1. Chapter 8 Chapter 8 Toxicology: Poisons and Alcohol “All substances are poisons. There is none which is not. The right dose differentiates a poison and remedy.” —Paracelsus (1495-1541). Swiss physician and chemist

2. Chapter 8 Kendall/Hunt Publishing Company 1 Toxicology Definition—the study of the adverse effects of chemicals or physical agents on living organisms. Types:  Environmental — air, water, soil  Consumer — foods, cosmetics, drugs  Medical, clinical, forensic

3. Chapter 8 Kendall/Hunt Publishing Company 2 Forensic Toxicology  Postmortem—medical examiner or coroner  Criminal—motor vehicle accidents (MVA)  Workplace—drug testing  Sports—human and animal  Environment—industrial, catastrophic, terrorism

4. Chapter 8 Kendall/Hunt Publishing Company 3 Toxicology Toxic substances may:  Be a cause of death  Contribute to death  Cause impairment  Explain behavior

5. Chapter 8 Kendall/Hunt Publishing Company 4 Historical Perspective of Poisoners  Olympias—a famous Greek poisoner  Locusta—personal poisoner of Emperor Nero  Lucretia Borgia—father was Pope Alexander VI  Madame Giulia Toffana—committed over 600 successful poisonings, including two Popes.  Hieronyma Spara—formed a society to teach women how to murder their husbands  Madame de Brinvilliers and Catherine Deshayes— French poisoners. AND many others through modern times.

6. Chapter 8 Kendall/Hunt Publishing Company 5 The Severity of the Problem “If all those buried in our cemeteries who were poisoned could raise their hands, we would probably be shocked by the numbers.” —John Harris Trestrail, “Criminal Poisoning”

7. Chapter 8 Kendall/Hunt Publishing Company 6 People of Historical Significance Mathieu Orfila — known as the father of forensic toxicology, published in 1814 “Traite des Poisons” which described the first systematic approach to the study of the chemistry and physiological nature of poisons.

8. Chapter 8 Kendall/Hunt Publishing Company 7 Aspects of Toxicity  Dosage  The chemical or physical form of the substance  The mode of entry into the body  Body weight and physiological conditions of the victim, including age and sex  The time period of exposure  The presence of other chemicals in the body or in the dose

9. Chapter 8 Kendall/Hunt Publishing Company 8 Aspects of Toxicity The time period of exposure  Chronic exposure Larger amounts spread out over a long period of time Causes medical problems such as weakness, sluggishness, hair & weight loss, mental instability, and skin & liver cancer.  Acute exposure Refers to a dose large enough to cause immediate problems, including death.

10. Chapter 8 Kendall/Hunt Publishing Company 9 Aspects of Toxicity The presence of other chemicals in the body or in the dose or in the dose of the toxin:  Synergism the combination of two chemicals increases their individual effects ex: sedatives and alcohol  Antagonism the combination of two chemicals decreases their individual effects ex: some blood-pressure medicines and OTC cold medicines with decongestants

11. Chapter 8 Kendall/Hunt Publishing Company 10 Lethal Dose  LD 50 —refers to the dose of a substance that kills half the test population (lab rats), usually within four hours.  Expressed in milligrams of substance per kilogram of body weight

12. Chapter 8 Kendall/Hunt Publishing Company 11 Toxicity Classes LD 50 (rat,oral) Correlation to Ingestion by 150 lb Adult Human Toxicity <1mg/kga taste to a dropextremely 1-50 mg/kgto a teaspoonhighly 50-500 mg/kgto an ouncemoderately 500-5000 mg/kgto a pintslightly 5-15 g/kgto a quartpractically non-toxic Over 15g/kgmore than 1 quartrelatively harmless

13. Chapter 8 Kendall/Hunt Publishing Company 12 Some Lethal Doses MaterialLD 50, mg/kg, rats, oral Sucrose (sugar)29,700 Ethanol (ethyl alcohol)7,060 Sodium chloride (table salt)3,000 Caffeine192 Sodium cyanide (spy novels – poison capsules) 6.4 Ricin0.020 Botulin toxin0.000005 – 0.00005

14. Chapter 8 Kendall/Hunt Publishing Company 13 It’s All in the Dose?  “All substances are poisons. There is none which is not. The right dose differentiates a poison and remedy.”  —Paracelsus (1495-1541). Swiss physician and chemist  Hormesis refers to the concept that substances that kill at high dosages are actually beneficial at low dosages.  Ex: botulin used to erase wrinkles and ease migraines.

15. Chapter 8 Kendall/Hunt Publishing Company 14 Federal Regulatory Agencies  Food and Drug Administration (FDA) – deals with pharmaceuticals, food additives, and medical devices.  Environmental Protection Agency (EPA) – works with agricultural and industrial chemicals released to the environment.

16. Chapter 8 Kendall/Hunt Publishing Company 15 Federal Regulatory Agencies  Consumer Product Safety Commission – concerned with toxins in consumer products.  Department of Transportation (DOT) – watches over the shipment of toxic chemcials  Occupational Safety and Health Administration (OSHA) – is concerned with exposure to chemicals in the workplace.

17. Chapter 8 Kendall/Hunt Publishing Company 16 Symptoms of Various Types of Poisoning Type of PoisonSymptom/Evidence  Caustic Poison (lye)Characteristic burns around the lips and mouth of the victim  Carbon MonoxideRed or pink patches on the chest and thighs, unusually bright red lividity

18. Chapter 8 Kendall/Hunt Publishing Company 17 Symptoms of Various Types of Poisoning Type of PoisonSymptom/Evidence  Sulfuric acidBlack vomit  Hydrochloric acidGreenish-brown vomit  Nitric acidYellow vomit  PhosphorousCoffee-brown vomit; onion or garlic odor

19. Chapter 8 Kendall/Hunt Publishing Company 18 Symptoms of Various Types of Poisoning Type of Poison Symptom/Evidence  CyanideBurnt almond odor  Arsenic, MercuryPronounced diarrhea  Methyl alcoholNausea & vomiting, aka wood alcohol unconsciousness  Isopropyl alcoholPossibly blindness aka rubbing alcohol

20. Chapter 8 Kendall/Hunt Publishing Company 19 Critical Information on Poisons  Form  Common color  Characteristic odor  Solubility  Taste  Common sources  Lethal dose  Mechanism  Possible methods of administration  Time interval of onset of symptoms. —John Trestrail from “Criminal Poisoning”

21. Chapter 8 Kendall/Hunt Publishing Company 20 Critical Information on Poisons  Symptoms resulting from an acute exposure  Symptoms resulting from chronic exposure  Disease states mimicked by poisoning  Notes relating to the victim  Specimens from victim  Analytical detection methods  Known toxic levels  Notes pertinent to analysis of poison  List of cases in which poison was used —John Trestrail from “Criminal Poisoning”

22. Chapter 8 Kendall/Hunt Publishing Company 21 To Prove a Case  Prove a crime was committed  Motive  Intent  Access to poison  Access to victim  Death was caused by poison  Death was homicidal

23. Chapter 8 Kendall/Hunt Publishing Company 22 Forensic Autopsy Look for :  Irritated tissues  Characteristic odors  Mees lines—single transverse white bands on nails. Order toxicological screens  Postmortem concentrations should be done at the scene for comparison  No realistic calculation of dose can be made from a single measurement

24. Chapter 8 Kendall/Hunt Publishing Company 23 Human Specimens for Analysis  Blood  Urine  Vitreous Humor of Eyes  Bile  Gastric contents  Liver tissue  Brain tissue  Kidney tissue  Hair/nails