This document discusses various topics related to toxicology including common types of poisoning, mechanisms of toxicity, signs and symptoms, and procedures for sample collection and analysis. It covers accidental, homicidal, and suicidal poisoning. Key points include how toxicity depends on dosage, routes of administration, rates of absorption and metabolism, and individual susceptibility. Fatal overdoses of various substances like ethanol, opioids, and stimulants are addressed.

2.  How common?
 Fatality
 What is poisoning?
 Adverse effect on cells, tissues, organs and organisms (toxicity)
 Anything can be toxic if it is ingested in sufficient quantity

3.  Self inflicted
 Accidental: house, industry, agriculture
 Homicide
 Suicidal poison is most common mode in female
 Common: aspirin, paracetamol, anti-depressant
 Corrosives are less common now

4.  Is it fixed dose?
 Lethal dose 50% (LD50):
 The dose of drug that cause death in half of tested animals
 Death can occur with lower dose
 Not all subject have same response
 Distribution of drug postmortem

5.  How long did it take to death to occur?
 What is absorption rate?
 What is the rate of metabolism?
 What is the rate of excretion?
 Is the analysis correct

6.  Tolerance
 Dependence (addiction)
 Synergy
 Idiosyncrasy

7.  Recognize
 Treat
 Retain drugs
 Cooperate with investigation
 Continuity of Evidence
 Common symptoms:
 Sudden vomiting/diarrhea
 Unexplained coma in depressed person
 Peripheral neuropathy
 Sudden CNS/GIT illness
 Self administration of poison (Munchausen’s Syndrome)

8.  Blood:
 Femoral/iliac
 ?heart ?Body cavity (not recommended)
 Contamination/diffusion
 Plain tube 15 ml
 Anticoagulant 10 ml
 Sodium fluoride tube 5 ml (for alcohol leve)

9.  Urine:
 20-30 ml in universal container
 Vomit
 Feces:
 20-30 g
 Heavy metal: arsenic, mercury, lead
 Liver, Lung
 Hair, Nail:
 Heavy metals

10.  Most common drug in the world
 Ethanol is small water soluble molecule
 Distribute evenly in the body
 Easily cross the blood-brain barrier
 Depressant effect
 Direct effect
 Indirect effect: accidents and assaults

11.  Yeast fermentation of sugar
 Beer 3-6 %
 Wine: 9-12%
 Whisky, vodka: 35-35%
 Unit of measure:
 Weight per volume (in grams per liter)
 One unit: 8 grams of alcohol
 Beer 300 ml: one unit
 Wine 100 ml: one unit
 Whisky 25 ml: one unit

12.  General guide:
 Men can handle 21 units per week
 Women can handle 14 units per week

13.  Stomach, duodenum and jejunum
 Factors affecting absorption:
 Stomach emptying
 Irritation
 Food, fatty food
 If stomach is empty 30-90 minutes are needed to complete
absorption

14.  90% metabolized in liver
 10% excreted by kidney, sweat and urine
 Rate is variable
 Chronic alcoholics have induced cytochrome P450
 Non-alcoholics can handle one unit per hour

15.  Blood alcohol concentration (BAC)
 Urine is more concentrated
 Breath alcohol test:
 1 mg/dl in blood ---- 0.34 micro gram/dl in breath

16.  With 30 mg/dl in blood
 In UK the limit is:
 80 mg/dl in blood
 35 mg/dl in breath
 107 mg/dl in urine

17.  Consent
 History
 Exam
 Test
 Sampling

18.  30-50 mg/dl: impaired driving skills
 50-100: talkativeness, laugh
 100-150: incoordination, slurred speech
 150-200: obvious drunk, nausea, ataxia
 200-300: vomiting, coma
 300-350: coma, aspiration
 350-450: death, respiratory paralysis

19.  Fall
 Head injury
 Pedestrian victim
 RTA
 Violence: fight, assault, injuries
 Burn

20.  Diseases:
 Liver disease
 Wernicke encephlopathy
 Korsakoff syndrome
 Cardiomyopathy

21.  World-wide problem
 Tolerance and Synergy
 Tolerance: The dose does not produce the effect
 Natural tolerance
 Acquired tolerance
 Cross-tolerance
 Synergy: eg. Alcohol and ether

22.  Inability of the user to give up
 Part is psychological
 Anxiety, muscle twitching, tremors, diarrhea, incontinence,
restlessness, insomnia, tachycardia, hypertension

23.  Problems:
 Phlebitis, thrombosis
 Fibrosis of skin
 Ulceration and atrophy
 Fat necrosis
 Septecemia
 T.B, pneumonia, infections Hep B, Hep C

24.  Dissolved in contaminated water
 Solid particles in vessels
 Micro emboli in lung

25.  IV heroin
 Contaminated material
 Hypersensitivity reaction
 Left ventricular failure
 Pulmonary edema
 Accidents, falls
 Violence, murder

26.  Codeine and Pethidine
 Heroin: injection or inhaled
 CNS depressant
 Excitation due to dis-inhibition

27.  Pinpoint pupills
 Sweating, warm skin
 Low blood pressure
 Slow breathing
 Respiratory arrest
 Arrhythmia
 Toxicity of pethidine:
 Dilated pupills
 Tachycadia
 Dry mouth

28.  Used to be common
 Phenobarbitone used in epilepsy

29.  Benzedrine, dexedrine
 Hyer excitement
 Hallucination
 Psychosis
 Hyperpyrexia, hypertension
 Subarachnoid hemorrhage

30.  Hashish, Marihuana
 Does not cause death

31.  Inhaled or injection
 Some smoke
 Few physical signs of withdrawal
 Check and swab nostril
 Ulceration in nasal septum
 Hypertension
 Dilated pupils
 Sweating
 Confusion
 Respiratory depression
 Scarring in heart
 dysrrhythmia