Pin point pupil poisoning and Oxalic acid poisoning

C i.e. Calcium gluconate

D i.e. Organophosphorus poisoning

Pinpoint pupils (miosis) is seen in ‘Bar Car OR Mor – Chlor’ i.e. Barbiturates, Carbolic acid (Phenol), Organophosphorus, Morphine (Opioid), Choral hydrate.Q & Pontine haemorrhageQ

So we are left with two options – Pontine haemorrhage & Organophosphorus.

B i.e. Opiate > A i.e. Organophosphorus; C i.e. Barbiturate

Ans. D: Datura poisoning

If the patient has bilateral pinpoint pupils consider the following possible etiologies:

Opiate use/abuse/overdose such as Heroin, Fentanyl, Codeine, Methadone and Morphine stimulate the parasympathetic side of the autonomic nervous system and cause pupil constriction.

Miosis in combination with depressed respirations are the hallmark signs of opiate overdose.

Pontine Hemorrhage

The pons is a knob-like structure located at the front of the brainstem. Intracranial hemorrhage in the area of the pons will typically cause bilateral pupil constriction. Intracranial hemorrhage can have both traumatic and atraumatic origins. Consider pontine hemorrhage in the presence of high mechanism head trauma and patients with a history of vascular disease, strokes and abnormal bleeding.

Organophosphate / Chemical / Nerve Agent Exposure

Organophosphate chemicals are the most common chemicals causing parasympathetic over-stimulation and, therefore, pinpoint pupils.

These compounds are effective pesticides used in agriculture. They are widely used because they break down easily in the environment unlike their cousin DDT. Malathion and parathion are examples of organophosphate pesticides. These chemicals kill insects by disrupting their nervous system function.

They can be absorbed through the skin, inhaled and ingested. Once absorbed they shut down acetylcholiesterase production and put the parasympathetic system into overdrive. This will create the classic SLUDGE presentation, characterized by excessive salivation, lacrimation (tears), urination, defecation and emesis. And two other telltale signs muscle cramps and pinpoint pupils.

Pupils are widely dilated with loss of accommodation for near vision is seen in datura poisoning.

Ans. A: Opium poisoning

The triad of coma, pinpoint-immobile pupil and respiratory depression are diagnostic of opiate poisoning. Following conditions present with dilated pupils:

• Acute alcohol poisoning
• Barbiturates poisoning
• Epileptic coma
• Cerebral hemorrhage

Ans. is ‘d’ i.e., Barbiturate poisoning

• Pin point pupil can be caused by : Opioids (morphine), organophosphates, phenothiazines, clonidine, mushroom poisoning, chloral hydrate, carbolic acid and pontine hemorrhage.