Pupillary Reaction to Various Drugs and Substances

PUPIL REACTION TO SUBSTANCE/DRUGS

Pupil of human eye constrict and dilate depending upon the need of the eye to focus on near object/far object, dim light/bright light and whether it is under stress/not. This response is solely dependent upon the muscles inside the eyes in the iris. The pupillae constrictor muscle respond to cholinergic agents and cause pupillary constriction while the dilator pupillae muscle is acted upon by sympathetic system and causes pupillary dilation.

Beside these natural response, the substances we come in contact with can also alter the pupillary size. Drugs such as Adrenaline, antidepresssants, antihistaminics, can cause pupillary dilatation. Pethidine being an exception is the only opoid to cause pupillary dilation. Herbal products such as belladona, strychinine, calotropis and Chemicals such as alcohol, formic acid, cyanide Carbon monoxide also have dilatatory effect based upon the dosing.

Phenols, Organophosphate, carbamates, Carbolic acid, cause pupillary cosntriction. Drugs such as Opoids, barbiturates, Benzodiaepines, methyl dopa and plant product such as Nicotine, caffiene and opium causes the dilatation of pupil. 

Know how to assess the pupillary reaction or light reflex.

DILATORS		CONSTRICTORS
A6 C5 (Big1 Co Ca Cola Can)		O2 B2 C5 ( Car Car Caf )
Formic Acid			Phenol (Carbolic Acid)
Pethidine2 (only exception in Opoid)		O	All Opoids2  (Except severe Acidosis/hypoxia/ respiratory depression)
Adrenaline*/ Ephidrine/Sympathetomimetics	A		Parasympathetomimetics*
Atropine*/ Belladona/ Dhatura	A	O	Organophosphate*
Amphetamine	A	B	Barbiturates
Alcohol3	A	B	Benzodiazepines
Antidepressants	A
Antihistaminics	A
Cocaine Crack	Co	Car	Carbamate
Carbon Monoxide/ CO	Ca/CO	Car	Carbolic Acid
Calotropis	Cola	Caf	Caffeine
Cannabis	Can		Coma of Alcohol3
Cyanide			Clonidine
Hypothermia*			Heat Stroke*
Strychnine			Nicotine4
			Methyl Dopa

HIPPUS: Alternating dilatation and constriction is done by ACONITE

Note: All A’s constrict the pupil. All B’s and O’s dilate the pupil.

¹ Big is not a part of drug rather means dilatation.

² Only opoid to cause pupillary dilatation is Pethidine.

³ Toxic Effect of alcohol causes pupillary constriction as patient develops coma.

⁴ Delayed effect of Nicotine is dilatation of pupil.

* The drugs/substances in row with different color across the table are physiological Counterparts

  

Drugs/Poisons resisting Putrefaction

Drugs/Poisons resisting Putrefaction

Organophosphorus

Edrin

Strychnine

Antimony

Arsenic

Nicotine

Dhatura

Yellow Oleander

@ OE SANDY

Difference between True bruise and Artificial Bruise

The concept of malingering has made it important to identify whether any bluish discoloration in the body is true bruise or bruise induced with use of various plant products. It is useful in forensic science to identify whether any assault / physical violence is true or the victim is fortifying the evidence to setup any guiltless.

True bruises can be present anywhere in the body and is generally associated with blister and itching. It changes color following the blunt trauma unlike false bruise which are stained by plant products and hence don’t change their color.

Click to know how is a respired lungs different from the unrespired lungs of a newborn.

Character	Artificial Bruise	True Bruise
Cause	Chemical Agent like plumbago, semicarpus, madar juice	Blunt Trauma
Location	Accessible part of body mostly	Anywhere
Blister	Present around the bruise	Not present
Itching	Present	Not Present
Color Changes	Absent	Characteristic
Fingers	Marks of scratching	Not so
Content	Acrid Serum	Extravagated blood
Chemical Analysis	Chemical detected	Not so

Classification Of Poison (Chart)

Follow to learn about active principles of various poisonous substances and plants.

Click for antidote to treat various poisons.

Special Antidote

Universal Antidote 

Composition

Activated charcoal 2 parts (Adsorbent)

Magnesium oxide 1part (Antacid)
Tannic Acid 1part (Binds alkaloid)

Dose

15g in a glass of water

Indication

Unidentified Poison
Multiple or combination of poisons

Coma Cocktail

Composition

100mg Thiamine

2mg Naloxone

100ml of 50% Dextrose

Indication

When the cause of coma is not known.

Antidote Classification

Poison and Their Antidote

Link: Classification of Poison

S. No.	Name of the poison	Name of Antidote	Dose	Remarks
1	Abrin	Antiabrin
2	Arsenic	BAL(British Anti Lewisite) + Freshly prepared Ferrous Sulfate	400-800mg 200-400mg 100-200mg	Day 1-2 Day 3-4-5 Subsequent days until urine level <50μg/dl
3	Benzodiazepine	Flumazenil	0.5mg iv over 30s
4	Botulinum	Guanidine
5	Carbonmonoxide	Carbogen	(95% O2 + 5% CO2)
		Adrenaline	0.5ml – 1ml
		Coramine	5ml
6	Copper	Freshly prepared Potassium Ferrocyanide		forms Cupric Ferrocyanide
		Penicillamine		EDTA BAL
7	Curare	Neostigmine Edrophonium Pyridostigmine
8	Cyanide	Eli Lilli Cyanide Aprroach Kit		Others Cobalt EDTA 4DMAP
		Amyl Nitrite	1 perle of 0.2ml crushed and inhaled every 30s
		Sodium Nitrite	3% solution 0.33ml/kg iv over 10-20 min
		Sodium Thiosulphate	25% solution 3-5ml/min (max 60 ml)
9	Dhatura	Physostigmine	0.5mg im
10	Ethylene glycol	4 Methyl pyrazole/ Fomepizole		Ethanol
11	Formic Acid	Folinic Acid	1mg/kg loading with maintainence of 0.5mg/kg	Fomepizol
12	Iron	Desferroxamine	1g im 500mg q4h 2 doses 500mg q4-12h (max 6g in 24 hr)
13	Lead	EDTA / BAL	18mg/kg/day 12mg/kg/day 6mg/kg/day	Day 1-2 Day 3-4-5 Day 6-7
14	Mercury	BAL	3.5mg/kg/q4h 2.5mg/kg/q6h 2.5mg/kg/bd	2 days 1 day according to severity
15	Methanol	Folinic  Acid		Fomepizole
		Ethanol	10mg/kg iv for 30 min OR 1mg/kg of 95% ethanol in fruit juice
16	Organophosphate	Atropine	2mg iv every 10-15min unless atropnized	Edrin though OP has no antidote
		Pralidoxime	1-2g iv over 5-30min repeated every 30min
17	Oxalic Acid	Calcium Gluconate
18	Paracetamol	N-acetylcysteine	150mg/kg iv infusion over 15 min
19	Phosphorus	CuSO4	0.1%
20	Snake Bite	Anivenin		Polyvalent Monovalent