A young female presented with consumption of some substance in the emergency department. Greenish blue froth was seen coming out of her nostrils and oral cavity. The poisoning is most likely due to which of the following?

Ans. b. Copper poisoning (Ref: Reddy 33/e p547, 29/e p490)Greenish blue froth from nostrils and oral cavity is seen in copper poisoning.PoisoningColour of Hair and SkinArsenic (As)* Yellow colour of skin, hair and mucous membraneQ* Milk rose (Brownish pigmentation)QCopper (Cu)* Jaundiced skin* Green-Blue skin, hair and perspirationQ* Green-Purple line of gumsQMercury (Hg)* Brown/Black-Blue line on gumsQ with loosening of tooth and necrosis of jaw* Brown deposits on anterior tens capsuleQ (Mercuria lends)* Acrodynia (Pink disease)QLead (Pb)* Blue stippled burtonian line on gumsQ, especially on upper jaw near dirty and infected teethCopper PoisoningCopper (Cu) as a metal is not poisonous. Poisonous salts include:SubstanceColorFatal DoseFatal periodCopper subacetate (Verdigris, zangal)Blue green15 gm1-3 daysQ(Usually 12-24 hours or may be up to 3-5 days or even a week)Copper sulphate (blue vitriol, nila tutia)Blue30 gmVerdigris is formed by the action of vegetable acids while cooking in copper cooking utensils, which have been not properly tin lined.Acute PoisoningChronic Poisoning* Symptoms start in 15-30 minutes of ingestion/inhalation and include metallic taste, increased salivation, thirst, burning/colic abdomen pain, nausea, eructations and blue-green vomiting* Diarrhea with liquid and brown but not bloody motions* Renal failure may lead to oliguria, albuminuria, hematuria, acidosis and uremia. Hemolysis, hemoglobinuria, methhemoglobinuria, jaundice, pancreatitis, leg cramps, spasms and convulsions may occur in severe cases.* Common among industrial workers e.g. metal fume fever in copper welders, histiocytic granulomatous lung and liver due to chronic inhalation of CuSO4 spray (vineyard' sprayer's lung disease)* Symptom complex is called Wilson's disease, hemochromatosis, bronzed diabetes and pigment cirrhosis. Presence of copper deposits in tissues is called chalcosis.* Symptoms consist of gradual anemia, purple (blue-green) line on gumsQ, nausea, vomiting with blue/green vomitusQ, colic, diarrhea, malaise, peripheral neuritis, muscle degeneration and atrophy.* Skin is jaundiced; urine, hair, froth, mucosa, and perspiration become green (blue-greenQ.