A middle aged man comes to OPD with paraesthesia of hands and feet, hyperkeratosis of palms, rain drop pigmentation and transverse lines on nails. Most likely the person is having:

Ans. a. Arsenic poisoning Garlic odour (in breath), white transverse lines (of Aldrich Mee's) on nails and gastrointestinalfeatures (i.e. pain abdomen), finely mottled patchy brown skin hyper pigmentation of flexures (rain drop pigmentation), hyperkeratosis of palms and soles and peripheral sensory motor polyneuropathy (leading to paresthesia and paresis), in a pest killer are indicative of chronic arsenic poisoning.Arsenic Poisoning* Arsenious oxide (Sankhya or somalkhar) also known as arsenic trioxide (AS2O3) is MC form of arsenic used.Other Arsenic Salts* Copper arsenite (Scheele's green)* Copper acetoarsenite (Paris green or emerald green)* Arsenic trichloride (butter of arsenic)* Arsenic trisulphide (yellow orpiment or hartal)* Arsenic disulphide (red realgar or manseel)Fatal dose:* 100-200 mgdeg is fatal dose* Arsenophagist: Take arsenic regularly as aphrodisiac or tonic can tolerate up to 300 mg dose.Fatal period:* Fatal period is 2-3 hours in narcotic form and 12 hours-2 days in gastrointestinal form0.* Patient may die from subacute poisoning in 7-10 days due to heart failure or from chronic poisoning in weeks due to liver or kidney damage0Clinical Features:* Acute poisoning:- Usually manifest within 15-30 minutes after the dose, but may be delayed if arsenic is taken with food- Nausea, burning pain in the esophagus, stomach and epigastrium, severe, persistent vomiting.- Stools are tinged with blood, watery like the rice water stools of cholera, and contain shreds of mucus membrane and fragments of the poison in three or four hours0.- Intense thirst is a constant feature0.- Skin eruptions may appear in late stages.- Collapse sets in, with cold clammy skin, pale anxious face, sunken eyes, dilated pupils, rapid feeble pulse, and sighing respirations.- Convulsions or coma may precede death.* Subacute poisoning:- In some cases where the patient survives the initial acute attack, the poisoning becomes subacute, the symptoms persisting in lesser degree for some time.- The patient becomes progressively weak and may die of heart failure and weakness in 7-10 days.* When a large dose of arsenic is taken:- Poison is quickly absorbed, the symptoms of gastroenteritis may be absent- Symptoms of narcotic poisoning, such as vertigo, headache, spasms, followed by stupor and vascular collapse may be present.- Death occurs in 2-3 hours.Tests:* Excretion of >100 mg in 24 hours urine0* Atomic absorption spectroscopy detection* Marsh's and Reinschs test0 are obsoleteDisadvantages:* Delays putrefaction0 and can be found in bones, hair and nails for several years0* Can be detected in completely decomposed bodies, charred bones or ashes0.