50radial nerve

00:19:51common peroneal

00:19:52nerve

00:19:52wrist drop

00:19:52and foot drop

00:19:53e encephalopathy

00:19:55and my dear friend

00:19:55this is common

00:19:56in children

00:19:57this is common

00:20:00in children

00:20:01toddler

00:20:01in 15 to 30

00:20:03months

00:20:03in toddler

00:20:03it's very common

00:20:04toddler

00:20:05facial pallor

00:20:07f facial pallor

00:20:08is the earliest

00:20:09sign

00:20:09earliest sign

00:20:10and even if

00:20:11if you want

00:20:11to write down

00:20:12it is the most

00:20:13consistent sign

00:20:14earliest sign

00:20:16and most

00:20:16consistent sign

00:20:17and i can

00:20:18i can use a

00:20:19better word

00:20:19most specific

00:20:20sign

00:20:20facial pallor

00:20:21a b c

00:20:22d e f

00:20:23if you want

00:20:24to add g

00:20:24it can cause

00:20:25gout also

00:20:26because it

00:20:28decreases the

00:20:29uric acid

00:20:29excretion

00:20:30it decreases

00:20:32uric acid

00:20:36excretion

00:20:37so it can

00:20:38cause gout

00:20:39these are some

00:20:40potential mcq

00:20:40of the lead

00:20:41which i discuss

00:20:42in simple manner

00:20:43now sir

00:20:44sir in lead

00:20:45the metallic

00:20:46and its salts

00:20:47all are poisonous

00:20:48metallic and

00:20:50its salts

00:20:50all are poisonous

00:20:51so it is metallic

00:20:52form is also

00:20:53poisonous

00:20:53now i am coming

00:20:54to different

00:20:54form number

00:20:55one is lead

00:20:56acetate

00:20:56most common

00:20:58first question

00:20:59comes in exam

00:21:00most common

00:21:01toxic form

00:21:02is lead

00:21:02acetate

00:21:03and it look

00:21:04like sugar

00:21:05crystal

00:21:06white sugar

00:21:07crystal

00:21:07that's why

00:21:08it is known

00:21:08as sugar

00:21:09of lead

00:21:10sugar of lead

00:21:12lead acetate

00:21:13most common

00:21:14a number

00:21:15most common

00:21:15s lead sulfide

00:21:17you can remember

00:21:18it is used

00:21:19for making

00:21:19s for surma

00:21:20that's eyeliner

00:21:21and i would

00:21:25use a word

00:21:26least common

00:21:27least common

00:21:30is lead

00:21:31sulfide

00:21:31ss

00:21:33lead sulfide

00:21:33surma

00:21:34lead

00:21:35tetroxide

00:21:36and also

00:21:36it is used

00:21:37for vermilion

00:21:38vermilion

00:21:38is a

00:21:39sindoor

00:21:39but just

00:21:42remember sir

00:21:43in sindoor

00:21:43mercuric

00:21:44sulfide

00:21:45is more

00:21:46commonly used

00:21:46mercuric

00:21:49sulfide

00:21:49is more

00:21:50commonly used

00:21:51than lead

00:21:53type tetraoxide

00:21:54tetraethyl

00:21:55lead

00:21:56tetraethyl

00:21:58lead

00:21:58so sir

00:21:58you can remember

00:21:59tetra

00:21:59e for ethyl

00:22:00it is mainly

00:22:01associated with

00:22:02e for

00:22:04encephalopathy

00:22:05most commonly

00:22:06associated with

00:22:07encephalopathy

00:22:07and it is used

00:22:09as a

00:22:10anti-knock

00:22:11agent

00:22:12anti-knock

00:22:17agent

00:22:17in petrol

00:22:18anti-knock

00:22:21agent

00:22:21in petrol

00:22:21tetraethyl

00:22:22lead

00:22:23carbonate

00:22:24car

00:22:25car

00:22:26purchase

00:22:26car

00:22:27car

00:22:27p for purchase

00:22:28it is used

00:22:29in pent

00:22:29p for purchase

00:22:31it is

00:22:31pent

00:22:32pent

00:22:33lead carbonate

00:22:34very commonly

00:22:34toxic

00:22:35now sir

00:22:36what are the

00:22:36lead roots

00:22:37if you see

00:22:38the most common

00:22:40root is

00:22:40inhalation

00:22:41most common

00:22:42root is inhalation

00:22:43and also if you

00:22:44see the pipe

00:22:44factory

00:22:45the plumber

00:22:48plumber in fact

00:22:50and in pent

00:22:52the lead

00:22:53fumes are

00:22:54inhaled

00:22:54the most common

00:22:55method is inhalation

00:22:56in the same

00:22:57factory

00:22:58like the

00:22:59pent

00:22:59and these

00:23:00can be

00:23:00ingested

00:23:01by children

00:23:02the pent

00:23:02and few

00:23:03things can be

00:23:03ingested

00:23:03by children

00:23:04specially

00:23:04pent

00:23:05that is

00:23:06ingestion

00:23:07and the

00:23:08third

00:23:08in

00:23:08chemical

00:23:09factory

00:23:10it can go

00:23:10through the

00:23:11skin

00:23:11that's a

00:23:12percutaneous

00:23:12root

00:23:12in chemical

00:23:14factories

00:23:14but anyways

00:23:15most common

00:23:16root is

00:23:16inhalation

00:23:17now sir

00:23:17chronic lead

00:23:18poisoning

00:23:18see very

00:23:19simple

00:23:19my dear

00:23:20friend

00:23:20lead is

00:23:20pb

00:23:21everyone

00:23:21knows

00:23:21lead is

00:23:24pb

00:23:24everyone

00:23:24knows

00:23:25so chronic

00:23:25lead

00:23:26poisoning

00:23:26for pb

00:23:27it become

00:23:27plumbism

00:23:28and it

00:23:30also known

00:23:31as

00:23:31saturnism

00:23:32plumbism

00:23:34or saturnism

00:23:35now

00:23:36first feature

00:23:37i already

00:23:38discussed the

00:23:38feature by

00:23:39a b c d

00:23:39e f

00:23:40but most

00:23:41specific feature

00:23:41again i am

00:23:42telling you

00:23:42the earliest

00:23:43and most

00:23:44consistent

00:23:44feature

00:23:45is

00:23:45circumoral

00:23:46it is

00:23:47circumoral

00:23:48facial

00:23:49pallor

00:23:49the earliest

00:23:50you can write

00:23:51down earliest

00:23:52and most

00:23:53consistent

00:23:54and most

00:23:54specific feature

00:23:55is circumoral

00:23:56facial

00:23:57pallor

00:23:58and also

00:23:58it is

00:23:58due to

00:23:58vasospasm

00:23:59it is

00:24:00the cause

00:24:01of this

00:24:02is

00:24:02vasospasm

00:24:03the cause

00:24:05of this

00:24:05is

00:24:06vasospasm

00:24:06the second

00:24:08very very

00:24:08important

00:24:08feature of

00:24:09the lead

00:24:09poisoning

00:24:10is anemia

00:24:10anemia

00:24:11and few

00:24:11questions

00:24:12i am

00:24:12anticipating

00:24:13in this

00:24:13exam

00:24:13anemia

00:24:15is

00:24:15micro

00:24:18cytic

00:24:20hypochromic

00:24:23anemia

00:24:24microcytic

00:24:26hypochromic

00:24:27anemia

00:24:27and also

00:24:28we can

00:24:29remember

00:24:29the other

00:24:29causes

00:24:30of

00:24:30microcytic

00:24:31hypochromic

00:24:31anemia

00:24:32by

00:24:32atrix

00:24:33cital

00:24:33cedar

00:24:35oblastic

00:24:35anemia

00:24:36iron

00:24:36deficiency

00:24:37anemia

00:24:37thalassemia

00:24:39major

00:24:39anemia

00:24:40due to

00:24:41chronic

00:24:41disease

00:24:42and lead

00:24:43poisoning

00:24:43cital

00:24:44other causes

00:24:45enzyme

00:24:47inhibited

00:24:47sir

00:24:48because

00:24:48this is

00:24:48a very

00:24:49potential

00:24:49mcq

00:24:50i am

00:24:50telling

00:24:51you sir

00:24:51how would

00:24:51you remember

00:24:52the enzyme

00:24:52inhibited

00:24:53by this

00:24:53c

00:24:54l

00:24:54e

00:24:55a

00:24:56d

00:24:56sir

00:24:58by this

00:24:58you can

00:24:59remember

00:24:59a d

00:24:59what are

00:25:00the enzyme

00:25:00inhibited

00:25:01by lead

00:25:01a d

00:25:02a for

00:25:04l

00:25:04d

00:25:07hydratase

00:25:08a d

00:25:10what is

00:25:11a d

00:25:11you can

00:25:11remember

00:25:12by this

00:25:12trick

00:25:12a d

00:25:13l

00:25:13hydratase

00:25:14now what

00:25:15i did

00:25:15l e

00:25:16i converted

00:25:17in

00:25:17fe

00:25:18ferrochilatase

00:25:23so another

00:25:26enzyme

00:25:26inhibited

00:25:27it is

00:25:27l e

00:25:28i converted

00:25:29in

00:25:29it

00:25:29so doctor

00:25:29what are

00:25:30the two

00:25:30enzymes

00:25:30i discussed

00:25:31till now

00:25:31these are

00:25:32inhibited

00:25:32by number

00:25:33one

00:25:33ferrochilatase

00:25:34number

00:25:35two

00:25:35l r

00:25:36dehydratase

00:25:36by name

00:25:37i concluded

00:25:37third enzyme

00:25:38which you rarely

00:25:39get the

00:25:39question

00:25:40that is

00:25:40co

00:25:41coproporphyry

00:25:47nogen

00:25:50oxidase

00:25:53coproporphyry

00:25:55nogen oxidase

00:25:56again i am

00:25:57revising

00:25:57what are

00:25:58the three

00:25:58enzymes

00:25:58inhibited

00:25:59by lead

00:25:59number

00:26:00one

00:26:00ferrochilatase

00:26:01l e

00:26:02i converted

00:26:02in fe

00:26:03number

00:26:03two

00:26:04a d

00:26:04not

00:26:05a s

00:26:06not

00:26:06l a

00:26:07synthase

00:26:07my dear

00:26:07friend

00:26:08it is

00:26:08l a

00:26:08dehydratase

00:26:09and last

00:26:10is

00:26:10coproporphyry

00:26:12nogen oxidase

00:26:12these are

00:26:13the three

00:26:13enzymes

00:26:13which are

00:26:14inhibited

00:26:15by lead

00:26:16during

00:26:16hym synthesis

00:26:17i am

00:26:17then

00:26:17le i

00:26:19converted

00:26:19in fe

00:26:19ferrochilatase

00:26:20very very

00:26:21potential

00:26:21word

00:26:21then

00:26:22a d

00:26:23l r d

00:26:23hydratase

00:26:23simple

00:26:24done

00:26:24and last

00:26:25is

00:26:26coproporphyry

00:26:27nogen

00:26:28oxidase

00:26:28so these

00:26:29are three

00:26:29enzymes

00:26:30again i am

00:26:30revising

00:26:31ferrochilatase

00:26:32l r d

00:26:33hydratase

00:26:34and coproporphyry

00:26:35nogen

00:26:36so

00:26:36this

00:26:36lead

00:26:38co

00:26:38lead

00:26:39co

00:26:40inhibit

00:26:40kane

00:26:40wale

00:26:40enzyme

00:26:41lead

00:26:41l e

00:26:42f e

00:26:42ferrochilatase

00:26:43a d

00:26:44l r d

00:26:44it is

00:26:45co

00:26:45lead

00:26:45co

00:26:46coproporphyry

00:26:47nogen oxidase

00:26:47that's the

00:26:48very same

00:26:48lead

00:26:48co

00:26:48inhibit

00:26:49kane

00:26:49wale

00:26:49blood

00:26:50picture

00:26:50sir

00:26:50what you

00:26:51will see

00:26:51in the

00:26:51blood

00:26:51picture

00:26:52you can

00:26:52remember

00:26:52by a

00:26:53trick

00:26:53cab map

00:26:54cab map

00:26:54what is

00:26:55cab

00:26:55cabot rings

00:26:56there will

00:26:59be the

00:27:00rings

00:27:01in the

00:27:01r b c

00:27:02this is

00:27:02known as

00:27:03cabot ring

00:27:06map

00:27:07m for

00:27:08i already

00:27:08discussed

00:27:09microcytic

00:27:10hypochromic

00:27:10anemia

00:27:11a for

00:27:13anisocytosis

00:27:16a for

00:27:19anisocytosis

00:27:20p for

00:27:22poikilo

00:27:22cytosis

00:27:26and

00:27:27polycythemia

00:27:30so that is

00:27:32the ring

00:27:32you can

00:27:33remember

00:27:33the lead

00:27:34has

00:27:34cab

00:27:35m for

00:27:39microcytic

00:27:40hypochromic

00:27:40anemia

00:27:40a for

00:27:41anisocytosis

00:27:42p for

00:27:43poikilo

00:27:43cytosis

00:27:44and

00:27:45polycythemia

00:27:46these are

00:27:47the picture

00:27:47of this

00:27:48very very

00:27:48important

00:27:49now

00:27:50dear friends

00:27:51in lead

00:27:52poisoning

00:27:52we have

00:27:53punctate

00:27:54basophilia

00:27:55which is

00:27:55also known

00:27:56as

00:27:56basophilic

00:27:56stippling

00:27:57punctate

00:27:59basophilia

00:28:00which is

00:28:01known as

00:28:01basophilic

00:28:02stippling

00:28:02how would

00:28:03you remember

00:28:03punctate

00:28:04p-u-n

00:28:05p-u-n

00:28:08it is

00:28:09a inhibition

00:28:10of enzyme

00:28:11of p-n-n

00:28:12so

00:28:13it is

00:28:14a inhibition

00:28:15of enzyme

00:28:16by lead

00:28:17p-n-n

00:28:18what is

00:28:18this p-5

00:28:19primidine

00:28:22and

00:28:24for

00:28:24nucleotidase

00:28:285

00:28:29primidine

00:28:30nucleotidase

00:28:31because of

00:28:32this enzyme

00:28:33the ribosome

00:28:34is not

00:28:35metabolized

00:28:36and ribosome

00:28:36gets accumulated

00:28:37in the lead

00:28:38you can see

00:28:38this is

00:28:40known as

00:28:40basophilic

00:28:41stippling

00:28:42this is

00:28:44known as

00:28:45basophilic

00:28:45stippling

00:28:45actually sir

00:28:46these are

00:28:47the accumulation

00:28:47of ribosome

00:28:49but sir

00:28:52you can

00:28:52get a

00:28:53question

00:28:53that

00:28:54basophilic

00:28:54stippling

00:28:55or

00:28:55punctate

00:28:55basophilia

00:28:56is caused

00:28:56by the

00:28:57inhibition

00:28:58of enzyme

00:28:58p-n-n

00:28:59what is

00:28:59p-n-n

00:29:00pyrimidine

00:29:01nucleotidase

00:29:02this 5p

00:29:03pyrimidine

00:29:03nucleotidase

00:29:04is inhibited

00:29:05ribosome

00:29:06are not

00:29:06degraded

00:29:06that ribosome

00:29:07accumulated

00:29:08in the

00:29:09RBC

00:29:10yes my

00:29:10different

00:29:11this cell

00:29:11is RBC

00:29:12this is

00:29:13known as

00:29:14punctate

00:29:15basophilia

00:29:16and basophilic

00:29:17stippling

00:29:17most of the

00:29:17people commit

00:29:18the mistake

00:29:18basophilic

00:29:19stippling

00:29:19is seen

00:29:20in basophil

00:29:20no it

00:29:21is seen

00:29:21in RBC

00:29:22and these

00:29:23are the

00:29:23blue dot

00:29:24these are

00:29:27blue dot

00:29:28in RBC

00:29:29punctate

00:29:29basophilia

00:29:30or basophilic

00:29:31stippling

00:29:31blue dot

00:29:32now sir

00:29:34lead line

00:29:36is seen

00:29:37in 50 to

00:29:3770 percent

00:29:38of the cases

00:29:39very very

00:29:39important sir

00:29:40lead lines

00:29:41are seen

00:29:42on the gums

00:29:43these are

00:29:44seen on the

00:29:44gums

00:29:45these are

00:29:46seen

00:29:47on gums

00:29:48very simple

00:29:49sir

00:29:49and observe

00:29:50these are

00:29:51common in

00:29:52those teeth

00:29:54which are

00:29:55caries teeth

00:29:56means

00:29:57why the

00:29:59reason is

00:29:59very simple

00:30:00sir

00:30:00because

00:30:01in caries

00:30:03teeth

00:30:03the bacteria

00:30:04bacteria are

00:30:05there

00:30:05and bacteria

00:30:06combine with

00:30:07the food

00:30:07and bacteria

00:30:09forms

00:30:09hydrogen

00:30:11sulfide gas

00:30:13and this

00:30:14hydrogen

00:30:14sulfide

00:30:15when combined

00:30:16with PB

00:30:17lead

00:30:17it forms

00:30:19lead

00:30:20sulfide

00:30:20it forms

00:30:23lead

00:30:24sulfide

00:30:24and observe

00:30:25it almost

00:30:26take

00:30:26one week

00:30:29to develop

00:30:29after exposure

00:30:30so both

00:30:30question comes

00:30:31in exam

00:30:31how much

00:30:32time does

00:30:32it take

00:30:33one week

00:30:33and how

00:30:34many percentage

00:30:35cases it

00:30:36is seen

00:30:36it is 52

00:30:37it is 52

00:30:3870 percent

00:30:39one week

00:30:40after exposure

00:30:41this is known

00:30:42as lead

00:30:43line

00:30:43and observe

00:30:43lead line

00:30:45we can use

00:30:46a word

00:30:46Bartonian

00:30:49line

00:30:49lead line

00:30:50we can use

00:30:51a word

00:30:52Bartonian

00:30:53line

00:30:53and observe

00:30:53but Bartonian

00:30:54line is not

00:30:55specific for

00:30:55lead

00:30:56there are

00:30:56blue lines

00:30:57B for

00:30:59Bartonian

00:31:00these are

00:31:00blue lines

00:31:00but seen

00:31:01in many

00:31:01poisons

00:31:01you can

00:31:02remember

00:31:02A G

00:31:04argentum

00:31:04B

00:31:05bismuth

00:31:06C

00:31:07copper

00:31:08D

00:31:09don't go

00:31:09for anyone

00:31:10E

00:31:11F

00:31:11you can

00:31:11make

00:31:12it

00:31:12F

00:31:12E

00:31:12iron

00:31:13these

00:31:13are

00:31:13the

00:31:13F

00:31:14E

00:31:14and

00:31:14then

00:31:15you

00:31:15can

00:31:15write

00:31:15down

00:31:15H

00:31:16G

00:31:16you can

00:31:17write

00:31:17down

00:31:17mercury

00:31:18also

00:31:18but sir

00:31:18again

00:31:19I am

00:31:19telling you

00:31:19these are

00:31:20not

00:31:20specific

00:31:20for

00:31:21this

00:31:21you can

00:31:21remember

00:31:22A

00:31:22argentum

00:31:23B

00:31:23bismuth

00:31:24C

00:31:24copper

00:31:24don't

00:31:25go

00:31:25for

00:31:25anything

00:31:25iron

00:31:26and

00:31:26mercury

00:31:26Bartonian

00:31:27line

00:31:27can be

00:31:28seen

00:31:28in many

00:31:28poisons

00:31:29but more

00:31:29specifically

00:31:30it is

00:31:30in lead

00:31:31blue

00:31:31color

00:31:31line

00:31:32as you

00:31:33can

00:31:33see

00:31:33my

00:31:33difference

00:31:34this

00:31:34is

00:31:34Bartonian

00:31:35line

00:31:35B

00:31:36line

00:31:37lead

00:31:38line

00:31:38or

00:31:38Bartonian

00:31:39line

00:31:39very

00:31:39simple

00:31:40now sir

00:31:40I am

00:31:40coming to

00:31:41the next

00:31:41slide

00:31:41very

00:31:42important

00:31:42sir

00:31:42lead

00:31:43osteopathy

00:31:44or bone

00:31:44line

00:31:45due to

00:31:46deposition

00:31:46of calcium

00:31:47sir

00:31:48most of

00:31:48the people

00:31:49most of

00:31:50the people

00:31:50think it's

00:31:51a deposition

00:31:51of lead

00:31:51no my

00:31:52difference

00:31:52it's a

00:31:52deposition

00:31:53of calcium

00:31:53now sir

00:31:55seen

00:31:55among

00:31:56mostly

00:31:56seen

00:31:57among

00:31:57children

00:31:58these are

00:32:01mostly seen

00:32:01among

00:32:01children

00:32:02deposition

00:32:03of calcium

00:32:04in the

00:32:05growing end

00:32:06of the

00:32:06bone

00:32:06it may

00:32:07be

00:32:07lower

00:32:08end

00:32:08of

00:32:09femur

00:32:09or

00:32:11it can

00:32:11be

00:32:12upper

00:32:12end

00:32:12of

00:32:13tibia

00:32:13and

00:32:14if you

00:32:14see

00:32:15these

00:32:16are

00:32:16radio

00:32:17opaque

00:32:18dense

00:32:19band

00:32:19these

00:32:21are

00:32:21radio

00:32:22opaque

00:32:22dense

00:32:23band

00:32:23in the

00:32:23growing

00:32:23end

00:32:24of

00:32:24the

00:32:24bone

00:32:24as

00:32:24I

00:32:24told

00:32:24you

00:32:25the

00:32:25lower

00:32:25end

00:32:25of

00:32:25the

00:32:25femur

00:32:26and

00:32:26upper

00:32:26end

00:32:26of

00:32:26the

00:32:26tibia

00:32:26it

00:32:27takes

00:32:28minimum

00:32:294

00:32:29weeks

00:32:30to

00:32:30get

00:32:30developed

00:32:31one

00:32:32week

00:32:32I

00:32:32told

00:32:32you

00:32:33for

00:32:33batonial

00:32:33line

00:32:33this

00:32:33takes

00:32:344

00:32:34week

00:32:34of

00:32:34exposure

00:32:35inhibition

00:32:36of

00:32:36the

00:32:36osteoclastic

00:32:37activity

00:32:38inhibition

00:32:39of the

00:32:39osteoclastic

00:32:39activity

00:32:40automatically

00:32:40the

00:32:40calcium

00:32:41is

00:32:41increased

00:32:42calcium

00:32:42is

00:32:43increased

00:32:43means

00:32:43calcium

00:32:44gets

00:32:44deposited

00:32:44this

00:32:45is

00:32:45known

00:32:46as

00:32:46lead

00:32:46line

00:32:46lead

00:32:48line

00:32:48lead

00:32:49osteopathy

00:32:49and this

00:32:50is very

00:32:50very

00:32:51important

00:32:51mainly

00:32:52on the

00:32:52metaphysial

00:32:53site

00:32:53metaphysis

00:32:54so you

00:32:56can get

00:32:57these

00:32:57questions

00:32:57the

00:32:58opacity

00:32:58of

00:32:58bone

00:32:59or you

00:33:00can

00:33:00see

00:33:00the

00:33:00radiopic

00:33:01dense

00:33:01line

00:33:01which

00:33:02are

00:33:02known

00:33:02as

00:33:02lead

00:33:03line

00:33:03or

00:33:03lead

00:33:03osteopathy

00:33:04colic

00:33:04and

00:33:05constipation

00:33:05lead

00:33:06doesn't

00:33:07cause

00:33:07diarrhea

00:33:07it

00:33:07causes

00:33:08constipation

00:33:08one

00:33:09question

00:33:09comes

00:33:09in

00:33:09exam

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00:38:35I

00:38:35will

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00:38:58caprol

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00:39:05BAL

00:39:05with

00:39:06EDTA

00:39:06children

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00:39:09encephalopathy

00:39:09I will

00:39:11tell you

00:39:11the reason

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00:39:13okay

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00:39:14the

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00:39:15shifts

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00:39:16to

00:39:16the

00:39:17brain

00:39:17so

00:39:17that

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00:39:19can

00:39:19neutralize

00:39:20that

00:39:20I will

00:39:20discuss

00:39:20again

00:39:21don't

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00:39:22the

00:39:22children

00:39:22without

00:39:23encephalopathy

00:39:24we use

00:39:25DAMSA

00:39:25everyone

00:39:27everyone

00:39:27knows

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00:39:27DAMSA

00:39:28is

00:39:28Saksimar

00:39:29it

00:39:30can

00:39:30be

00:39:31used

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00:39:32it

00:39:33can

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00:39:33used

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00:39:34DAMSA

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00:39:36the

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00:39:37adult

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00:39:39why

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00:39:39I will

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00:39:40you

00:39:40more

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00:39:4070

00:39:41children

00:39:42more

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00:39:4245

00:39:42we

00:39:42use

00:39:43yes

00:39:43and

00:39:44DAMSA

00:39:44and

00:39:45Saksimar

00:39:45is used

00:39:46orally

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00:39:47and Saksimar

00:39:48is used

00:39:49orally

00:39:49very very

00:39:50potential

00:39:50DAMSA

00:39:51or Saksimar

00:39:52is used

00:39:52orally

00:39:55if you

00:39:56want to

00:39:56go for

00:39:57overall

00:39:57treatment

00:39:57removal

00:39:58of the

00:39:58exposure

00:39:58sir

00:39:59calcium

00:40:00disodium

00:40:01EDTA

00:40:02calcium

00:40:03disodium

00:40:04EDTA

00:40:04we use

00:40:05when the

00:40:05lead

00:40:05concentration

00:40:06blood

00:40:07lead

00:40:08concentration

00:40:09is

00:40:0945

00:40:10microgram

00:40:11per deciliter

00:40:13or more

00:40:13than this

00:40:1445

00:40:15we can

00:40:15use this

00:40:16between

00:40:1745 to

00:40:1869

00:40:19microgram

00:40:20per deciliter

00:40:20we use

00:40:21DAMSA

00:40:21or Saksimar

00:40:22sir

00:40:23this question

00:40:24comes in

00:40:24exam

00:40:24if it

00:40:25is a

00:40:25more than

00:40:2670

00:40:26microgram

00:40:27associated

00:40:28with lead

00:40:28encephalopathy

00:40:29and I

00:40:29told you

00:40:30I told

00:40:31you

00:40:31if

00:40:32more than

00:40:3370

00:40:33microgram

00:40:34plus

00:40:35associated

00:40:36with lead

00:40:36encephalopathy

00:40:37we give

00:40:38the combination

00:40:39of

00:40:40BAL

00:40:40with this

00:40:42I can

00:40:43highlight

00:40:43this

00:40:44so more

00:40:45than 70

00:40:45we always

00:40:46use

00:40:47BAL

00:40:48plus

00:40:48EDTA

00:40:49now sir

00:40:49why do

00:40:50we use

00:40:51BAL

00:40:51with

00:40:51EDTA

00:40:52EDTA

00:40:53redistribute

00:40:54lead to

00:40:55brain

00:40:55EDTA

00:40:57redistribute

00:40:58lead to

00:40:59brain

00:40:59and BAL

00:41:00prevents

00:41:01that

00:41:01BAL

00:41:03prevents

00:41:05that

00:41:06because

00:41:07BAL

00:41:08can cross

00:41:09blood

00:41:09brain

00:41:10barrier

00:41:10and EDTA

00:41:12redistribute

00:41:13lead towards

00:41:14the brain

00:41:14EDTA

00:41:15lead

00:41:15and there

00:41:16will be

00:41:16encephalopathy

00:41:17encephalopathy

00:41:18can be

00:41:18precipitated

00:41:19so

00:41:20EDTA

00:41:21redistribute

00:41:22that can

00:41:22precipitate

00:41:23the

00:41:23encephalopathy

00:41:24so

00:41:27BAL

00:41:27which crosses

00:41:28blood brain

00:41:29barrier

00:41:29that

00:41:30prevents

00:41:30this

00:41:30that is

00:41:31the reason

00:41:31that is

00:41:32the reason

00:41:33BAL

00:41:33is used

00:41:34along with

00:41:34EDTA

00:41:35very very

00:41:36potential MCQ

00:41:37lead encephalopathy

00:41:39in children

00:41:40or in adult

00:41:41in adult

00:41:41more than 70

00:41:42we use BAL

00:41:42plus EDTA

00:41:43in children

00:41:43more than 45

00:41:44we use BAL

00:41:45plus EDTA

00:41:45no encephalopathy

00:41:46succimer is

00:41:47given

00:41:47okay

00:41:48that's very

00:41:48simple

00:41:48and in

00:41:49renal failure

00:41:50EDTA is

00:41:50contraindicated

00:41:51because lead

00:41:52is excreted

00:41:53from the

00:41:53kidney

00:41:53if it's a

00:41:54renal failure

00:41:55the lead

00:41:55will be

00:41:56accumulated

00:41:56that can

00:41:57cause

00:41:57danger

00:41:57of your

00:41:57life

00:41:58EDTA

00:41:59if this

00:42:00level

00:42:00we can

00:42:00go for

00:42:00EDTA

00:42:01between

00:42:01level

00:42:02between

00:42:03level

00:42:03we can

00:42:04use

00:42:04succimer

00:42:04what is

00:42:05succimer

00:42:06is nothing

00:42:06but it's

00:42:06a DAMSA

00:42:07and BAL

00:42:08is used

00:42:09with EDTA

00:42:09more than

00:42:1070

00:42:10as I

00:42:11discussed

00:42:11or lead

00:42:12encephalopathy

00:42:13but just

00:42:14remember one

00:42:14very very

00:42:15important

00:42:15concept

00:42:16that has

00:42:16to be

00:42:17kept in

00:42:17your mind

00:42:18that

00:42:19EDTA

00:42:20redistributes

00:42:20the lead

00:42:21to the

00:42:21brain

00:42:21that is

00:42:22prevented

00:42:22by BAL

00:42:23because

00:42:23BAL

00:42:23crosses

00:42:24blood

00:42:25brain

00:42:25barrier

00:42:26so this

00:42:26is all

00:42:27about

00:42:27lead

00:42:28poisoning

00:42:28very very

00:42:29potential

00:42:29MCQ

00:42:29you can

00:42:30get in

00:42:30your

00:42:30example

00:42:30my dear

00:42:31friends

00:42:31we are

00:42:31coming to

00:42:32a very

00:42:32very important

00:42:33category

00:42:33of the

00:42:33poison

00:42:34which is

00:42:34miscellaneous

00:42:35poison

00:42:35in

00:42:35miscellaneous

00:42:36poison

00:42:36the first

00:42:37category

00:42:37is

00:42:37hallucinogen

00:42:38which

00:42:38causes

00:42:39hallucination

00:42:40hallucination

00:42:42is a

00:42:42disorder

00:42:43of

00:42:43perception

00:42:45so I

00:42:48discuss

00:42:48hallucination

00:42:49in the

00:42:49forensic

00:42:50psychiatry

00:42:51but sir

00:42:51very very

00:42:52important

00:42:52word

00:42:53what is

00:42:54the first

00:42:54hallucinogen

00:42:55LSD

00:42:56what is

00:42:56LSD

00:42:56it is

00:42:58lysergic

00:42:58acid

00:42:59diethylamide

00:43:00it is

00:43:01lysergic

00:43:02acid

00:43:02diethylamide

00:43:04and what

00:43:04are the

00:43:04other name

00:43:05of this

00:43:05we can

00:43:06use a

00:43:06word

00:43:06acid

00:43:07we can

00:43:08use a

00:43:08word

00:43:08blotter

00:43:09or we can

00:43:09combine the

00:43:10word

00:43:10acid

00:43:10blotter

00:43:11or we can

00:43:12use the

00:43:12word

00:43:12paper

00:43:13stamp

00:43:13acid

00:43:14blotter

00:43:15acid

00:43:15blotter

00:43:15pepper

00:43:16stamp

00:43:16it is

00:43:17taken as

00:43:17a fumes

00:43:18pepper

00:43:18stamp

00:43:19now sir

00:43:19it is

00:43:20obtained

00:43:20from a

00:43:21fungus

00:43:22which

00:43:22fungus

00:43:22is a

00:43:23producing

00:43:23fungus

00:43:24ergut

00:43:24so the

00:43:25same

00:43:25fungus

00:43:26which is

00:43:27on the

00:43:27wheat

00:43:27and rye

00:43:28that can

00:43:28produce

00:43:29the LSD

00:43:29so this

00:43:30is ergut

00:43:30producing

00:43:31fungus

00:43:31sir

00:43:33it increases

00:43:33serotonin

00:43:35level

00:43:35that is the

00:43:36main reason

00:43:375HT

00:43:37it increases

00:43:39serotonin

00:43:39level

00:43:40serotonin is

00:43:405HT

00:43:41in the

00:43:41brain

00:43:42and it

00:43:42causes

00:43:43this question

00:43:43comes in

00:43:44exam

00:43:44only and

00:43:45only

00:43:45psychological

00:43:46dependence

00:43:47only and

00:43:48only

00:43:48psychological

00:43:48dependence

00:43:49no physical

00:43:50dependence

00:43:50it associated

00:43:52with trip

00:43:52now sir

00:43:54this trip

00:43:55can be

00:43:55good trip

00:43:57and this

00:43:58trip can be

00:43:59bad trip

00:44:00good trip

00:44:02means you

00:44:03are feeling

00:44:04visual

00:44:04hallucination

00:44:05and illusion

00:44:06like you

00:44:08are seeing

00:44:08different

00:44:09color

00:44:09you are

00:44:10having

00:44:10smell

00:44:11you are

00:44:12having

00:44:12taste

00:44:12you can

00:44:12feel

00:44:13very good

00:44:13that is

00:44:14a good

00:44:15trip

00:44:15bad trip

00:44:17you feel

00:44:18anxiety

00:44:18and you

00:44:21feel panic

00:44:22attack

00:44:22this is known

00:44:24as bad

00:44:24trip

00:44:24so if a

00:44:26word comes

00:44:27in exam

00:44:27that trip

00:44:28is mainly

00:44:29seen in

00:44:29LSD

00:44:30most commonly

00:44:30seen in

00:44:31LSD

00:44:31and another

00:44:32very very

00:44:33important

00:44:33flashback

00:44:35phenomena

00:44:35what is

00:44:37flashback

00:44:37phenomena

00:44:37flashback

00:44:38phenomena

00:44:39is

00:44:39re-experience

00:44:41re-experience

00:44:47the past

00:44:49experience

00:44:49re-experience

00:44:53the past

00:44:54experience

00:44:54like

00:44:54the past

00:44:55you were

00:44:55taking

00:44:56LSD

00:44:56and you

00:44:56are feeling

00:44:57the same

00:44:57like you

00:44:58are taking

00:44:59LSD

00:44:59like same

00:45:00feeling is

00:45:00there

00:45:00re-experiencing

00:45:01the past

00:45:01experience

00:45:02it is

00:45:03known as

00:45:04flashback

00:45:04phenomena

00:45:04it is known as flashback phenomenon so this is a very very important topic lsd is the first

00:45:10hallucinogen the second i am coming to mdma mdma first see the full form m methylene d dioxy m

00:45:21metha a amphetamine mdma it is also known as ecstasy and my dear friend we also use a word

00:45:30moly moly it is also known as rave drug club drug or party drug it causes euphoria excessive

00:45:41happiness and sometime you go in amnesia you forget anything whatever happened with you

00:45:49so this is that's why it is known as rave drug club drug or party drug moly it is also known as mdma

00:45:57and it is also known as hug drug

00:45:59hug drug all are seen now sir what is love bot what is love bot in love bot we take cigarette

00:46:09we can take cigarette of tobacco or we can take cigarette of marijuana

00:46:15we take cigarette of tobacco or marijuana cannabis product and we mix this with pcp or formaldehyde what

00:46:27is pcp phencyclidine we mix this with pcp or formaldehyde this combination is known as love bot

00:46:39drugs of phencyclidine is also known as angel dust phencyclidine is also known as angel dust

00:46:47another hallucinogenic drug is amphetamine another drug which causes hallucination it is amphetamine

00:46:56and the urine of the amphetamine that is like if you are taking amphetamine regularly your urine can

00:47:03be used as a liquid gold liquid gold word can be used but sir that's a slang that's a slang we use

00:47:08otherwise the amphetamine is also a very very important hallucinogen so you can write down

00:47:14the second hallucinogen is this the third is amphetamine fourth i told you that is not a

00:47:20hallucinogenic drug that is causing tactile hallucination this i discussed in cocaine

00:47:27intoxication magnan magnan symptom tactile hallucination so these are hallucinogen drugs

00:47:33my dear friend chloral hydrate chloral hydrate what is chloral hydrate chloral hydrate is also known as dry

00:47:41wine dry wine it's a colorless and crystalline drug chloral hydrate colorless and crystalline drug it is

00:47:51also known as dry wine it is also known as mickey's fin it is also known as knockout drops

00:48:06knockout drops and it is given in the combination with alcohol in the combination of alcohol a chloral

00:48:15hydrate very very potential and also i already discussed chloral hydrate give acrid smell i told

00:48:23you acrid aldehyde see chloral hydrate i told you para aldehyde and chloral hydrate has acrid smell

00:48:29in combination of alcohol it is given and you are knockout you are knockout that's why we use the word

00:48:35knockout drops knockout drops so this is chloral hydrate so you can see chloral hydrate dry wine mckeffin and

00:48:42knockout drops we use word for this and you are actually knockout this is chloral hydrate now sir

00:48:48another very very important poison is conium maculatum my dear friend conium maculatum is also known as

00:48:56hemlock and it is actually a nerve poison it is actually a nerve poison it mainly involves your motor

00:49:04nerves it is a nerve poison and it was used

00:49:13it was used to kill socrates it was used to kill socrates arsenic the most of the people think but

00:49:20there are many other theories also arsenic was used to kill

00:49:26napoleon after that they got to realize that it was mercury but arsenic was supposed to use for

00:49:32napoleon socrates was killed by hemlock all part of the plant it's a very important all part of the

00:49:38plant are poisonous you can see these are the flower of the hemlock that's a conium maculatum you can see

00:49:44the purple color it is purple stipled hemlock it is a purple stipled hemlock it is a nerve poison

00:49:56the smell of the hemlock is mousy mousy active principle it is conine it is active principle is

00:50:06conine or methylcone

00:50:11unrived fruit and seeds are more poisonous yes more poisonous now sir what happens it's a it involves

00:50:17the motor nerves so first it involves the lower limb muscles so it causes lower limb

00:50:29paralysis first it involves lower limb paralysis then it extend upwards then it extend upward from

00:50:39lower extremity this is characteristic for hemlock so first it involves lower limb paralysis

00:50:47it involves lower limb muscles then it extends upwards this is very very important doctor death is

00:50:53because of respiratory muscle paralysis without any doubt no specific antidote symptomatic treatment is given

00:51:02symptomatic treatment is given so this is conium this is conium maculatum which is also known as hemlock

00:51:09jishni sukrat ko paunchaya yamlock arsenic killed was used to kill napoleon that's a different okay

00:51:16narupoeson now sir a very very important word comes what is a body pecker syndrome and what is a body

00:51:24stuffer syndrome body pecker syndrome and body stuffer syndrome sir what they do body pecker see they take the drug

00:51:36drug and put the drug in some i would say the polythene or in condom in a planned way in a planned way

00:51:52in a planned way and where they put they put either they swallow either they swallow or

00:52:00they put in the orifices like vagina rectum so this is a plant you can you can use this for drug smuggling

00:52:14you can use this for drug smuggling this is known as body pecker syndrome you can see and it is also known

00:52:26a surgical mool syndrome surgical mool syndrome so they do in a plan they do it in a planned way okay

00:52:33now sir what is body stuffer what is body stuffer they put in the like your vagina

00:52:44or your anal canal but suddenly suddenly they got some news like someone is there

00:52:52so what they do to conceal this one what they do they hurried they hurriedly swallow this

00:53:03so i would say this is unplanned this is an plant

00:53:12and it may be a not proper packaging it may be a damaged package

00:53:16or it may be unpackaged

00:53:25they swallow from the like the authority this they swallow to hide this from authority for from authority

00:53:32they swallow in hurried hurriedly so if you swallow in hurriedly it's a body stuffer but if you do it in

00:53:39a planned way it's a body stuff body packer or surgical mool syndrome now type of conductor if you see the

00:53:46type of conduct it is scheduled it is scheduled it is scheduled as i told it's a planned but sir it is

00:53:55spontaneously suddenly

00:53:59suddenly you swallow

00:54:03suddenly you swallow that is body stuffer now packet number here many packet here the packet numbers are

00:54:10many here the number of packets are few and risk risk in body packer you use some polythene and condom

00:54:18which are like good and everything is good so risk risk is

00:54:25medium or high but sir here always high higher risk is there because because as i told you this may be a

00:54:34a a damaged packet or this may be a not non-packet you are swallowing so again i'm telling you if you

00:54:42do it in planned way this is body packer but suddenly or spontaneously you do in hurried way

00:54:48that is body stuffer you have to like and which is having the large quantity the large quantity for drug

00:54:54smuggling it is packet number are many here packet number are few so this is body packer and body

00:55:01stuffer syndrome so aap puri planning karke aap swallow this is body packer and suddenly

00:55:09spontaneously in hurried way you swallow that is known as body stuffer this is a very important

00:55:14difference okay so be careful this question comes in exam here you also put in vagina and anal canal or

00:55:20ear but suddenly you swallow now sir suicide type i told you in india the most common method of suicide

00:55:27is hanging suicide is atmatya now three more type of suicide we have complex suicide if you attempt

00:55:40more than one

00:55:46method of suicide

00:55:51if you attempt more than one method of suicide like wrist cutting as well as hanging

00:55:54hanging as well as poisoning both two or three methods are attempted or committed this is known as

00:56:00complex suicide now sir complicated suicide

00:56:07you attempt

00:56:11one method that's different but you die

00:56:16due to unintentional trauma

00:56:25you attempt one method like you attempted suicide by hanging but you die from fall from height or by

00:56:32head injury this is known as complicated suicide

00:56:36para suicide sir here

00:56:39your intention is

00:56:46not to die and you attempt for suicide

00:56:53you attempt for suicide and this is also known as

00:56:59pseudocide pseudocide you attempt for suicide your intention is not to die

00:57:05most common type is drug ingestion

00:57:11drug ingestion or some poison ingestion but sir again i'm telling you it is an attempted suicide

00:57:19it is not a complete suicide it is just an attempt your intention is not to die

00:57:27your intention is not to die most common is drug ingestion or poison ingestion so i discuss

00:57:32suicide means death most common method is hanging complex if you are attempting more than one method

00:57:38complicated you attempt one method but die due to some unintentional trauma

00:57:41and para suicide is attempted suicide you attempt for suicide you don't want to die this is para

00:57:47suicide hello friends so a very important category of the poison is cns depressant and one of the very

00:57:53important poison in cns depressant is one of the very important alcohol which is ethanol

00:57:58sir ethanol everyone knows it's a shower it is colorless transparent and a volatile poison

00:58:04ethanol itself is a colorless transparent we mix something then it becomes colorful now toxicity

00:58:13isopropyl alcohol

00:58:18is most toxic then

00:58:19methanol is second and then ethanol is third most toxic is isopropyl alcohol then methanol then ethanol

00:58:32docs of absolute alcohol contain

00:58:3799.95 percent ethanol

00:58:41rectified spirit contain almost 95 percent ethanol

00:58:45ethanol and it is used to

00:58:49preserve viscera for toxicological analysis i already discussed

00:58:55i already discussed denaturated or methylated spirit

00:59:00denaturated or methylated spirit

00:59:03it contain almost

00:59:0790 percent ethanol plus

00:59:09at least 5 to 10 percent

00:59:18methanol or you can say wood naphtha

00:59:23wood methanol or wood naphtha but sir again i'm telling you it is variable not 90 percent ethanol it can

00:59:29be 75 to 90 like almost 95 percent but that is variable methanol will be present

00:59:35it's a methylated or denaturated spirit

00:59:39100 percent proof ethanol is 50 percent

00:59:42100 proof ethanol is 50 percent ethanol

00:59:45it means if proof ethanol is 100 percent

00:59:48proof ethanol is 100 percent if it will contain 50 percent

00:59:51if the proof ethanol is an 80 80 proof ethanol that means it will contain 40 percent ethanol half

00:59:58will be the percentage of ethanol

01:00:00half will be the percentage of ethanol now sir i'm coming to the pharmacokinetic

01:00:05The ethanol absorption starts from your mouth and even from some absorption from esophagus.

01:00:15But sir, 20% absorbed from stomach and 80% from small intestine.

01:00:23Small intestine.

01:00:25It means the maximum absorption occurs in small intestine.

01:00:28Sir, ethanol follows zero-order kinetics.

01:00:33Zero-order kinetics.

01:00:35And the rate of fall of ethanol in your body is 15 mg percentage per hour.

01:00:4415 mg percentage per hour.

01:00:46It is metabolized or rate of fall of ethanol.

01:00:49These are some questions.

01:00:50Factor affecting alcohol absorption.

01:00:52Actually, sir, everyone knows about this.

01:00:54Increase absorption.

01:00:55If there is an empty stomach, sir, it's an empty stomach.

01:00:58It will be increased, my dear friend.

01:00:59Because it's a full stomach, full stomach.

01:01:01So it will take time.

01:01:03In empty stomach, it will go in small intestine faster.

01:01:06So it will increase.

01:01:07Carbonated.

01:01:08Docs have carbonated drinks.

01:01:10Soda and everything.

01:01:11It increases surface area of the fluid by bubbles.

01:01:19So absorption would be fast.

01:01:21Surface areas increase.

01:01:22So the absorption will be fast.

01:01:24Warm alcoholic drink also absorbs faster, my dear friend.

01:01:27And gastrectomy patient.

01:01:29Like if the stomach or the gastric part is removed, definitely it will go faster to the small intestine.

01:01:34Decrease absorption, sir.

01:01:35If it is a food, so the processing of alcohol will be slow.

01:01:38Decrease absorption.

01:01:39Ice drink.

01:01:40If we mix the ice, that decrease absorption.

01:01:43The reason is ice drink.

01:01:44They actually dilute the proof alcohol.

01:01:47That means the absorption will be less.

01:01:49Ice drink.

01:01:50Okay.

01:01:51Now another very, very important.

01:01:52If you want to go in detail.

01:01:53In air chlorehydria.

01:01:59Because of less HCL production or no HCL production, absorption will be less.

01:02:04Very, very important.

01:02:05In chronic gastritis, absorption will be less.

01:02:07And also if you have higher concentration of alcohol, like I am giving example.

01:02:10If it is more than 40% alcohol, it can cause pyloric spasm.

01:02:18Pyloric spasm.

01:02:20So there will be less absorption.

01:02:22If any drug like atropine, atropine or benzene, that decreases GI motility, there will be less absorption.

01:02:35So these are many causes which decreases less absorption.

01:02:38There are many things which causes more absorption.

01:02:41And especially sir, the protein which is, the food which is rich in protein, there will be less absorption.

01:02:50Okay.

01:02:50So you can remember these are the causes of increased absorption or less absorption.

01:02:55Now sir, see if your whole blood is 1 milligram percentage.

01:03:00If whole blood is 1 milligram percentage, what will be the different blood?

01:03:04And I am just telling you the trick.

01:03:05Vitruous, vitruous, vitru.

01:03:07It is a 1.2.

01:03:08Uri, uri, uri, uri, 3.

01:03:10It is a 1.3 milligram percentage.

01:03:12Now brain, it is the biggest one.

01:03:14That is the main important.

01:03:1685.

01:03:160.85 brain.

01:03:19CSF, F, F for first.

01:03:211.1.

01:03:221.1 milligram percentage.

01:03:23Allular air, you can keep in mind because allular air is a little bit different.

01:03:27It is 0.0021 milligram percentage.

01:03:31Remaining are same almost.

01:03:33It is a plasma or serum.

01:03:341.12 to 1.2.

01:03:36You can remember 1.2.

01:03:38So these are different.

01:03:39If we compare with the blood.

01:03:40If blood is whole blood is 1 milligram percentage, plasma will be this.

01:03:44CSF will be this.

01:03:45Urine will be this.

01:03:46Vitruous humor will be this.

01:03:47Brain will be this.

01:03:47These you have to remember.

01:03:48Allular air, 0.0021.

01:03:50This is you have to keep in your mind.

01:03:52Now, sir, driving limit.

01:03:54According to the Motor Vehicle Act.

01:04:00Motor Vehicle Act.

01:04:03The driving limit of blood is 30 milligram percentage.

01:04:08MG.

01:04:0930 milligram percentage.

01:04:10Now, friends, if the female and male are consuming the same amount of alcohol, the blood alcohol in female will be 25% higher.

01:04:24The reason is two reasons.

01:04:26The number one is small aqueous compartment.

01:04:29And second is more fat.

01:04:31The water containing compartment are less and fat is more.

01:04:35So, doctor, fat is more.

01:04:37So, the absorption will be fast.

01:04:38Absorption will be fast.

01:04:40Now, the third.

01:04:41The lower activity of an enzyme.

01:04:44The metabolizing enzyme is low in female.

01:04:46That is alcohol dehydrogenase.

01:04:51That is less in female.

01:04:53Activity is less.

01:04:55So, fat is more.

01:04:55Absorption is more.

01:04:57Blood concentration will be higher.

01:04:58Metabolism is less.

01:04:59Alcohol dehydrogenase enzyme is less.

01:05:01And small aqueous compartment.

01:05:04Water compartment.

01:05:05Water containing compartment are less.

01:05:07These are three reasons.

01:05:09That's why the concentration of female alcohol in blood will be 25% higher.

01:05:14Now, what are the tests for alcohol?

01:05:16For tests, we use the blood sample.

01:05:18We use the blood sample.

01:05:19The best sample is the blood sample.

01:05:21And what are the preservative we use for blood sample?

01:05:24Sodium fluoride and potassium oxalate.

01:05:28This I also discussed in the toxicology, basic toxicology part.

01:05:32Sodium fluoride inhibits the glycolysis and bacteria.

01:05:35Potassium oxalate is an anticoagulant.

01:05:37But, sir, during autopsy, during autopsy, normal autopsy, we can also preserve vitreous humor.

01:05:45Vitreous humor is a very good sample for alcohol.

01:05:47Now, what are the name of the tests?

01:05:49You can remember by KBC Hero.

01:05:52KBC Hero.

01:05:53What are the KBC Hero tests?

01:05:54You can see K, Kozelka test.

01:06:02B, Bread Analyzer test.

01:06:09Bread Analyzer test.

01:06:10C, Kevitt test.

01:06:16Hero for, very, very important, Kozelka and Heini test.

01:06:21Kozelka and Heini test.

01:06:23And, chromatography.

01:06:31Chromatography, which is a gas chromatography test.

01:06:35Gas chromatography test.

01:06:37My dear friend, the best test is gas chromatography.

01:06:43And, gas chromatography is quantitative as well as qualitative test.

01:06:55Quantitative and qualitative test.

01:06:57Remaining tests are Kozelka, Kevitt and Heini.

01:07:01These tests are qualitative test.

01:07:06Remaining tests are qualitative test.

01:07:09So, what is Bread Analyzer?

01:07:11Bread Analyzer is different.

01:07:13It is like when you are driving, the police use this test.

01:07:16Investigating officer use this test to take.

01:07:19So, Bread Analyzer, it is a infrared rays based test.

01:07:29And, it is based on Henry's Law.

01:07:35It is based on Henry's Law.

01:07:37Infrared rays based test.

01:07:39And, actually, by your alveolar air, we can detect the blood ethanol level.

01:07:44By your alveolar air, we can detect your blood ethanol level.

01:07:48This is Bread Analyzer, which is also known as Drunkometer.

01:07:53Which is also known as Drunkometer.

01:07:55But, sir, which is the overall best test?

01:07:58Gas chromatography.

01:07:59K, Kozelka.

01:08:00B, Bread Analyzer.

01:08:01C, Kevitt.

01:08:02H, Heini.

01:08:03Or, you can remember by a trick, chromatography.

01:08:07It is a gas chromatography.

01:08:09Gas chromatography is the best test.

01:08:12So, you can remember C for Kevitt and C for chromatography.

01:08:15Gas chromatography.

01:08:16Which is the best test?

01:08:18Quantitative as well as qualitative.

01:08:20That is a gas chromatography.

01:08:21What is the meaning of qualitative?

01:08:22Whether alcohol is present or not.

01:08:24That is a qualitative.

01:08:24And, what is the quantity of alcohol?

01:08:27It is a quantitative test.

01:08:28Now, sir, what is 510 IPC?

01:08:30It is misconduct done after alcohol consumption.

01:08:38So, after drinking alcohol, you are doing misconduct with anyone.

01:08:41This is 510 IPC.

01:08:45Now, sir, I am coming to symptoms of alcohol.

01:08:49First is test of excitement.

01:08:51You will be very much excited.

01:08:52Feeling very good excitement.

01:08:54It is impaired cognitive function at 30 mg percentage.

01:09:00Your cognitive functions are impaired.

01:09:02Impaired reaction time at 50 mg percentage.

01:09:08When you are blood alcohol.

01:09:09These all are blood alcohol.

01:09:11Blood concentration.

01:09:12And, my dear friend, this is alcoholic gauge nystagmus, which is also known as lateral gauge nystagmus.

01:09:20This is seen almost at 80 to 100 mg percentage.

01:09:28Or the better word will be 80.

01:09:29Nystagmus.

01:09:30The eyes start bubbling.

01:09:31Nystagmus.

01:09:32Lateral gauge nystagmus or alcohol.

01:09:34This is the stage of excitement.

01:09:3730, 50, 80.

01:09:38This is the symptom.

01:09:40Now, sir, the second stage is stage of in-coordination.

01:09:45Stage of in-coordination.

01:09:46You are in-coordinated.

01:09:47Your movement is in-coordinated.

01:09:49That is seen.

01:09:50And this is seen around at 150 to 200 mg percentage.

01:09:57There will be rapid pulse and flushing of the face.

01:09:59Now, I am coming to the third one, stage of coma.

01:10:03Stage of coma, the motor, sensory, speech and coordination all are severely affected.

01:10:11Now, sir, the Mackie-Van sign is present.

01:10:15What is Mackie-Van sign?

01:10:17Normally, in alcohol intoxication, when you have this stage, your pupil is constricted.

01:10:25Now, what you do?

01:10:27You pinch the skin.

01:10:29The pupil gets dilated and again come back in the constricted position slowly.

01:10:42Constricted position again come back in this constricted position slowly.

01:10:48This is known as Mackie-Van sign.

01:10:50And why this sign is done?

01:10:51It is to differentiate coma caused by alcohol.

01:10:56And it is seen almost at the 300 mg percentage or more than 300 mg percentage.

01:11:02It is used to differentiate coma.

01:11:06This is a stage of coma.

01:11:07Coma caused by alcohol and coma by other like OPM, coma by head injury.

01:11:15So, this is Mackie-Van sign.

01:11:17What is Mackie-Van sign?

01:11:18Pupil is constricted.

01:11:20You pinch the skin.

01:11:22The pupil is dilated.

01:11:23Again, the pupil come back in the constricted position.

01:11:26This is known as Mackie-Van sign.

01:11:27It suggests the alcohol-induced coma.

01:11:30It suggests the alcohol-induced coma.

01:11:32It is used to differentiate this coma from other coma.

01:11:35Coma by other situation.

01:11:37Mackie-Van sign.

01:11:38So, stage of excitement, I told you.

01:11:40Stage of incoordination, I told you.

01:11:41Now, the third stage is stage of coma.

01:11:43Now, sir, when do we say that person is sober, drinking, or under the influence?

01:11:49Sir, sober means if your blood alcohol concentration is less than 10 mg percentage.

01:11:56Now, drinking after 10, you can say like 10 to 70 or 10 to 80, it will be drinking.

01:12:05Under the influence, my dear friend.

01:12:06It's very, very important.

01:12:0980 mg to 100 mg percentage or up to 150 mg percentage, it comes under the influence.

01:12:18Or like, when would you say the intoxicated or heavily drunk?

01:12:26Intoxicated or heavily drunk, 150 to 300 mg percentage.

01:12:34And the coma is after that.

01:12:37Coma is after that.

01:12:38So, you can get a question.

01:12:39What is sober?

01:12:40What is drinking?

01:12:42Drinking is started drinking.

01:12:44And this question comes in exam under the influence.

01:12:4780 to 100 mg percentage or 80 to 150 mg percentage.

01:12:50This comes under the influence.

01:12:53Now, sir, we use a formula which is known as Widmark formula.

01:12:58And what is a Widmark formula?

01:12:59It is A, weight of alcohol.

01:13:05Weight of alcohol.

01:13:07First question done.

01:13:08P, body weight, A, weight of alcohol.

01:13:15P, body weight.

01:13:17C, concentration of alcohol in mg percentage.

01:13:27In mg percentage.

01:13:28C, and R is a constant, my dear friend.

01:13:37R is a constant.

01:13:38For male, the value is 0.68.

01:13:43And for female, the value is 0.55.

01:13:49So, for the male, the value is 0.68.

01:13:53For female, the value is 0.55.

01:13:57So, weight of alcohol, weight of the body, the concentration of the alcohol.

01:14:03And R is the constant.

01:14:05This is known as Widmark formula.

01:14:06This is used for blood.

01:14:07But if you want to use this formula for urine.

01:14:13Because I told you, if your whole blood concentration is 1 mg percentage, the urine will be 1.3 mg percentage.

01:14:23So, for urine concentration and for urine everything, you will use the formula that will be different.

01:14:35This will be 3 by 4th of blood formula.

01:14:413 by 4th of the blood formula.

01:14:42This is urine, this is urine, this is for different for urine.

01:14:48So, you can make it separately.

01:14:50This will be different for urine.

01:14:53Because blood is if 1 mg percentage, urine will be 1.3.

01:14:58So, by urine, if you want to calculate the blood, this will be 3 by 4th.

01:15:02By urine, if you want to calculate the blood concentration, this will be 3 by 4th of that concentration.

01:15:08Okay.

01:15:09That's very simple.

01:15:10Alcoholic withdrawal symptoms, sir.

01:15:12The first symptom is tremor, my dear friend.

01:15:15Tremor is seen in 6 to 8 hours.

01:15:18So, you are taking alcohol for a long time.

01:15:20Suddenly, you stop.

01:15:20Tremor will be seen in this.

01:15:21Hallucination is seen around 12 hours after stopping this.

01:15:27And most common hallucination is auditory hallucination.

01:15:33Most common hallucination is auditory hallucination.

01:15:37Caesar in almost 12 to 24 hours.

01:15:41This will be GTCS, generalized tonic cloning Caesar.

01:15:46Generalized tonic cloning Caesar.

01:15:48But, sir, the most dangerous one.

01:15:51D, D for though, T, T for 3.

01:15:54So, you can remember.

01:15:55Though, T for 3.

01:15:58D, though, D, though, T3.

01:16:00So, you can remember by trick.

01:16:02Though, 3.

01:16:03In 2 to 3 days.

01:16:05D, though, T3.

01:16:07In 2 to 3 days.

01:16:08And in bracket, you can write down.

01:16:10In 48 to 72 hours of withdrawal,

01:16:15there will be a dangerous situation which is known as delirium tremens.

01:16:21Delirium tremens.

01:16:22My dear friend, what is delirium tremens?

01:16:25Delirium tremens is disorientation.

01:16:32It is number one disoriented.

01:16:34Confused state.

01:16:35And the person is disoriented to time, place, and person.

01:16:46And there will be many hallucinations also.

01:16:48This is known as delirium tremens.

01:16:49And my dear friend,

01:16:51this is seen in 48 to 72 hours.

01:16:53I told you the trick.

01:16:54D, though, T3.

01:16:552 to 3 days if it's withdrawal.

01:16:57And in this condition,

01:17:00if you commit the crime,

01:17:05you are not responsible

01:17:09because you will be treated as an insane

01:17:11and you will get an advantage of 84 IPC.

01:17:15I already discussed.

01:17:16Now, how would you remember the delirium tremens?

01:17:18D, E, A, T, H, death.

01:17:19D, there will be delirium.

01:17:22Yes, my dear friend, delirium tremens.

01:17:24E, A, D, E, A.

01:17:25Increase autonomic activity.

01:17:32Increase autonomic activity.

01:17:35Increase BP.

01:17:36Increase heart rate.

01:17:38Increase sweating and fever.

01:17:40This will be seen.

01:17:41T, there will be tremor.

01:17:44Coarse tremor.

01:17:49And H, as I told you,

01:17:51hallucination.

01:17:54Specially, there will be visual hallucination

01:17:57or other hallucination.

01:17:58These are common.

01:17:59This condition is known as delirium tremens

01:18:02seen after 2 to 3 days of withdrawal of alcohol.

01:18:06These are the common.

01:18:07And my dear friend,

01:18:08the most common,

01:18:09there will be tremor.

01:18:10The most common alcohol withdrawal symptom is tremor.

01:18:13So, you can remember tremor,

01:18:14hallucination,

01:18:15seizures,

01:18:16and delirium tremens.

01:18:17You can remember these are four.

01:18:19In delirium tremens,

01:18:20we can remember by death.

01:18:21D, E, delirium.

01:18:22A, autonomic activity is increased.

01:18:24T, tremor will be there.

01:18:25H, hallucination will be there.

01:18:26Now, sir,

01:18:27in chronic alcoholism,

01:18:29like you are taking alcohol

01:18:30for a very long period

01:18:32and chronic alcoholism,

01:18:34there will be

01:18:34some problem.

01:18:36The first is vitamin B1 deficiency.

01:18:39This is thiamine deficiency.

01:18:41Thiamine deficiency.

01:18:42This is known as

01:18:43Wernicke's encephalopathy.

01:18:45And everyone knows

01:18:46that Wernicke's encephalopathy,

01:18:49we can remember by

01:18:49Goa.

01:18:52What is Goa?

01:18:54Global

01:18:54confusion.

01:18:57Confused mind.

01:18:58Global confusion.

01:18:59O,

01:19:02of

01:19:02thalmoplysia.

01:19:05Because of this

01:19:08abducent nerve palsy.

01:19:11Abducent nerve palsy.

01:19:13A,

01:19:15ataxia.

01:19:16So, this is Goa.

01:19:18And also,

01:19:18what we do in Goa?

01:19:19We used to drink

01:19:20Goa may P.

01:19:21P for

01:19:22poly

01:19:24neuropathy.

01:19:27That's a very simple thing.

01:19:29You can see

01:19:29G,

01:19:30global confusion.

01:19:31O,

01:19:31of

01:19:32thalmoplysia

01:19:32and ataxia.

01:19:33This is

01:19:34like if you have the

01:19:35decreased vitamin B1.

01:19:37But sir,

01:19:37if the further decrease

01:19:39severe vitamin B1

01:19:40deficiency.

01:19:41So,

01:19:42my defense,

01:19:42this is the late

01:19:44neurological disorder

01:19:45due to vitamin B1

01:19:47deficiency.

01:19:48So,

01:19:48I would say,

01:19:48what's the difference?

01:19:49It's a late

01:19:50neurological disorder.

01:19:51It is known as

01:19:52Korsakov psychosis.

01:19:53How would you remember

01:19:54by Korsakov?

01:19:55You can remember

01:19:57by Kors.

01:19:58Kors is equal to

01:19:59Kors.

01:20:00What is Kors?

01:20:01Number one,

01:20:02confabulation.

01:20:04What is confabulation?

01:20:05I'll tell you.

01:20:06And A,

01:20:11enterograde

01:20:12amnesia.

01:20:17Confabulation

01:20:18and enterograde amnesia.

01:20:19Enterograde

01:20:19is the forward

01:20:20memory is lost.

01:20:21What you did?

01:20:22Confabulation.

01:20:23What is confabulation?

01:20:26Like,

01:20:26you are

01:20:27filling

01:20:30the memory

01:20:33of brain

01:20:34with some stories.

01:20:39You are filling

01:20:40the memories

01:20:41of brain

01:20:41with some stories.

01:20:43With some fake stories.

01:20:44You are thinking,

01:20:45but you are filling

01:20:45your memory with brain.

01:20:47This is known as

01:20:47confabulation.

01:20:48So, again,

01:20:49I'm telling you,

01:20:49my dear friend,

01:20:50very simple.

01:20:51Here,

01:20:51it's a global

01:20:52confusion

01:20:53and it is

01:20:54confabulation.

01:20:55You can remember,

01:20:56C confabulation,

01:20:57A enterograde

01:20:58or very rarely

01:20:59it's a retrograde amnesia.

01:21:00So,

01:21:01both are due to

01:21:01vitamin B1

01:21:02deficiency,

01:21:03thymine deficiency,

01:21:04which I discussed.

01:21:05Vernique's

01:21:05encephalopathy,

01:21:06Goa.

01:21:06Goa may P,

01:21:07polyneuropathy.

01:21:08Global confusion

01:21:09of thalmoplasia,

01:21:10ataxia and P

01:21:11for polyneuropathy.

01:21:12Okay.

01:21:13But, sir,

01:21:13what is a

01:21:14Korsakov call

01:21:15is equal to

01:21:15CAR.

01:21:16Confabulation,

01:21:17enterograde amnesia

01:21:18with some

01:21:18this is it.

01:21:19But,

01:21:19it's a late

01:21:20neurological

01:21:20manifestation.

01:21:21Very simple.

01:21:22Now, sir,

01:21:23Marchifawa syndrome,

01:21:25another important

01:21:26one, sir.

01:21:26It is more

01:21:27commonly seen in

01:21:28chronic alcoholic

01:21:29who are male,

01:21:29M for male.

01:21:31C,

01:21:32sir,

01:21:33it is a

01:21:34atrophy of,

01:21:35it is a

01:21:36atrophy of

01:21:37corpus

01:21:38callosum.

01:21:41It is a

01:21:42atrophy of

01:21:43corpus callosum.

01:21:44demyelination.

01:21:45You can use

01:21:46a word

01:21:46demyelination.

01:21:52So, because of

01:21:53this, there will

01:21:54be ataxia,

01:21:55there will be

01:21:55dementia,

01:21:56there will be

01:21:57coma and the

01:21:58last but not

01:21:59the least,

01:21:59that would be

01:22:00death.

01:22:00M, male,

01:22:01it's very common.

01:22:02C, corpus

01:22:03callosum.

01:22:03What is involved?

01:22:04Corpus callosum,

01:22:05demyelination and

01:22:06atrophy of

01:22:07corpus callosum.

01:22:08And it can lead

01:22:09coma,

01:22:09ataxia and

01:22:10death.

01:22:10So, these are

01:22:11some very,

01:22:11very important

01:22:11features.

01:22:12So, the next

01:22:13variety of

01:22:13alcohol is

01:22:14methanol.

01:22:15And my dear

01:22:16friend, for

01:22:17methanol, we

01:22:18use a word

01:22:19wood alcohol.

01:22:22Wood alcohol.

01:22:23And my dear

01:22:23friend, it is

01:22:24also known as

01:22:25illicit liquor.

01:22:30Illicit

01:22:31liquor.

01:22:34Illicit liquor

01:22:35means it is

01:22:36which is

01:22:37illegally made.

01:22:39Which is

01:22:39illegally made.

01:22:41Which is

01:22:42illegally made.

01:22:43Adulterated

01:22:43liquor.

01:22:44Not illegal

01:22:46liquor.

01:22:47It means

01:22:48in your

01:22:49ethanol,

01:22:50methanol is

01:22:50mixed or

01:22:51methanol is

01:22:52formed in

01:22:52that one.

01:22:53This causes

01:22:54a tragedy

01:22:55which is

01:22:58known as

01:22:58huge tragedy.

01:22:59This question

01:23:00has come many

01:23:00times in

01:23:01exam.

01:23:02That huge

01:23:02tragedy is

01:23:03caused by

01:23:03which

01:23:04intoxication?

01:23:04The answer

01:23:05is methanol.

01:23:06Huge tragedy.

01:23:07The fetal

01:23:08dose,

01:23:09because the

01:23:09fetal dose

01:23:10of methanol

01:23:11comes in

01:23:11exam,

01:23:12it is

01:23:13almost

01:23:1480 to

01:23:15120 ml.

01:23:17In few

01:23:18books, it

01:23:18is written

01:23:18up to

01:23:19200 ml.

01:23:2080 to

01:23:21120 ml

01:23:22or 200 ml.

01:23:23It is a

01:23:23very dangerous

01:23:23one.

01:23:24Small dose

01:23:25can be

01:23:25fatal.

01:23:26Metabolism,

01:23:26sir, you

01:23:26can see

01:23:27the methanol

01:23:28converts in

01:23:29formaldehyde by

01:23:30the enzyme,

01:23:32the same

01:23:32which I

01:23:33discussed,

01:23:33alcohol

01:23:33dehydrogenase

01:23:34and

01:23:35formaldehyde.

01:23:37Formaldehyde

01:23:37converts in

01:23:38formic acid,

01:23:39the same

01:23:39enzyme,

01:23:41aldehyde

01:23:42dehydrogenase.

01:23:45Yes,

01:23:46formic acid

01:23:46causes metabolic

01:23:48acidosis and

01:23:49effect on the

01:23:49retina.

01:23:51In the

01:23:51retina,

01:23:52the formic acid

01:23:53causes the

01:23:54damage of

01:23:55the retina.

01:23:57It is

01:23:58known as

01:23:59snow-filled

01:24:00region.

01:24:01So,

01:24:02sometime you

01:24:02can get a

01:24:03question that

01:24:03retinal damage

01:24:04is because of

01:24:04the formation

01:24:05of formic

01:24:05acid,

01:24:06methanol,

01:24:07formaldehyde,

01:24:07formic acid.

01:24:08Alcohol

01:24:09dehydrogenase,

01:24:09aldehyde,

01:24:10b-al-in.

01:24:10If you

01:24:11see,

01:24:12the formaldehyde

01:24:13is 33

01:24:14times more

01:24:15poisonous or

01:24:16more damageable

01:24:17than methanol

01:24:19and formic acid

01:24:20is 6 times

01:24:22more poisonous

01:24:22than methanol.

01:24:2333 times more

01:24:24poisonous and

01:24:25formic acid 6

01:24:26times more

01:24:27poisonous.

01:24:28This is another

01:24:28very important

01:24:29point.

01:24:30Now,

01:24:30symptom and

01:24:31fetal dose.

01:24:31Fetal dose,

01:24:32I already discussed

01:24:32my dear friend,

01:24:33no need to

01:24:33problem.

01:24:35Severe

01:24:35abdominal cramp

01:24:37my dear friend

01:24:37is the first

01:24:38symptom of

01:24:38the methanol

01:24:39intoxication.

01:24:40There will be

01:24:40severe abdominal

01:24:41pain.

01:24:41Then,

01:24:42muscular weakness

01:24:43and hypothermia,

01:24:44the temperature

01:24:44of the body

01:24:44will be decreased.

01:24:46As I told you,

01:24:46sir,

01:24:47snow-filled

01:24:48reason and

01:24:48complete,

01:24:49as I told you,

01:24:50it causes

01:24:51blindness

01:24:52because of

01:24:54optic neuritis.

01:24:56Formic acid

01:24:56act on the

01:24:57retina,

01:24:58optic neuritis

01:24:59will be there,

01:24:59it will cause

01:25:00the blindness.

01:25:01Fixed and

01:25:01dilated pupil,

01:25:02sir,

01:25:02you can get

01:25:03this question

01:25:03on your exam.

01:25:04fixed and

01:25:06dilated pupil

01:25:07and

01:25:08CNS and

01:25:08cardiac

01:25:09depressant.

01:25:09Two questions

01:25:10can come

01:25:10from

01:25:11snow-filled

01:25:12retina

01:25:12and

01:25:13snow-filled

01:25:14retina

01:25:14question

01:25:14can come

01:25:14you can

01:25:15get two

01:25:15questions

01:25:16snow-filled

01:25:16retina

01:25:17and

01:25:17this one

01:25:18CNS

01:25:19depression

01:25:19and

01:25:20cardiac

01:25:20depression.

01:25:22Fixed and

01:25:22dilated

01:25:22pupil

01:25:23get the

01:25:24fetal dose

01:25:2480 to

01:25:25120 ml

01:25:26isko

01:25:27dimaag

01:25:27me

01:25:27rakhna.

01:25:28Kya

01:25:28bana

01:25:28methanol

01:25:29formaldehyde

01:25:29formic acid

01:25:30main

01:25:30contributor

01:25:31ko

01:25:31ne

01:25:31damage

01:25:31ka

01:25:31formic acid

01:25:32which

01:25:32act

01:25:32on

01:25:32the

01:25:32retina

01:25:32but

01:25:33formic acid

01:25:34causes

01:25:34metabolic

01:25:34acidosis.

01:25:35Okay,

01:25:35I told

01:25:36you two

01:25:36more

01:25:36acidosis.

01:25:37One

01:25:37was in

01:25:38this

01:25:38CO

01:25:39poisoning

01:25:40and

01:25:40another

01:25:40was in

01:25:41cyanide

01:25:41hagma.

01:25:42It's

01:25:42very

01:25:42more.

01:25:43Treatment,

01:25:43sir,

01:25:43what is

01:25:44the

01:25:44treatment?

01:25:44First,

01:25:44stabilize

01:25:45the

01:25:45patient.

01:25:46Second,

01:25:47sir,

01:25:47treatment

01:25:47of

01:25:48choice

01:25:48is

01:25:49hemodialysis.

01:25:53Hemodialysis

01:25:54is

01:25:54treatment

01:25:54of

01:25:55choice.

01:25:55But as

01:25:56far as

01:25:56antidote

01:25:56is

01:25:57concerned,

01:25:58the

01:25:58first

01:25:59antidote

01:25:59is

01:26:00ethanol

01:26:01and

01:26:02second

01:26:03is

01:26:03formipazole.

01:26:06Sir,

01:26:06formipazole

01:26:07is very

01:26:08simple.

01:26:08It

01:26:08inhibits

01:26:09alcohol

01:26:13dehydrogenous

01:26:15enzyme.

01:26:16It

01:26:16inhibits

01:26:16alcohol

01:26:17dehydrogenous

01:26:17enzyme.

01:26:18But what

01:26:19is the

01:26:19mechanism

01:26:19of

01:26:20this

01:26:21ethanol,

01:26:22sir?

01:26:22Actually,

01:26:22sir,

01:26:22we all

01:26:23know

01:26:23there

01:26:24is

01:26:24an

01:26:25enzyme

01:26:26which

01:26:27is

01:26:27alcohol

01:26:27dehydrogenous

01:26:28and

01:26:29there

01:26:29are

01:26:29two

01:26:29things

01:26:30are

01:26:30there.

01:26:32One

01:26:33is

01:26:33ethanol

01:26:33and

01:26:34another

01:26:34is

01:26:34methanol

01:26:34in your

01:26:35body.

01:26:36Now,

01:26:36what will

01:26:36happen,

01:26:36sir?

01:26:37What

01:26:37will

01:26:37happen?

01:26:38This

01:26:38alcohol

01:26:39dehydrogenous

01:26:40has

01:26:41more

01:26:42affinity.

01:26:44It

01:26:45is

01:26:45having

01:26:45more

01:26:45affinity

01:26:46for

01:26:46ethanol.

01:26:47So,

01:26:48I

01:26:48can

01:26:48say

01:26:48it's

01:26:48a

01:26:48competitive

01:26:49inhibitor.

01:26:50It has

01:26:50a

01:26:50competition

01:26:51with

01:26:51methanol.

01:26:53Alcohol

01:26:53dehydrogenous

01:26:54will combine

01:26:54with me.

01:26:55So,

01:26:55it has

01:26:56more

01:26:56competition.

01:26:56It's

01:26:56a

01:26:57competitive

01:26:57inhibitor.

01:26:57So,

01:26:58I will

01:26:58say that

01:26:59ethanol

01:26:59is a

01:27:01competitive

01:27:05inhibitor

01:27:06of

01:27:06methanol

01:27:07because

01:27:07alcohol

01:27:08dehydrogenous

01:27:09has more

01:27:09affinity

01:27:10than

01:27:10ethanol.

01:27:10folinic

01:27:12acid.

01:27:12It

01:27:13increases

01:27:14excretion

01:27:15of

01:27:15formic

01:27:20acid.

01:27:22It

01:27:22increases

01:27:23excretion

01:27:23of

01:27:23formic

01:27:23acid and

01:27:24sodium

01:27:25bicarbonate

01:27:26to treat

01:27:26acidosis.

01:27:29Sodium

01:27:30bicarbonate

01:27:31to treat

01:27:31acidosis.

01:27:32So,

01:27:32these are

01:27:32some very

01:27:33very important

01:27:33treatment of

01:27:34choice is

01:27:34as you can

01:27:35go for

01:27:35hemodialysis.

01:27:36Antidote of

01:27:37choice is

01:27:38ethanol.

01:27:38Why

01:27:38ethanol?

01:27:40Because

01:27:40alcohol

01:27:40dehydrogenase

01:27:41has more

01:27:41affinity for

01:27:42ethanol.

01:27:43It's a

01:27:43competitive

01:27:43inhibitor of

01:27:44methanol.

01:27:45Competitive

01:27:45antagonism.

01:27:47This

01:27:47folinic

01:27:48acid increases

01:27:49excretion of

01:27:50the formic

01:27:51acid and

01:27:51this sodium

01:27:52bicarbonate is

01:27:53used to

01:27:53treat this

01:27:54one.

01:27:55Now,

01:27:55you can get

01:27:55to post

01:27:56matem

01:27:56finding.

01:27:57Post matem

01:27:58clotting is

01:27:59absent,

01:28:00my dear

01:28:00friend,

01:28:01in

01:28:01methanol

01:28:01death.

01:28:03And the

01:28:03last but

01:28:03not the

01:28:04least,

01:28:04which is

01:28:05hemorrhagic

01:28:05necrosis of

01:28:06putamin.

01:28:07Here I am

01:28:07mentioning the

01:28:08putamin.

01:28:09If you

01:28:09remember in

01:28:10carbon monoxide

01:28:10also mentioned

01:28:11bilateral

01:28:13cavitation

01:28:13necrosis of

01:28:14globus,

01:28:15pallidus and

01:28:15putam.

01:28:17So,

01:28:17this is all

01:28:17about a

01:28:18very,

01:28:18very important

01:28:19topic.

01:28:20That is

01:28:20methanol and

01:28:21ethanol I

01:28:21discussed.

01:28:22Good luck.

01:28:23Goodbye.

01:28:23These are

01:28:24CNS

01:28:24depresant

01:28:25poison.

01:28:25Go ahead.

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