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Toxicology
By
Dr. Houssein Nofal (PhD) MD.
Ass. Professor of Forensic Medicine
College of Medicine – KFU – Dammam
– SA
Forensic Toxicology
It is a branch of Forensic Medicine
dealing with Medical and Legal
aspects of the harmful effects of
chemicals on human beings.
Homicidal
(arsenic, aconite, thallium,
organophosphorus, oleander, etc.).
Poisoning
Older poisons like opium and arsenic
are replaced by newer poisons.
properties,
action,
toxicity,
fatal dose,
detection estimation of,
interpretation of the result of
toxicological analysis
Important Definitions:
Poison:
A Poison is defined as any substance
which when administered in living
body through any route (Inhalation,
Ingestion, surface absorption etc)
will produce ill-health
or death
by its action which is
due to its physical, chemical or
physiological properties.
Important Definitions:
Drug (WHO 1996):
“Drug is any substance or product
that is used or intended to be used
to modify or explore physiological
systems or pathological states for
the benefit of the recipient.”
Toxinology
refers to toxins produced by living
organism which are dangerous to
man,
e.g.: snake venom, fungal and bacterial
Important Definitions:
Chelating Agents:
are the substances which act on absorbed
metallic poisons.
They have greater affinity for metals as
compared to endogenous enzymes.
The complex of agent and metal is more
water soluble than metal itself, resulting in
higher renal excretion of the complex.
Chronic Poisoning
is caused by smaller doses over a
period of time, resulting in gradual
worsening.
Important Definitions:
Subacute poisoning
shows features of both acute and
chronic poisoning.
Fulminant poisoning
is produced by a massive dose. In this
death occur rapidly, sometimes
without preceding symptoms.
Important Definitions:
Parasuicide
(attempted suicide or pseudicide) is a
conscious often impulsive, manipulative
act, undertaken to get rid of an intolerable
situation.
Culpable Homicide:
Causing death of a person by an act,
f) Remote Action
Neurotics
Cardiac Poisons
Classification of poisons
According to the site and mode of action
b)Local Action
Corrosive
Strong Acid: mineral acid and organic acid
Strong alkali
Metallic: Mercuric Chloride
Irritant
Mechanical: Glass Powder
Chemical
Inorganic: weak acid, weak alkalies, Inorganic
non-metals, Inorganic Metals.
Organic: Chemical preparations, Animal and
vegetable origin.
Classification of poisons
a) Remote Action
Neurotics
C.N.S. Poisons
Somniferous: opium and its alkaloids, Barbiturates.
Inebriant (Intoxicant): Alcohol, ether, Chloroform.
Stimulant
Deliriant: Dhatura, Belladona, Hyocyamus, cannabia
indica.
Stupefaciant
Hallucinogens
Convulsant:
Spinal (Convulsant)
XIII.Strychnos Nux Vomica
Peripheral Nerves
Local Anaesthetics: Cocaine, Procaine.
Classification of poisons
Remote Action
Cardiac Poisons
KCN, NaCN, Digitalis, Aconite,
Nicotine, Quinine, Oleander
Asphyxiants: Carbon Dioxide(CO2), CO,
hydrogen sulphide(H2S)
Nephrotoxic: Oxalic Acid, Mercury,
Cantherides
Hepatotoxic: Phosphorus, Carbon
tetrachloride, Chloroform.
Miscellaneous: Food Poisons.
7. Age:
some poisons are better tolerated in
some age groups.
9. Presence of disease:
In certain diseased conditions some
drugs are tolerated exceptionally
well
Factors influencing the
actions of a poison in the
body
10. Intoxication arid poisoning states
In certain poisoning cases some drugs
are well tolerated, like, in case of
strychnine poisoning, barbiturates
and sedatives are better tolerated.
12. Exercise
Action of alcohol on C.N.S. is slowed during
exercise because more blood is drawn to
Factors influencing the
actions of a poison in the
body
13. Cumulative action of poisons:
Preparations of cumulative poisons
(poisons which are not readily excreted from
the body and are retained in different organs
of the body for a long time) like lead may
not cause any toxic effect when
enters the body in low dose.
15. Idiosyncracy:
some persons may react adversely to
a particular drug though the general
population tolerates the drug well.
Symptoms and Signs
The symptoms and signs may be
different for different poisons and
is responsible on the nature and
action of the poison.
They are:
Sudden vomiting and diarrhoea
Unexplained coma in children and adults
known to have depressive illness
Rapid onset of a peripheral neuropathy
Rapid onset of neurological or
Diagnosis of poisoning
In the Living
In the Dead
Diagnosis of poisoning
In the Living
History of the case as stated by the patient
himself and his/her relatives or friend.
Full information about time of onset of the present
illness, Initial symptoms, progress, relation with
food, condition of other persons taking same food or
drink, possible source, any previous history of
poisoning, H/o depression, quarrel.
Also note down the colour, smell, consistency,
taste and quantity of the possible poisonous
substance.
Symptoms and Signs.
Details of examination.
Preservation and laboratory investigation of
vomitus, excreta, stomach wash, scraps from any
Diagnosis of poisoning
In the Dead:
History of the case as stated by police
or relatives. H/o 2 or more vital points
(1 how long the victim survived after initial
symptoms. 2. any treatment).
Post-mortem Examination (external
and internal)
Chemical Analysis: detection of
poison in the body fluids.
Preservation of viscera and other
Postmortem Findings in Case
Of Death Due To Suspected
Poisoning
External Examination
Postmortem Staining:
Deep blue - In case of asphyxiant poisons and
aniline.
Bright red or cherry red - In case of CO and
HCN poisoning.
Deep Cyanosis - With opium and cardiac
poisons.
Early Rigor mortis - With strychnine.
Early appearance of the sign of
Postmortem Findings:
External Examination
Haemorrhagic spots under the skin
and mucus membrane: Phosphorus. .
Ulceration on lips and near the
angles of mouth - Corrosive poisons.
Stain near mouth and on hands -
Nitric acid and copper sulphate.
White froth from mouth and nose –
Opium and its alkaloids. .
Blood tinged froth from mouth and
nose Organophosphorus compounds.
Postmortem Findings
External Examination
Alopecia, hyper pigmentation and
hyperkeratosis - Arsenic poisoning
over a long period.
Staining, erosion and ulceration
near the female external genitalia - Use
of abortifacient agents or torturing
agents.
Injection marks - Injection of poisons
(snake bite or otherwise), sign of
treatment.
Postmortem Findings in Case
Of Death Due To Suspected
Poisoning
Internal findings:
The G.I.T. should be examined very carefully
since signs of corrosive or irritant poisons
are likely to be find therein.
In corrosive poisons.
Convulsant poisons.
Unconscious or semi-conscious
patients
In infants and children: Ryle’s
tube or infant feeding tube is
used.
Antidote
Antidotes are substances which
counteract the effect of poison.
Dose:
30mg/Kg BW/Day in 4 divide doses
for 7 days.
Desferroxamine
It is specific antidote for iron.
Organic Acids.
Barbiturates.
Tranquillisers.
Arsenic
as the metal itself is not poisonous but its
salts, called arsenites, are. Arsenic gas
(AsH3) is poisonous also.
In chronic ;
Removed from the source
BAL
Hospital admitted.
Mercury poisoning
is an industrial poison but previously it was used in the
treatment of syphilis, as a protection from rheumatism
(quicksilver was carried in the pocket) and as a diuretic.
Stages of Intoxication
1. Excitement (<100)
2. Confusion (100-200)
3. Stupor (>200)
Recovery
Recovery is in three phases
c) Social
Marital & family problems, including
domestic violence ,Work problems,
unemploymentRoad accidents and crime.
CAUSES OF DEATH IN CHRONIC
ALCOHOLICS (Clark, 1988)
1. Trauma.
The largest group (26%).
Fire deaths were the most common.
Drunken falls were frequently followed by
fatal head injury.
Murder,
Road traffic accidents (pedestrians),
Drowning,
Railway line accidents,
Accidental poisonings, and
Accidental hangings
CAUSES OF DEATH IN
CHRONIC ALCOHOLICS
Hypothermia
2. Incidental Natural Disease
(25%). Ischaemic heart disease,
cerebral haemorrhage, chronic
obstructive airways disease and
malignancy.
3. Alcohol Related Disease (22%).
Bronchopneumonia and lobar
pneumonia are the commonest.
Cirrhosis of the liver due to ruptured
varices or hepatic failure
CAUSES OF DEATH IN
CHRONIC ALCOHOLICS
4. Acute Intoxication (24%).
Simple intoxication causing
respiratory depression
3. Dizziness,
4. sedation,
5. Incoordination
6. Sexual dysfunction,
7. weight gain
8. Hypotension
9. & coma with high dose
BENZODIAZEPINES
Chronic effects:
Tolerance Physical & psychological
dependence
A state of chronic intoxication
with slurred speech,
poor concentration,
impaired comprehension,
impaired memory,
emotional liability,
Irritability
and depressed mood.
AMPHETAMINES
Amphetamines are synthetic
stimulants.
Their use is popular in rave culture.
Psychological dependence
leads to anxiety, depression, disturbed sleep
and irritability on cessation
COCAINE
Acute intoxication:
Short acting & dose dependent.
It causes the body to secrete
adrenaline in a similar fashion to
amphetamines
but the detrimental and
pleasurable effects are more
florid.
COCAINE
Physical:
Tachycardia,
hypertension,
Tachypnea
Dilated pupils,
Increased mental excitement
Hyperpyrexia,
COCAINE
Psychological:
2. Euphoria & well-being
3. Irritability & confusion
4. Hallucinations,
5. formication (sensation of
insects crawling under the skin)
6. Depression,
7. paranoia as effects wear off
COCAINE
Chronic effects & External signs of
cocaine abuse:
Intense psychological dependence
Chest pains, muscle spasms
Weight loss
Male impotence & female orgasm
problems
Nasal septum may become ulcerated and
perforated due to ischaemia and blood
vessel spasm.
Eyes may exhibit "crack keratitis" due to
the local anaesthetic effect allows
excessive rubbing of the eyes.
COCAINE
Cocaine has serious detrimental
effects both acutely and chronically
on the coronary arteries,
heart muscle
and central nervous system
COCAINE
The coronary arteries
Proliferation and thickening of the inner
lining
reduces blood flow.
Premature hardening and narrowing
(atherosclerosis).
(myocardial infarction)
Increased incidence of coronary artery
thrombosis & myocardial infarction).
COCAINE
The heart muscle
myocarditis.
cardiomyopathy.
As a result of this myocardial damage
there is a risk of sudden death due to
cardiac arrhythmia which is most
likely to occur during acute
intoxication
COCAINE
Brain:
Stroke, due to hypertensive blood
vessel rupture
within the brain (intracerebral
haemorrhage) or on the surface of
the brain (subarachnoid
haemorrhage).
Physical:
Constricted pupils
Suppression of cough reflex
Nausea & vomiting
Decreased heart & breathing rate
Unconsciousness,
respiratory arrest
and death
Fatal reaction to impurities
OPIATE ABUSE
Chronic effects:
Tolerance
Physical & psychological
dependence
Constipation
Loss of libido
Complications of intravenous
injection
OPIATE ABUSE
withdrawal syndrome
Symptoms (easily fabricated by
the addict wanting more drugs):
Craving for the drug,
Anxiety, restlessness,
irritability, insomnia
Alternate sweating and
shivering
Generalised aches
Pains and cramps in the back,
OPIATE ABUSE
withdrawal syndrome
Physical signs:
Dilated pupils
Watering of the eyes (lacrimation),
Yawning,
Tachycardia, hypertension
Cold clammy skin with goose flesh
Loudly audible bowel sounds
(borborygmy)
Diarrhoea.