Chapter 8 Toxicology: Poisons and Alcohol

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 ( ). Swiss physician and chemist Kendall/Hunt

Chapter 8 “All substances are poisons. There is none which is not. The right dose differentiates a poison and remedy.” —Paracelsus ( ). Swiss physician and chemist Kendall/Hunt

Kendall/Hunt Publishing Company
Chapter 8 Was Paracelsus right? Take arsenic for example: We all know that arsenic is poisonous, yet we take in compounds of arsenic through he water we drink and the foods we eat, because it is a naturally occurring substance. Kendall/Hunt Publishing Company Kendall/Hunt

Long-term exposure to arsenic via drinking-water causes cancer of the skin, lungs, urinary bladder, and kidney, as well as other skin changes such as pigmentation changes and thickening (hyperkeratosis). Kendall/Hunt Publishing Company

Chapter 8 Some research indicates that trace amounts of arsenic will affect humans in positive ways. Scientists know that arsenic deficiency stunts growth in chickens, rats, pigs, and goats. Kendall/Hunt Publishing Company Kendall/Hunt

Way back in July of 2011, we first told you about told you about the the extremely high levels of arsenic found in Mott’s Apple Juice. Then in September Dr. Oz and his team, ran their own tests and found that it was true; most apple juice brands contained more arsenic than the EPA deems safe in drinking water. Kendall/Hunt Publishing Company

Chapter 8 In the past, arsenic compounds have been used as a remedy for everything from asthma to jealousy! Even in the early 20th century, an organic arsenic compound was used to treat syphilis until penicillin fortunately became available in the early 1940’s. Arsenic is now used to treat a rare kind of cancer. Kendall/Hunt Publishing Company Kendall/Hunt

Specifically, a form called arsenic trioxide has been used as a therapy for a particular type of leukemia for more than 10 years. Now researchers at the Stanford University School of Medicine have shown that it may be useful in treating a variety of other cancers. Kendall/Hunt Publishing Company

Clostridium botulinum
Scientists think of botulin, produced by the bacterium Clostridium botulinum, as the most deadly poison known (one gram evenly spread out and inhaled would kill more than a million people), yet doctors are now using botulin to erase wrinkles and to prevent migranes. Kendall/Hunt Publishing Company

Is there anything for which Paracelsus’s “rule” doesn’t work?
Chapter 8 Is there anything for which Paracelsus’s “rule” doesn’t work? The term hormesis refers to the concept promoted by Paracelsus: that substances that kill at high doses are actually beneficial at low doses – *****the poison is in the dosage. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 The History of Poisons Kendall/Hunt

Historical Perspective of Poisoners
Chapter 8 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. Kendall/Hunt Publishing Company Kendall/Hunt

During the European Renaissance, poisoning became an art, even an occupation or a hobby. Kendall/Hunt Publishing Company

Chapter 8 The earliest recorded use of poison was Socrates’ execution in 339 B.C. with an extract of hemlock. Common poisons at the time came from plants such as hemlock, monkshood, beladonna, and toxic metal salts, with arsenic being by far the favorite. It left no trace, it was easy to get and use, and the symptoms looked like death by natural causes. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Poison Hemlock Poison hemlock is not an evergreen tree, but a plant related to the carrot. It contains an alkoloid similar to nicotine. Alkaloids are organic compounds, derived from amino acids, that especially affect the nervous system. Kendall/Hunt Publishing Company Kendall/Hunt

Toxic metal salts monkshood beladonna Kendall/Hunt Publishing Company

Chapter 8 Now, with modern analytical instruments, it is easier than ever to find poisons, yet people still use them for murder and suicide. Kendall/Hunt

Chapter 8 Some of the factors that influence the effects of poisons in the body are: A. The chemical or physical form of the substance B. How it enters the body C. Body weight and physiological condition f the victim, including age and sex D. The time period of exposure E. Whether other chemicals are present in the body or in the dose. F. Dosage Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 For example . . . Arsenic is a metal, rather insoluble in stomach acid, and thus is not particularly poisonous. On the other hand, the compounds of arsenic trioxide (As2O3) and arsenic pentoxide (As2O5) are very poisonous. Arsenic can also be changed into a poisonous gas, arsine (A5H3) which is used in the Marsh Test. Kendall/Hunt Publishing Company Kendall/Hunt

Forensic toxicology was developed in the 19th century.
Chapter 8 Forensic toxicology was developed in the 19th century. In 1814 Mathiew Orfila published “Traits’ des Poisons,” the first systematic approach to the study of the chemistry of poisons. Most of the important alkaloids present in plants were isolated in the 1800’s. Kendall/Hunt Publishing Company Kendall/Hunt

The Marsh Test In 1836 a chemist named James Marsh developed a very sensitive and reliable test to detect arsenic in body tissues and fluids. It was called the Marsh Test. Kendall/Hunt Publishing Company

Marie Lafarge and the Marsh Test
Chapter 8 Marie Lafarge and the Marsh Test In 1840 the Marsh test came to popular attention in the trial of Marie Lafarge, charged with killing her husband, who died after eating a slice of her cake. Marie Lafarge, notably unhappy with her arranged marriage to the owner of a rat-infested forge, was accused of using arsenic as a murder weapon. Their maid swore that she had seen Marie adding a white powder to his drink and it was shown that she had twice bought arsenic oxide from the local pharmacy, supposedly to kill rats at her husband’s forge. Application of the Marsh test to his body showed no arsenic present, though it was detected in food in the Lafarge house. Orfila, appearing for the defense, claimed that the test was unreliable; however, when he himself applied the test to the body, he found arsenic. Kendall/Hunt Publishing Company Kendall/Hunt

In 1832 police arrested John Bodle for lacing his grandfather's coffee with poison. Chemist James Marsh tested the drink in his laboratory, and confirmed the presence of arsenic by producing a yellow precipitate of arsenic sulfide. But the precipitate was unstable and, by the time of trial, had deteriorated. Without forensic proof, Bodle was acquitted. Stung by the verdict, Marsh devised a test that could better stand up in court. His 1836 "Marsh Test" won worldwide acclaim and became a standard procedure. But in subsequent decades Marsh's test was shown to be problematic, and in turn underwent a series of improvements. Kendall/Hunt Publishing Company

Chapter 8 Intake of Toxins We think of poisons as being swallowed, yet some substances are more toxic when injected, such as some recreational drugs. Other substances can be absorbed through the skin, such as some particular nasty chemical warfare agents. Inhaling many common industrial chemicals causes health problems; Exposure is regulated by government agencies. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Infants are more susceptible to toxins than adults. Old age can also weaken the body’s ability to fight poisons. Kendall/Hunt Publishing Company Kendall/Hunt

The time period of exposure to toxins is very important.
Chapter 8 The time period of exposure to toxins is very important. Small amounts of arsenic ingested over time will actually build up a tolerance for the poison. Chronic exposure smaller amounts over a longer period of time will causes medical problems such as weakness, sluggishness, hair and weight loss, mental instability, and skin and liver cancer. Acute toxicity refers to a dose large enough to cause immediate problems, including death. Occurs almost immediately upon exposure. Large dose over a short period of time. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 The product information that comes with some antihistamines and sedatives clearly says that they should not be taken with alcohol, which would make the effects of both stronger. Synergism – the combination of two chemicals can increase their individual effects. The sum of their individual effects. Antagonism – the combination of two chemicals can decrease their individual effects. Taking a chelating agent (an organic compound that complexes with a metal to form a ring structure) after swallowing an arsenic compound will decrease the effects of both. Kendall/Hunt Publishing Company Kendall/Hunt

Synergism Kendall/Hunt Publishing Company

Antagonism Kendall/Hunt Publishing Company

Chapter 8 Over the years, scientists have developed ways to measure toxicity. . .however . . . Because of the variables involved, there is no sure way to measure poison levels in humans, even using (accidental) human results. Instead, scientist use standardized animal toxicity tests, most often by feeding a chemical to rats or mice. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 LD50 The term LD50 (or lethal dose) refers to the amount of a substance that kills half of the test population, usually within four hours. It is given in milligrams (mg) of substance per kilogram (kg) of body weight. LD50 allows scientists to compare the toxicity of substances and even scale the amounts to different sized animals. Animal Welfare Act Passed into law in 1966, this act ensures that pets and animals used in research and for exhibition purposes are provided humane care and treatment. Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Nicotine Estimating lethal doses in humans based on those for lab mice, rats, or rabbits is very uncertain because resistance can be so different between species. For example: Nicotine kills: humans at 0.9 mg/kg in dogs is 9.2 mg/kg, in pigeons is 75 mg/kg in rats is 53 mg/kg Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Toxicity Classes (all substances can be toxic depending on the dosage!) LD50 (rat,oral) Correlation to Ingestion by 150 lb Adult Human Toxicity <1mg/kg a taste to a drop extremely 1-50 mg/kg to a teaspoon highly mg/kg to an ounce moderately mg/kg to a pint slightly 5-15 g/kg to a quart practically non-toxic Over 15g/kg more than 1 quart relatively harmless Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Testing on Animals Animal Welfare Act Passed into law in 1966, this act ensures that pets and animals used in research and for exhibition purposes are provided humane care and treatment. Because a single test may kill as many as 100 animals, the United States and other embers of the Organization for Economic Cooperation and Development agreed in December 2000 to phase out the LD50 test in favor of alternatives that greatly reduce (or even eliminate) deaths of the test animals. Kendall/Hunt Publishing Company Kendall/Hunt

The 3 most lethal compounds are natural products
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Ricin Ricin – castor oil bean product. it is present in the mash that is left over after grinding castor beans into oil. Ricin works by getting into the cells of the body and preventing the cells from making the proteins they need. Without proteins the cells die. Eventually death will occur. The effects of Ricin poisoning depends on whether ricin was ingested, inhaled, or injected. Kendall/Hunt Publishing Company

Chapter 8 Dioxin Poisoning In December 2004, doctors confirmed that Viktor Yshchenko, the Ukrainian presidential candidate running against the old line Russian establishment, was suffering from dioxin poisoning. This isotope of dioxin (TCDD) is as toxic as ricin, so one drop of the pure substance would undoubtedly have killed him. Unlike ricin, however, the fat soluble dioxin is more of a chronic poison; thus he may have been fed small amounts of the material over time. Doctors found blood levels of dioxin 6,000 times or more than normal. One symptom of dioxin poisoning is the outbreak of facial cysts, which were quite evident in photographs of Yshchenko. TCDD was one of the contaminants found in Agent Orange that caused so many medical problems in Vietnam War Veterans Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 Dioxin Poisoning Kendall/Hunt Publishing Company Kendall/Hunt

Ukraine's Prosecutor General's Office Questions Yushchenko Poisoning Kendall/Hunt Publishing Company

Dioxin Dioxin - Dioxin gets into the air when we burn waste with chloride: for example advertising papers, plastic, straw and milk cartons . Victims of the Seveso accident suffer from a range of dental problems – abnormal enamel, missing incisors and impacted canines During the war in Vietnam more than 18 million gallons of dioxin-laden Agent Orange and other herbicides were sprayed over ten per cent of South Vietnam between 1961 and 1971, poisoning and defoliating millions of hectares of forest and croplands. In neighboring Laos about half-a-million gallons of herbicide were sprayed over 80,000 hectares. Kendall/Hunt Publishing Company

Vietnam 35 Years Later: Agent Orange 5:01 Kendall/Hunt Publishing Company

Clostridium Perfringens food poisoning
Clostridium food poisoning is usually caused by Clostridium Perfringens. The bacteria may contaminate gravies or cooked meats that have been kept too long at room temperature before they are eaten. At room temperature, the bacteria grow in the contaminated food and produce a toxin that can kill cells along the inside lining of the intestines. Symptoms of food poisoning usually begin within seven to 15 hours of eating the contaminated food. C. botulinum is a very deadly bacteria that causes a disease known as botulism. Kendall/Hunt Publishing Company

Symptoms of botulism food poisoning
Symptoms of botulism may include dry mouth, difficulty swallowing, slurred speech or difficulty speaking, muscle weakness, blurred vision, double vision, and drooping eyelids. Symptoms usually appear 12 to 36 hours after consuming Clostridium botulinum toxin; however, symptoms can occur as early as 6 hours or as late as 10 days following the consumption of contaminated food. Botulism can be fatal, and should be treated as a medical emergency. If left untreated, muscle paralysis may progress to the arms, legs, trunk, and respiratory muscles, possibly resulting in death. A patient with severe botulism poisoning may require use of a breathing machine and intensive medical care for several months. Patients may experience fatigue and shortness of breath for several years following their recovery from botulism poisoning Kendall/Hunt Publishing Company

Salmon Honey The Botulism Movie - Disease Project :05 Botulism – UK 7:18 Kendall/Hunt Publishing Company

Botulin toxin - The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased. Gas gangrene is a serious wound infection that can follow a "dirty" wound (car accident, crush injury, farm accident, factory injury). Clostridium bacteria from the intestines or the soil contaminate the wound and produce toxins that destroy skin and muscles nearby. As the bacteria grow in the wound, they also manufacture "gas" as a by-product, and this gas can often be seen by health care providers when they look at x-rays or scans of the wound area. Although at least seven different types of Clostridium bacteria may cause gas gangrene, about 80 percent of cases are due to Clostridium Perfringens. Kendall/Hunt Publishing Company

May 5, 2009: Botulinum Toxin Products Labeling Change: Black Box Warning BOTOX®, Myobloc®, and Dysport® all contain the same toxin that causes botulism. The FDA has mandated the Black Box Warning following reports that the effects of the botulinum toxin may spread from the injection site to other areas of the body, causing symptoms similar to those of botulism, including unexpected loss of strength or muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids. Kendall/Hunt Publishing Company

Chapter 8 Lead Poisoning Lead compounds are not highly poisonous, but chronic exposure to lead poses a real health problem for many Americans, especially children, who are far more at risk for lead poisoning. The National Safety Council estimates that there are more than 400,000 children under the age of 6 who have higher than normal blood levels of lead. This can lead to subtle brain damage, affecting memory and thought processes as measured, for example, by IQ tests. Kendall/Hunt Publishing Company Kendall/Hunt

Lead Poisoning Symptoms

The most common method of exposure is contact with lead based paints.
Chapter 8 The most common method of exposure is contact with lead based paints. Before these were banned in 1978, lead was a common ingredient in paint. One of the strange properties of lead compounds is that they taste sweet, so a child teething on a windowsill, for example, will want more mouth contact. It is estimated that there are still more than 38 million houses in the U.S. that contain some lead based paint. In 1992, the federal government passed a law requiring anyone selling an older house to certify that no known lead based paint is present. Kendall/Hunt Publishing Company Kendall/Hunt

How do you know whether there is lead in paint?
Chapter 8 How do you know whether there is lead in paint? Two chemical properties are commonly used as a qualitative spot test. The reaction of dissolved lead with sulfide ion to for insoluble, brown-black lead sulfide A reaction with an organic complexing agent, sodium rhodizonate, to make a characteristic pink color. Neither of these tests is specific to lead compounds, but it is unlikely that interfering substances in the paint will give a false positive. Kendall/Hunt Publishing Company Kendall/Hunt

Other sources of lead in the everyday environment
Chapter 8 The ban of leaded gasoline in 1995 reduced a source of environmental lead, but tons still remain in our soils. Lead has been found in soil and dirt along highways and even in school playgrounds. Leaded Gas In 1986, a nationwide ban restricted the use of lead pipes in homes, yet some towns still have older lead pipes, carrying drinking water in their systems. This is not normally a problem because metallic lead is so insoluble, but if the water is acidic, lead can be leached from the metal. Solder joints in older houses contain lead. Lead crystal glassware and some ceramics should not be used to store acidic food and drink. X-ray shielding Kendall/Hunt Publishing Company Kendall/Hunt

Chapter 8 The public’s ignorance about the possible toxicity of tested drugs, environmental agents, and industrial chemicals has prompted the federal government to create regulatory agencies to ensure public safety. Food and Drug Administration (FDA) Deals with pharmaceuticals, food additives, and medical devices. Environmental Protection Agency (EPA) works on agricultural and industrial chemicals released to the environment. Consumer Product Safety Commission Concerned with toxins in consumer products Occupational Safety and Health Administration (OSHA) Concerned with exposure to chemicals in the workplace. Kendall/Hunt Publishing Company Kendall/Hunt

Poisons Poisons generally enter the body in a single massive dose or accumulate to a massive dose over time. Poisons can be counteracted by prompt treatment and most organ damage (except for serious CNS injury) may be repairable. While poisons are identifiable by their symptoms, many toxins tend to disguise or mask themselves. Kendall/Hunt Publishing Company

Symptoms of Various Types of Poisoning
Chapter 8 Symptoms of Various Types of Poisoning Type of Poison Symptom/Evidence Acids (nitric, hydrochloric, sulphuric) Burns around mouth, lips, and eyes. hydrochloric – greenish brown vomit; nitric acid – yellow vomit; sulfuric – black vomit Arsenic (metals, mercury, copper) Severe unexplained diarrhea Bases (lye, potash, hydroxides) Burns around the mouth, lips, and eyes Caustic Poison (lye) Characteristic burns around the lips and mouth of the victim Carbolic acid (or other phenols) Person smells like disinfectant Carbon Monoxide Red or pink patches on the chest and thighs, unusually bright red lividity Cyanide Quick death, red skin color burnt almond odor Food poisoning Vomiting, abdominal pain Metallic compounds Diarrhea, vomiting, abdominal pain Nicotine Convulsions Oxalic Acid (Phosphorous) Coffee brown vomit. Onion or garlic odor Sodium Fluoride Convulsions Strychnine Dark face and neck, convulsions Methyl (wood) or Nausea and vomiting, unconsciousness, Isopropyl (rubbing) alcohol possibly blindness Kendall/Hunt Publishing Company Kendall/Hunt

Deaths Caused by Poisoning
The true incidence of poisoning in North America is unknown. Approximately 2 million cases are voluntarily reported to poison control centers each year, and officially, a rather steady figure of about 700 deaths by poisoning is reported each year. Children account for the majority of reported poisonings, but adults account for the majority of deaths by poisoning, most of which is intentional rather than accidental. Kendall/Hunt Publishing Company

Deaths caused by Poisoning
Most Frequent Cause of Reported Poisonings: 1. household cleaners 2. analgesics (aspirin, acetaminophen) 3. cosmetics 4. cough and cold remedies 5. plant scapes, insect bites 6. pesticides 7. topical creams 8. hydrocarbons (gasoline, kerosene) 9. antibacterial soap 10. sedatives/hypnotics/antipsychotics 11. food poisoning 12. alcohol Most Frequent Cause of Death by Poisoning 1. antidepressant drugs 2. analgesics (aspirin, acetaminophen) 3. street drugs 4. cardiovascular drugs 5. alcohol 6. gases and fumes 7. asthma therapies 8. industrial chemicals 9. pesticides 10. household cleaning supplies 11. anticonvulsant drugs 12. food, plants, and insects. Kendall/Hunt Publishing Company

How are poisons detected in an autopsy?
A sequence of analyses by forensic toxicologists may detect and identify a number of poisons in commonly available specimens. urine stomach contents and scene residues Kendall/Hunt Publishing Company

Chapter 8 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 Kendall/Hunt Publishing Company Kendall/Hunt

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

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

Chapter 8 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 Kendall/Hunt Publishing Company Kendall/Hunt

The Severity of the Problem
Chapter 8 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” Kendall/Hunt Publishing Company Kendall/Hunt

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

Critical Information on Poisons
Chapter 8 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 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” Kendall/Hunt Publishing Company Kendall/Hunt

How to Avoid Potential Toxic Poisoning at Home 3:46 Keep your Home Safe for Kids 3:46 10 Poisonous Foods We Like to Eat 2:11 Top 10 Most Polluted Cities in the World 2:27 Kendall/Hunt Publishing Company

Chapter 8 Toxicology: Poisons and Alcohol

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