Opium (Afim)
Opium is the dried juice of the white poppy {papaver somniferum}, when the capsule is still on the plant. It is dark brown or black and has a peculiar smell and has a bitter taste. Poppy seeds are white, harmless, demulcent and nutritive and are used as food. Active principle: it has about 25 alkaloids, the major ones being, 1. Phenanthrene: morphine, codeine and thebaine 2. Isoquinolines: papaverine, narcotine and noscapine The opiods are either natural {morphine, codeine}, semi-synthetic {heroin, hydromorphone, oxycodone} and synthetic{meperidine, methadone, fentanyl,etc} Other aspects related to opium: • Codeine is methyl morphine which is used a cough suppressant. • Heroin is diacetyl morphine • Brown sugar is crude heroin • Morphine and pethidine are used as anelgesics • Homicidal and accidental poisoning is common among infants and children
Route :
Ingestion of opium or its alkaloids or injection of morphine
Fatal Dose :
2gms, morphine 0.2gms, codeine 0.5gms
Fatal Period :
6 to 12 hours
Clinical Picture :
Stage1: Stage of excitement and euphoria There is increased sense of well being, increased mental activity, flushing of face. Convulsions are seen in children Stage 2: Stage of stupor Headache, nausea, vomiting, giddiness, lethargy, drowsiness, contracted pupils, cyanosed face and itching all over the body. Stage 3: Stage of narcosis Deep coma, muscles relaxed, areflexia, pin point pupils-not responding to light, hypotension, sweating, hypothermia, cyanosis and froth at mouth and nose. The triad of coma, pin point pupils and depressed respiration{4-5 per minute} strongly suggests opium poisoning
Treatment :
• Gastric lavage {even for injected morphine as it is excreted in the stomach} • Enema and purgatives • High tension oxygen and Coramine as cardio-respiratory stimulant • Symptomatic treatment • Antidote: Naloxone 1-2mg I.V. every 5 minutes till patient becomes conscious and pupils dilate.
11/01/2020 12:48:03 Opium (Afim)
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