76. How overdose of drugs can cause death? Users gradually increase the drug intake as tolerance grows. When tolerance develops to effects like euphoria, the increased drug intake may be dangerously high and may lead to respiratory depression, coma and death. The purity of illegal drugs like heroin can only be guessed at. A user may use the same quantity as usual but may unknowingly take an overdose if the quality is superior to what he has been using so far. A combination of alcohol and sleeping pills is particularly dangerous. While alcohol is readily absorbed and the effect is felt immediately, sleeping pills take longer to act. The user may continue to drink alcohol under the impression that he is not “high”enough. Later on resulting overdose can cause death. 77. After how much time features of organophosphorus poisoning appears? In fatal cases the symptoms begins in ½ hour and death results in ½ to 3 hours. In non-fatal cases, the effect last for about 30 hours and fade off in the next 48-72 hours. Occasionally the symptoms last up to 3 weeks. The symptoms will be according to route of entry the respiratory or gastro-intestinal symptoms are more marked. However most common symptoms are vomiting, constricted pupil, pulmonary edema, giddiness, abdominal pain, excessive sweating, salivation, lacrimation and stupor. Symptoms may also include severe muscular weakness, mental confusion, diarrhoea, tenesmus, delirium, are lexia, incontinence, bronchorrhoea, convulsion, electrolyte imbalance, shock or coma. Kerosene or garlic like smell has been observed in cases of diazinon poisoning. 78. What is the fatal dose of organophosphorus compounds? Tetra ethyl pyrophosphate (TEPP) is the most toxic and Hydroxy ethoxy phenyl - thymine (HEPT) the least. The single dose that will produce symptoms is 5mg intramuscular or 25 mg orally, while 45-50 mg of TEPP intramuscular or 25-100mg orally will be fatal. About 80mg of parathion given intramuscularly or intravenously or 25175mg orally will also be fatal to an adult weighing 70 kgm. MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 56

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