TOXICOLOGY

TOXICOLOGY – the branch of science which treats of poison, their origin, physical and chemical
properties, physiological action, treatment of their noxious effect and methods of detection.

TOXICOLOGY:

TOXIC – means poison

OLOGY – means science

Poison – from the medical point of view, is a substance which when introduced into the body and is
absorbed through the blood stream and acting chemically is capable of producing noxious effect or even
causes death.

CLASSIFICATION OF POISON

1. According to kingdom

▪ Animal – ex. Cantharides

▪ Vegetable – ex. Strychnine

▪ Mineral – ex. Hydrochloric acid

2. According to chemical properties

A. Inorganic poisons

▪ Volatile and non-volatile – ex. Bromine, chlorine, iodine, sulfuric acid

▪ Mineral acid – ex. Hydrochloric acid

Mineral Alkali – ex. Sodium hydroxide

B. Organic poisons

▪ Volatile – ex. Alcohol, chloroform

▪ Alkaloids – ex. Strychnine

Alkaloids – are nitrogenous organic basic compound with bitter taste containing usually oxygen
that occurs especially in seed plants.

▪ Animal poison – ex. Snake venom

▪ Bacterial poison – ex. Ptomaine

▪ Organic poison – Salicylic acid

 ▪ Glucosides – ex. Digitalis

4. According to physical Actions

❖ Corrosives – these are highly irritant poisons which cases local destruction of tissues and
characterized by nausea, vomiting, and great local distress. Ex. Strong acids and alkalis.

❖ Irritants – One which produces irritation or inflammation of the mucus membrane and
characterized by vomiting, pain in abdomen, and purging. Ex. Arsenic

❖ Narcotics – poisons which produce stupor, complete insensibility or loss of feeling.

Ex. Opium, Demerol, cocaine.

Neurotics – one which act chiefly on the nervous system

❖ Tetanics – substance which acts directly upon the spinal column producing such spasmodic and
continuous contraction of muscles as a result of stiffness or immobility of the parts to which
they are attached.

❖ Depressants of sedatives – agents which retard or depress the physiological action of organ.

Ex. Nicotine and cocaine

❖ Aesthenics or exhaustive – agents which produce exhaustion, marked loss of vital or muscular
power.

Ex. Hyrdrocyanic acid.

4. According to Pharmacological Action

• Substance characterized but local action.

Ex. Volatile oils, skin irritants

• Substances characterized by their action after absorption.

Ex. Alkaloid

• Heavy metals and metalloids.

Ex. Arsenic and mercury

5. According to method isolation

• Volatile poisons and those that are isolated by distillation with or without current of steam.

Examples: alcohol, phenol, chloroform

 • Non-volatile poisons – those that are isolated by extraction with organic solvents.

Examples: alkaloids, organic acids

• Metallic poisons

Examples: arsenic, mercury

• Substances for which special method of isolation are required.

Examples: acids and alkali metals are extracted by water.

TYPES OF POISONING

1. From medical point of view.

2. From the legal point of view.

TYPES OF POISONING FROM THE MEDICAL POINT OF VIEW

1. Acute poisoning – one in which there is prompt and marked disturbance of function or death
within a short time due to either taking a strong poison in excessive single dose or several doses
at short interval.

2. Sub-acute poisoning – cases of short duration and extreme violence which may include
symptoms of chronic poisoning

3. Chronic poisoning - a kind of poisoning in which there is gradual deterioration of tissue function
and may or may not result in death. It is produced by either taking several small doses at long
intervals or taking only toxic doses of the drug.

TYPES OF LEGAL POISONING FROM THE LEGAL POINT OF VIEW

1. Accidental poisoning – those in which the poison was taken without intention to cause death. It
may be taken by mistake or without knowing that it is poisonous.

2. Suicidal poisoning – those in which the poison was taken by the victim voluntarily for the
purpose of taking his own life.

3. Homicidal poisoning – those in which the poison was given willfully and with intent to cause the
death of the victim.

4. Undetermined – those in which the history is hazy as to how the poison was obtained and why it
was administered.
ACTIONS OF POISONS

a. Local – the changes or disturbance produced on the part with which the poison comes in
contact. Ex. The corrosions produced by corrosive poisons

b. Remote – the changes or disturbance produced in distant part from the site application. Ex
Dilation of the pupils when belladonna is taken orally.

Combined – the effect of the poison is not only localized on the site but also affect remote organs. Ex.
Phenol causes corrosion of the gastro-intestinal tract (local) and causes convulsion (action on the cord).

CONDITIONS MODIFYING THE ACTION OF POISONS

A. THOSE ATTRIBUTED TO THE INDIVIDUAL

• Age and sex

• Health

• Habit – the repeated taking of small doses of drug

• Idiosyncrasy – a term applied to individuals who exhibit unusual reactions to certain substances.

• Diseases

• Food

• Sleep

Exhaustion

B. THOSE ATTRIBUTED TO THE POISON:

• Physical stated or form of the poison

• Dilution

• Solubility if the poisons

• Mode of administration at one time

• Chemical combination

• Mechanical combination

• Dose – is the quantity of a poison to be administered.

• POSOLOGY – a branch of science, which treats the form and quantity of medicine to be
administered within a certain period of time.
KINDS OF DOSE

1. Safe dose – one that does not cause any harmful effect.

2. Toxic or Poisonous dose – one that is harmful to both the healthy and sick

3. Lethal dose – one that kills

4. Minimum dose – is the smallest amount that will produce the therapeutic effect without causing
harm.

5. Maximum dose – is the largest amount that will cause no harm and at the same time produces
the desired therapeutic effect

ENTRANCE OF POISON

POISON MAY ENTER THE BODY THROUGH:

1. Mouth are absorbed into the circulation after passing through the stomach and intestinal wall.

2. The noses and enter the blood from the upper respiratory passages or lungs.

3. Eyes

4. Rectum, vagina, urethra, bladder and ureter by injection.

5. Hypodermic injection

Intravenous injection

ELIMINATION OF POISONS

Poisons may be eliminated by:

1. Emesis

2. Respiration

3. Feces

4. Urine

5. Milk

6. Saliva

7. Sweat

8. Tears
DIAGNOSIS OF POISONING BEFORE DEATH – Diagnosis of poisoning before death is very difficult
because of:

1. The large number of poison and the factors modifying them

2. Some of the symptoms observed in cases of poisoning are also seen in certain diseases.

DISTINGUISHING POISON FROM DISEASE

1. Symptoms of poisoning come suddenly in a person who previously has been in good health,
while diseases are usually preceded by a number of hours, days, or even weeks of local or
general disposition.

2. In case of poisoning, the symptoms commonly make their appearances after taking of food and
medicines.

3. If several persons take the same food and drinks, they should all show similar symptoms.

4. Diseases are generally much slower in their progress and are preceded by circumstances such as
exposure, recognized symptoms and general or local indisposition of longer duration.

SYMPTOMS CAUSED BY POISONING AND DISEASE

1. Vomiting (frequently associated with purging and abdominal pain)

POSIONS: arsenic, antimony, corrosive acid and alkali, barium, cantharides, digitalis, copper, iodine,
mercury, phosphorous, phenols, wood, alcohol

DISEASE: gastritis, gastro-enteritis, choler, acidosis, early stage of pregnancy, brain tumor.

2. Convulsion

POISON: cyanide, strychnine

DISEASE: tetanus, epilepsy, uremia

3. Coma

POISON: opium, and most of its derivatives, chloral hydrate, paraldehyde, CO2, chloroform, atropine,
various alcohols and phenols

DISEASE: uremia, acidosis, cerebral thrombosis

Dilation of pupils

POISON: belladonna, cocaine, nicotine

DISEASE: certain nervous diseases cause optic atrophy

5. Contraction of pupils

POISON: opium and its derivatives, physostigmine and its derivatives

DISEASE: certain diseases of the nervous system

6. General and partial paralysis

POISON: cyanides, CO and CO2, botulism

DISEASE: brain tumor, meningitis.

. Slow respiration

POISON: opium and its derivatives, CO

DISEASE: uremia, compression of the brain as from hemorrhage

8. Rapid respiration

POISON: atropine group, cocaine, C02

DISEASE: acute respiratory disease

9. Delirium

POISON: atropine group, cannabis, cocaine

DISEASE: epilepsy, insanity, meningitis

10. Cyanosis

POISON: nitrobenzene, aniline, acetanilide, opium

DISEASE: disease of cardiac and respiratory system

GENERALL TREATMENT OF POISONING

After the physician has recognized that he is dealing with poisoning cases, his chief effort should
be directed towards treatment of the patient.

The plan of the procedure as it follows:

1. Removal of poison from the stomach

2. Administration of antidotes

3. Elimination of poison by excretion

4. Stimulation and other symptomatic treatment

 5. Special treatment

REMOVAL OF POISON FROM THE STOMACH

If the poison is taken orally, the removal of the poison is brought about by:

1. Inducing vomiting using emetics

EMETIC- substance or agent that produces vomiting

2. Use of stomach pump of stomach tube

If the poison is applied or instilled – wash

If the poison is injected – ligatures and bleeding

ANTIDOTES – are any agents which neutralize a poison or otherwise counteract of oppose it or its
effects.

ADMINISTRATION OF ANTIDOTES

KINDS OF ANTIDOTES

A. Mechanical antidote – an agent that removes the poison without changing it or coats the
surface of the organ so that absorption is prevented.

Examples of mechanical antidote:

1. Stomach or tubes of pumps

2. Emetics

3. Cathartics

4. Demulcents

EMETIC – is a substance the produces vomiting.

CLASSES OF EMETICS

a. Local Emetics – produce their effects by their irritation of the terminal nerve filaments of the
pharynx, esophagus or stomach.

b. System or general emetics – produce their effects through the medium of circulation.

CATHARTICS – agents which produce intestinal evacuation.

DEMULCENTS – substance which soothe and protect the part which they are applied.
PERCIPTANTS – these are substances which prevent absorption of poisons by precipitating them and
rendering them soluble.

A. Chemical Antidotes – is a substance that makes the poison harmless by chemically altering it.

B. Physiological Antidotes – sometimes called antagonist. An agent that acts upon the system so as
to counteract the effect of the poison. It merely mask the symptoms produced.

C. ELIMINATION OF POISON BY EXCRETION

D. Poison are eliminated through the excretory organs. This is done by the intravenous
infusion of saline solution, diluted alkali solution or diluted solution of glucose. The poison is
generally excreted through the urine, feces, vomitus or saliva.

STIMULATION OF OTHER SYMPTOMATIC TREATMENTS

1. Fore excessive pain – morphine or analgesic

2. For convulsion – chloroform

3. For shock – oxygen inhalation

SPECIAL TREATMENT

a. If the poison is a gas – there is an immediate need for fresh air and artificial respiration.

b. If the poison is external, like burn on the hand by concentrated acid – wash with plenty of water
or with alcohol, sodium bicarbonate, lime water, or milk of magnesia.

c. If alkali burn – wash with lemon or other citrus fruits.

d. If the poison came from a bite or injection – the poison can be checked from spreading through
the body by applying tourniquet or a restricting band tightly above the wound. This retards the
absorption of the poison by the blood. The poison may then be removed by sucking.

INVESTIGATION OF FATAL CASES

In the investigation of fatal cases, it is not necessary that an investigator should be an expert in
poisons since he will be assisted in his investigation by a medico legal officer and a toxicologist. Then
again, it is important and will be of great help to him if he knows the following:

1. Symptoms of various kinds of poisoning

2. The lethal dose of poisoning

3. The length of time that may elapse after the poison has been taken before death occurs

4. Where the poison was obtained

 5. The chemical formula of the poison

6. Other names it is known in the market

7. Use of poison

Antidote of the poison

EVIDENCE OF POISONING IN THE LIVING BODY

The evidence of poisoning will depend upon whether the poisoning is acute or chronic. In acute
poisoning, the symptoms appear suddenly while the individual is in good health. The person is usually
affected with a group of symptoms of definite characteristics out of consonance with his precious state
of health. In chronic poisoning, the onset of symptoms is more gradual and insidious due to the small
quantity of poisons which has been administered on such occasion since the intention of the prisoned is
to kills the victim slowly in order to advert suspicion.

EVIDENCE OF POISONING IN THE DEAD

In all cases of poisoning whether homicidal or suicidal, fatal or not, the presence of poison must
be proven and proofs of poisoning in the dead may be obtained from:

1. The post - mortem examination or autopsy – an examinations of a dead body especially to

determine the cause of death.

2. Evidence from chemical analysis of the organs taken from the body – the most important proof
of poisoning is the detection of the poison within the body. In some cases, however, on account
of the decomposition of the tissue, the lapse of time between death and examination, and the
instability of some poisons, negative results may be obtained even if the time of death certain
poisons are present.
SPECIMEN/ ORGANS TO BE SUBMITTED FOR CHEMICO-TOXICOLOGICAL ANALYSIS

SPECIMEN/ORGANS MINIMUM AMOUNT POISONS FOR WHICH BEST SUITED

1. Stomach content all available in case of poisoning in which it is suspected that the poison was
taken by mouth within a few hours.

2. Stomach the whole stomach for all types of poisoning taken by mouth

3. Intestinal contents all available for cases in in which poison was taken by mouth within one or
two days.

4. Liver 300 grams metals, barbiturates, fluorides, oxalate, sulfonals and many other poisons.

5. Kidney one kidney metals, especially Hg, sulfonamides Blood at least 10 cc all gas poisons,
sulfonamides, bromides alcoholism, drowning for chloride contents.

6. Brain 500 grams volatile poisons, barbiturates, alkaloids, alcoholism

7. Urine all available in nearly all types of poisoning

8. Bone 200 grams lead, arsenic, radium

9. Muscles 200 grams in most acute poisoning and internal organs are badly putrefied

10. Hairs 5 grams chronic arsenic poisoning

REASONS FOR NEGATIVE RESULTS OF THE TOXICOLOGICAL EXAMINATION

1. Some poisons may be rapidly altered in the body to a form which is not detectable by the
methods of analysis employed.

2. Some poisons with or without previous chemical change may be rapidly excreted although its
toxic effect remains, and may only be detectable in the urine but not in the body tissues or
organs.

3. Sometimes symptoms of poisoning may appear, which may be fatal fallowing the administration
of even small and ordinarily harmless quantity of a substance classed as a poison.
FORENSIC QUESTIONS FOR THE TOXICOLOGIST TO EXPLAIN/ANSWER:

In every case of poisoning, the expert is often confronted with forensic questions which he
should explain in order to help the investigator in assessing the evidence.

1. Was the death or illness of the subject cause by poison?

2. What poison produced the illness or death?

3. When and how was the poison administered?

4. Could the substance that was administered cause illness or death?

5. Was the poison found by the toxicologist in the body the poison which caused the death?

6. Is the substance given in minute quantity a poison?

7. Was the poison taken in sufficient quantity to produce death?

8. May poisoning have occurred and the poison either be or become detectable?

9. May the poison extracted from the body have an origin other than that of poisoning?

May the poisoning be stimulated?

PRESERVATION OF SPECIMENS FOR TOXICOLOGICAL EXAMINATION

1. Blood – place in a tube test with sodium oxalate or anticoagulant.

2. Refrigerate with solid carbon dioxide (dry ice) good for 72 hours
 3. Chemical preservative – 100 cc ethyl alcohol (95%) for each 100 grams of sample and extra 250
cc for analysis.

4. Do not use denatured alcohol, rubbing alcohol, or similar preservative since denaturant will give
false and misleading results in the analysis.

5. Formalin – extremely undesirable as preservative of specimen for toxicological examination

since it will seriously interfere with the test for most organic poisons.

LABORATORY METHODS USED IN TOXICOLIGICAL ANALYSIS

1. Physical test

2. Crystalline test

3. Chemical test

4. Spectrophotometric test

5. Chromatographic test

LAWS REGARDING THE SALE AND STORAGE OF POISONS – The laws controlling the sale and storage of
poison are found under Section 755 to 757 of the Administrative Code.

1. Section 755 – provisions relative to dispensing of violent poisons like arsenic, cyanide, atropine,
cocaine, morphine, strychnine

2. Section 756 – provisions relative to dispensing of less violent poisons like aconite, belladonna,
cantharides, digitalis, ergot, carbolic acid, chloroform

3. Section 767 – receptacle for poisonous drugs

THREE STAGES IN CHLOROFORM POISONING

1. Stage of excitement

2. Stage of surgical anesthesia

3. Stage of paralysis

COMMON VOLATILE, NON-VOLATILE AND METALLIC POISONS:

1. Benzene – also called Benzol. A solvent for rubber, gums resins and fats.

2. Carbon disulfide – a solvent for sulfur. Burns with bluish flame giving carbon dioxide and carbon
disulfide.
3. Nitrobenzene – a pale yellow, oily liquid with sweet odor. Resembles oil of bitter almond.

4. Acetone – used as solvent for cellulose acetate and nitrocellulose. Colorless liquid of
characteristic odor.

5. Ether – highly volatile and inflammable liquid. Transparent, colorless, mobile liquid. Used as
general anesthesia. Safer than chloroform

6. Caffeine – found in coffee

7. Salicylic acid – found in “ap-ap” solution.

8. Formalin – an embalming fluid

9. Cocaine – found in coca leaf

10. Picrotoxin – derived from fish berries (the fruit of pictroxin.) Locally known as “lagtang”.

11. 11. Ethyl alcohol or ethanol – alcohol found in wine. Also called grain

12. alcohol.

13. 12. Ergot – develops in rye plants. A fungus that grows in kernels of rye and

14. other cereal grains.

15. Barbiturates – sleeping pills. A derivative of malonyl urea or barbituric

16. acid. Example: secobarbital, Phenobarbital, amobarbital

17. Strychnine – an alkaloid found in dried ripe fruits of nux vomica.

18. Nicotine – found in leaves of tobacco plants.

19. Morphine – found in poppy plants (papaver somniferum). An alkaloid present in opium by
about 9%; white crystals.

20. Physostigmine – also called serine. Found in calabar beans.

21. Chloral hydrate – used as “knock out” drops.

22. Carbolic acid or phenol – obtained from coal tar. A very violent poison.

23. Arsenic – a rat poison. Brittle, steel gray.

24. Lysol – a disinfectant. A brown liquid from cresol and soap emulsion.

25. Methyl alcohol or methanol – causes blindness. A solvent for varnish. An

26. anti-freeze in automobiles. Also called wood alcohol.

27. . Chloroform – colorless liquid with sweet taste and suffocating odor. An

anesthesia.

28. Carbon tetrachloride – a dry cleaning agent. Found in “pyrene” fire

29. extinguisher.

30. 25. Formic acid – acid found in ants and spiders.

31. 26. Hydrogen cyanide – found in kamoteng kahoy. Also called hydrocyanic

acid of prussic acid.

32. Acetic acid – acid found in vinegar. In pure form, it is called glacial acetic

acid.

33. Aspirin – an analgesic. Its chemical name is acetosalicylic acid.

34. Atropine – obtained from the plant group “SOLANACEAE”

35. Phosphorous – glows in the dark.

 Recommended specimens collected in post-mortem cases.

Type of death case Recommended specimens
Suicides, motor vehicle crashes, Blood, urine, vitreous humour, liver
and industrial accidents
Homicides and/or suspicious Blood, urine, vitreous humour,
gastric contents, bile, liver, hair
Drug-related Blood, urine, vitreous humour, gastric contents,
bile, liver, hair
Volatile substance abuse Blood, urine, vitreous humour, lung
fluid or tied-off lung, liver
Heavy metal poisoning and
exposure to other poisons Blood, urine, vitreous humour, liver, hair,
kidney