Poisoning

Dr. Lising

 E.g. snake bite

MEDICOLEGAL ASPECT OF POISONING 2. Remote Action
Poisoning o Production of Shock
DEFINITIONS o Absorption into the Blood and carried to the
 Poisoning – harmful effect that occurs when a toxic organs they affect
substance is swallowed, inhaled, or comes in contact with o By Transmission through the nerves of the local
the eyes or the mucous membranes site to the central nervous system and then to the
 Poisons – any injurious substance or beverage, which if organs they control (Neurotoxins)
applied or administered internally or externally, is capable 3. Both Local and Remote
of destroying the action of vital cellular functions, or of o Poison may act at the site of application and in
placing the solids and fluids into such state as to prevent some distant place
the continuance of life
 Thallium poisoning – interferes with cellular Site of Remote Action of the Different Poisons
respiration 1. Brain
 Some poisons are specifically applied dermally o Narcotics, Alcohol, Cerebral Stimulants
like Venom. When bitter, the hemotoxic venom  Usually are ingested
starts breaking the blood, neurotoxic venom 2. Cord
spreads towards the nervous system o Strychnine
 Intent is the central element in the law  an organic poison from a plant that was
 Art 264 of the Revised Penal Code: Administering used in arrows that can cause paralysis
injurious substances or beverages WITHOUT 3. Peripheral Nerves
intent to kill o Conium, Curare
 If there is intent to kill it is now considered 4. Alimentary Tract
MURDER o Corrosives: Acids and Alkalis
5. Salivary Glands
Techniques used to identify poisons
o Mercury
1. Chromatography 6. Liver
 separates the parts of the poison o Phosphorus
o Paper  seen in matches (Red Phosphorus)
o Gas 7. Mucous Membrane
o Liquid o Arsenic
2. Mass Spectrometry 8. Heart
 will give spectrogram where it will be compared to o Digitalis
spectrograms of known substances 9. Blood Vessels
3. Immunoassay o Ergot, Nitrites
 body will create antibodies towards a foreign  Causes vasodilatation
substance. And if harvested, it will neutralize the 10. Blood Cells
toxic substance o Snake venom
 Hemotoxic – will cause breakdown of blood
where hemoglobin will be in the bloodstream.
Hemoglobin is very toxic to the kidneys =
KIDNEY FAILURE
11. Kidneys
o Cantharides

Factors affecting action of poisons

1. Method of Administration
Chromatography Immunoassay  IV route has a faster effect than orally
administered
2. Idiosyncrasy
o Sensitivity to certain foods or drugs
 Some persons are more susceptible to certain
poisons
3. Age
 Extremes of age are more susceptible wherein a
non-toxic dose to a healthy individual can be a
toxic dose to them
4. Habit
o Body may acquire tolerance to some drugs that it
diminishes the effect of certain poisons
Mass Spectrometry o Tobacco, alcohol, opium, barbiturates, arsenic
Site of Action 5. Dose
o Effect of drugs and poisons in the body is usually
1. Local Action proportional to the dose taken
o Act on the skin or on the mucous membrane or 6. State of the Stomach and Kidneys
on any part of the body where it is applied
 Action will be on where the poison is placed

TRANSCRIBERS
Trisha Oberio, Kristine Navarro, Aisle Paler 1 of 3
  Stomach is where it is first administered, in the  Malathion – even if only exposed to skin can
Kidneys, especially the tubules are very cause poisoning. Need A LOT of the antidote
susceptible to poisons before the patient will respond
Method of Administration  Herbicides
 Used to kill weeds
A. Orally (Ingested)  Gaseous Poisons
o Poisons must be digested or absorbed in the  HCN, war gases, tear gases, Sarin, Chloride gas
gastric or intestinal mucosa before producing  Halogenated Hydrocarbons
effect  CFCs, Carbon pentachloride – most commonly
o Except irritants and corrosives used in dry cleaning
B. Hypodermically (Injected)
 Gasoline and Kerosene
o Reaches the blood stream without passing the
 If ingested, once it enters the body, it vaporizes.
digestive organs
So instead of just ingestion, you will also have
o Substances that are soluble in the lymph and
inhalation.
tissue juices
 Needs to treat both, needs Intubation
C. Intramuscularly (Injected)
 Ethylene Glycol
o Absorption is faster than in the hypodermic
 Anti-freeze – has a sweet taste that it could easily
method
be misidentified as a non-toxic substance
D. Endodermically
 Nicotine
o Poison may be rubbed into and absorbed through
the skin  Vape – has liquid nicotine. “safer” because it has
E. Rectum, Vagina or Bladder (Inserted) no or lesser carcinogens than tobacco. But still
o Absorption through the rectum is about twice as Nicotine is dangerous
much as absorption through the mouth  Carcinogens
F. Lungs (Inhaled)  Food poisoning
o Substance which can be transformed to gaseous
state Classification of Poisons
 Corrosives
Dose  Irritants
 Fatal Dose – smallest dose known to cause death  Narcotics
 Toxic Dose – Smallest dose to produce symptoms or  Depressants
disability  Exito-motor Poisons
 LD50 – minimum lethal dose to cause death in half the test  Poisonous and Irrespirable Gases
animals.  Contact Poisons
 Statistical measurement. The dose wherein 50% of  Vulnerants
test animals dies. Not the same as the toxic dose
CORROSIVES
 Most commonly used
 In Acids and Bases ingestion, do not put NGT because it
can perforate the esophagus
Strong Acids o Acids such as Sulfuric Acid, Nitric Acid
 Causes smaller damage than alkali
Caustic Alkalis o Hydroxides such as Lye
 Can melt your esophagus that will turn
to fibrosis. Surgical management is
needed
LD50 Compounds o Zinc Chloride
o Antimony
Functional Classifications of Poisoning
IRRITANTS
 Stimulants, Excitants and Hallucinogens
o Amphetamines, LSD, Cocaine, Ecstasy, Non-metals
Ketamine Salts of Metals
 Convulsant poisons Vegetable Irritants o Castor Oil – can cause diarrhea
o Strychnine o Digitalis
 causes convulsions from its action in the spinal o Belladonna
cord o Croton Oil
 Tranquilizers
o Hypnotics and Sedatives Animal Irritants o Cantharides
 Benzodiazepines, Midazolam, Barbiturates  can cause burning of the skin
 Hypoglycemics
 Most potent Food Irritants  Food allergies
o Insulin
 Overdose in insulin can cause seizures NARCOTICS
 Corrosive and Metallic Poisons Somniferous o Opium, Choral Hydrate, Synthetic
 Acids and Bases Group Hypnotics
 Metallic Poisons: Thallium, Arsenic Deliriant o Belladonna
 Agro-chemical poisons o Hyoscyamus
 Insecticides like Malathion o Stamonium
o Cocaine

Poisoning 2 of 3
DEPRESSANTS NBI Classification
Neural o Aconite  4 Major Classifications according to NBI
Depressants –  from wolfsbane plant, used A. Gaseous Poisons
Paralysis of the primarily as an arrow poison B. Inorganic Poisons
Spinal Cord o Conium 1. Corrosives
 from hemlock or poison hemlock  Acid
Cerebral o HCN – usually seen in sweet potatoes  Alkali
Depressants – Oil of Bitter Almond  Halogens
Inhibiting Brain  Corrosive Mineral Salts
function  Organic Corrosives
2. Metallic Poisons and Salts
Cardiac o Digitalis  Heavy Metals
Depressants o Camphor  Inorganic Salts
 from camphor laurel or evergreen C. Organic Poisons
plant. It has a very distinct smell. 1. Volatile Poisons
No effect if inhaled, by poisonous 2. Alkaloidal Poisons
if ingested 3. Non-alkaloidal Poisons
D. Miscellaneous Poisons
POISONS THAT ARE EXITO-MOTOR IN ACTION 1. Food Poisoning
2. Poisonous Plants
Strychnine  Neuromuscular junction blocker that
3. Animal Venom
can stop breathing
 There is no standard classification of poisons, it usually is
Brucine  Neuromuscular junction blocker that dependent on the institution where it is processed
can stop respiration
Thebaine  Opiate derivative. Over ingested can Medical Examination of Poisoning
cause convulsions  History
o Previous Suicidal Attempts
POISONS AND IRRESPIRABLE GASES o Mental conditions such as depression
Poisonous Gases o CO2, CO, H2S, CS2, Arseniureted o Social History – business, marital and social
Hydrogen failures
 Even if the body still has oxygen, but if o History of conflicts
the carbon dioxide reached a certain o Possible source of poisons
level, a person will lose consciousness o Order of occurrence of symptoms
because the body will interpret this as  In Thallium poisoning, there is the
no oxygen presence of Mee’s line in the nails

Irrespirable Gases o Chlorine

 Mostly used in WWI
o Benzene
o HCN

WAR GASES
Lacrimator or Tear Gas o Chloroacetophenone
 found in mace sprays
Vesicant or Blistering Gas o Mustard Gas Tokyo Sarin Attack in 1995 Mee’s line
o Lewisite
Lung Irritants o Chlorine
o Phosgene Gas Actions needed to be taken
Stermutator (Vomiting Gas)
 Call PGH Poison Control if patient is suspected to have
 Gas)
Paralysants (Nerve Sarin
been poisoned.
Blood Poisons  HCN
 Gather samples of the vomit, urine, feces, nail clippings,
TOKYO SARIN ATTACK 1995 hair or other discharge for possible analysis.
 Perpetrated by Aum Shinrikyo
 Released Sarin Gas which is a nerve agent to the Tokyo
Subway
 They did not know how to deliver sarin gas properly that’s
why it has a smaller effect
CONTACT POISONS
 Vegetable Irritants
 Animal Irritants
 Chemical Irritants
VULNERANTS
 Usually are found incidental in food References
 E.g. while drinking Coke, you found shards of glass in the
 MCKB trans
bottom of the bottle
 Recording from previous trans 
 Nails
 Sorry no Book Summary for this topic. If you have the
 Broken Glasses
book, read Vol. 2 Chapter 12.
 Dust

Poisoning 3 of 3