forensic toxicology

In dictionaries, poison is defined as: “mineral, herbal, animal sourced or synthesized substance that has destructive or fatal effects on human body.”

Forensic toxicology is the use of toxicology in legal investigation.

219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

“The dose makes the poison”

Paracelsus (1493-1541)


Effects of PoisoningDepends on, The structure of the poison,Application way (exposure type),Exposure duration,Exposure repetition,Personal sensitivity


Dose Definitions Effective Dose (ED) Toxic Dose (TD) Lethal Dose (LD)


EVALUATION OF DOSE-RESPONSE RELATIONSHIP -1

It is the relationship between the response of a biological system and applied toxic amount.

LD50 is the amount of a toxic substance in mg/kg that will, in a single dose, kill 50% of animals in a test group.


EVALUATION OF DOSE-RESPONSE RELATIONSHIP -2

Threshold dose is lowest amount or exposure level of a chemical substance at which a specified and measurable effect manifests. It cannot be defined empirically.


Most Observed Poisoning Types According to National Poisoning Center Data -1

Drugs; Analgesic, Antidep, Antihist, Antihypert. etc.

Agricultural drugs and insecticides; Organophosphates, Carbamates, Pyretin group etc.

Household chemicals; Household bleach, Drain opener, Lime remover, Detergent, Naphthalene etc.


Most Observed Poisoning Types According to National Poisoning Center Data -2

Toxic gases; Carbonmonoxyde, Suffocating gases,

Plants and aliments; Mushroom, Mad honey, Apricot kernel, indoor plants etc.

Poisonous animal bites and stings ; Scorpion, Snake, Spider etc.


Poisoning ClassificationAccording to;Sources,Duration and frequency of exposure,OriginAffected locations,Toxicological analyze methods,


Poisonings According to SourceHerbal sourced; Belladonna, various

alkaloids and heart glycosides,Animal sourced; Snake, scorpion, spider

and insulin,Mineral sourced; Lead, mercury, arsenic,Synthesized; DDT, parathion, amphetamine,


According to Duration and Frequency of Exposure

Acute poisoning,Sub-acute poisoning,Chronic poisoning,


According to OriginAccident; Real accidents, Treatment related

or work-related poisonings,Suicide; Generally using prescribed drugs

Homicide; Arsenic, mercury, corrosive acids, strychnine, narcotics, barbiturates, cyanides, organophosphates insecticides, other pesticides and acanitines, phosphor, Zinc blende and radioactive substances


Forensic Medical Examiner’s Responsibilities in Poisoning Cases

Since poisoning is a forensic case, informing judicial authority and healthcare administrators is a legal obligation.

Negligence of this obligation is a delinquency for physician according to TCK 280 and CMK 159.

Autopsy should be performed according to CMK 89.


Forensic Autopsies-Istanbul 2010 Firearm Injuries

327 Incisive,incisive-penetrative, penetrative injuries 161 Blunt Trauma 133 Falling down from Height 286 Traffic accidents 528 Deaths due to Explosions 10 Deaths due to Burns 36 Hangings 340 Strangulation, throttling and

mechinical asphyxia 29 Drowning 183

Carbonmonoxide poisoning 72

Narcose,drugs poisoning 54Alcohol (ethylene and

methylene) poisonings 21

Medicine poisonings 18

Other poisonings 18Dead births 21

Child Deaths 497

Pathological Deaths 767

Sending to Commissions 554

Others 365

TOTAL: 3923 1519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

In Forensic Toxicology Poisoning claim exists. It is determined during routine

investigation . * Physician who performs autopsy

should take samples appropriate to claim and/or evidences.


Autopsy in Poisoning CasesIn most of the cases autopsy findings are

insufficient since these substances are rarely corrosive or damaging.

Diagnosis is based on toxicological analysis of body fluids and tissues other than history and crime scene investigation.


Before AutopsyTerminal clinical information should be

noted as substance intake time and findings’ start time and types. First physical examination, performed treatment and laboratory findings if applied to a hospital should be taken into account as well.


Findings in External ExaminationUsually no signs of findings in toxicology

cases, but intravenous drug usage let the needle leave a mark on skin, atrophic scar or ulceration, bite marks due to snake, scorpion, insect bites/stings and insect stings can be seen.


Findings in Internal Examination 1Mouth and nose space; Dust or colourful

material artifacts (tablet or capsule artifacts, pestiside or herbiside artifacts and intranasal drug usage)

Nasal septum Perforation; Cocain

Brain smell and colour change; Carbolic acid, alcohols, cyanide, methyl salisilate


Gastrointestinal system; Many drugs (deaths in short time), plastic packages (package body syndrome), odor (alcohols, acid carbolic, cyanide), irritation and necrosis (acids, alkalis, heavy metals),

Liver; Parenchymatous degeneration(phosphor, carbon tetrachloride,glycols), necrosis (phosphor, carbon tetrachloride, mushroom poisoning),

Findings in Internal Examination -2


Kidneys; Hemorrhage (heavy metals, cantharidine), parenchymatous tubulus degeneration and/or cortex necrosis (phosphor, carbon tetrachloride, poisonous mushrooms), papilla necrosis (phenacetin),

Heart; Subendocardial hemorrhages (arsenic),

Blood; Color change (CO, cyanide),

Vomit; Color change (acid borique and copper sulphate).

Findings in Internal Examination -3


Toxicologic Analysis ExamplesIn routine; blood, urine, stomach contents,

liver and kidney samples are taken for systematical toxicological analysis.

Peripheral blood (especially femoral vein blood) must be preferred firstly for toxicological analysis.

It is useful to take other samples like brain, hair and bone in addition to liver, kidney and muscle samples when the body is putrefied.


Glass container is the most proper material in preservation and transportation of postmortem biological fluids.

Generally 50 ml culture tubes are the best choices for blood and urine samples.

Smaller tubes (i.e. 15, 20 and 30 ml) are more suitable for smaller amounts of blood, vitreous humor and bile samples.


Blood samples should be preserved by adding sodium fluoride. Some laboratories might want to add potassium oxalate, EDTA or 5 mg/mL concentrated sodium citrate anticoagulants as well.

Samples like urine, bile, vitreous tissues generally needn’t preservative material. However, sodium or potassium fluoride must be added to samples for alcohol analysis.


Plastic containers are suitable for gastric content and solid organ samples.

All samples should be preserved in refrigerator temperature (+4°C) if short term like two weeks , in freezer temperature (-20°C) if long term preservation is the case.

Room temperature is proper for hair and nail samples.


ÖRNEK

Miktar

Hangi Olgularda alınmalı? Açıklamalar

Kalp kanı 50-100 ml Her zaman %2 sodyum florid ve potasyum oksalat ile korunmalı, Mümkünse bir kısmı koruyucu olmadan saklanmalı

Periferik kan 5-10 ml Toksikolojik testlerinin tamamlanması için Mümkünse femoral ve subklavian kan alımalı

Kan pıhtısı Tüm pıhtı Travma vakaları

İdrar Hepsi Her zaman Herhangi bir miktarda toplanmalı (1 ml’den az olsa bile) immunassay için

Safra Hepsi Her zaman Kontaminasyonu azaltmak için safra kesesini bağla, karaciğerden önce topla

Vitreus humor Hepsi Her zaman Her iki göz içi sıvısı tek tüpe konulmalı

Sermet Koç, Otopside Doğru Toksikolojik Örnekleme, 1. Adli Toksikoloji Günleri, 15 Nisan 2011, İstanbulSermet Koç, Otopside Doğru Toksikolojik Örnekleme, 1. Adli Toksikoloji Günleri, 15 Nisan 2011, İstanbul..

Rutin Toksikolojik Örnek Toplama KılavuzuRutin Toksikolojik Örnek Toplama Kılavuzu(Hearn L. Postortem Toxicology)


Blood and Urine

In internal organs

In addition to internal organs

AlcoholCarbon monoxideHashishOpiate and kinds CocaineAmphetaminesHallucinogens Rodenticides… …

SalicylatesBarbituratesPhenothiazinesBenzodiazepines PyrazoloneTricyclic antidepressantsInsecticidesStrychnine… …


ALCOHOL INTOXICATIONSAlcohol is the most encountered toxic

substance in forensic cases as its abuse is frequent.

The most common types are ethyl and methyl alcohol.


ETHYL ALCOHOL Obtained by two ways;Fermentation: Generally sugar in

fresh/dried fruit and grains are fermented by yeast fungi.Concentration of the alcohol obtained by

fermentation is 15-17 %. In the case of exceeding this percentage, fermentation ends due to death of yeast fungi.

Beer, vine, vermouth and liqueur are alcohol examples obtained by fermentation.


Distillation: Separation of the ethyl alcohol from water by vaporization benefiting from its lower degree of vaporization in order to gather it.Its alcohol ratio is 35-45%. Raki, vodka, gin,

whiskey, cognac are such alcohols obtained by distillation.


The amount and speed of drinking,Alcohol ratio of the beverage ( beverages with 10-

30% ratio have the highest absorption quickness)Other foods accompanying to the beverage

( absorption is quicker when stomach is empty, fat food slows down the absorption of alcohol)

Personal factors (tolerance, sex, weight, physical structure, GIS mucosal surface area, GIS blood flow and motility, diabetes, gastrectomy etc. And psychogenic factors are effective) .

Factors Affecting Absorption of Alcohol


Ethyl alcohol blocks Glutamate NMDA receptors and it is the indirect agonist of GABA receptors. Besides, it augments membrane fluidity.

Alcohol Acetaldehyde Acid acetic Water + CO2

1. Alcohol dehydrogenase2.Aldehyde dehydrogenase (Disulfiram affection point)Following oral intake, alcohol passes quickly from

esophagus to stomach.20% of absorption is realized in stomach and 80% in

small intestine mucosal surface.

Ethyl Alcohol Metabolism -1


Chronic alcoholics metabolizes the alcohol faster than others.

While 90% of taken alcohol is metabolized in liver, 10% is excreted from lung, kidney, saliva and sweat without metabolisation.

In an hour, 15-20 mg/100ml. ethyl alcohol is metabolized. This information is helpful in determination of the present alcohol amount at the moment of event.

Ethyl Alcohol Metabolism -2


It is stimulant at low doses, depressant at high doses.

Person in alcohol intoxication may arrive with different complaints such as dizziness, nausea, vomiting, slurred speech, sweating, discomfort, gait disturbance, impairment of consciousness/unconsciousness.

Effects of Ethyl Alcohol


Kan Alkol Konsantrasyonuna Bağlı MSS Etkileri

BAC(mg/100ml)

Kişideki davranış değişiklikleri ve klinik bulgular

10-50(0,1-0,5) Düşüncede açıklık, kendine güven, atılganlık, konuşkanlık, iyimserlik

51-100(0,51-1)

Serebellar ve motor hareketlerde hafif bozulma, yüksek komplike iradeli fonksiyonlarda bozulma, fazla konuşma, gülme, hafif duygusallaşma

101-150(1,01-1,5)

Hareketlerde uyumsuzluk; konuşma, yürüme bozukluğu, huzursuzluk

151-200(1,51-2) Belirgin sarhoşluk, amaca yönelik koordine hareketlerin belirgin olarak yapılamaması, ataksiler, mide bulantısı

201-300(2,01-2,5)

RAS hareketlerinde bozulma, kusma, baş dönmesi, hipotansiyon, solunumun bozulması, konfüzyon-amnezi, komaya yakın dönem

301-350(3,01-3,5)

Kusmaya bağlı aspirasyon tehlikesi, stupor, koma

>350 Solunum yüzeyel, düzensiz, kalp atımı alınmaz, kan basıncında ileri derecede düşme, solunum depresyonuna bağlı olarak yavaş yavaş yavaş gelişen ölüm

37

Promille: The amount of alcohol( gr/lt) in one liter blood.

In order to convert mg to promil, it is divided by 100.


Alcohol level over than 200 mg/100 ml is considered to be “life-threatening” when clinical findings also support.

However, there exist some cases survived in spite of 1500 mg/100 ml level.


DEATHPerson under effect of alcohol is open to

traumas. Death can occur as a result of traumas such as traffic accidents, falls, electric shocks, burning or of pathologies such as aspiration of food, stomach bleeding.

Autopsy findings; Findings are non-specific in acute ethyl alcohol intoxication.


Autopsy Findings in Chronic Ethyl Alcohol Intoxication -1

Trauma, malnutrition, portal hypertension, varices, gastrointestinal bleeding, alcoholic hepatitis, chronic pancreatitis, acute hemorrhagic pancreatitis, chronic gastritis, peptic ulcus, achlorhydra are the probable findings to be obtained.


At the beginning; hepatomegaly due to hepatosteatosis, pale yellow appearance, at advanced stage; gray-yellow color small liver with hard consistency, macro nodular cirrhosis are observed.

Atrophy in cerebrum and cerebellum, dilatation of the side ventricles and of interhemispheric fissures occur.

Autopsy Findings in Chronic Ethyl Alcohol Intoxication -2


METHYL ALCOHOL

Obtained from distilation of wood.Its origin is frequently an accident and

rarely a suicide.It is not toxic before oxidation.58% is absorbed. Its absorption in

gastrointestinal system is very quick.


Methyl alcohol Formaldehyde Acid formic CO2+H2O

1.Alcohol dehydrogenase2.Aldehyde dehidrogenaseIts toxic affect depends on the

accumulation of acid formic.


After methyl alcohol intake there exists a typical 12-24 hour period before findings appear.

Sample taking, preserving and analysis methods are the same with ethyl alcohol.


Alcohol level over than 30 mg/100 ml or if problems related to optic functions appears, the situation is considered to be “life-threatening” when clinical findings also support.

80-100 mg/100 ml blood level is the limit lethal level.


In physical examination, smell of alcohol in breath, CNS symptoms, Kussmaul breathing, respiratory depression, blurred vision, scintillation, photophobia, visual field defects, or different visual disturbances from 'snow storm' image to a complete loss of light perception, nausea, vomiting, abdominal pain are probable to be observed.


In acute poisoning cases blindness does not occur although in chronic poisoning blindness occur.


Methyl Alcohol Autopsy FindingsNo specifically pathologic finding.Long time exposure to methyl alcohol may

result in optic nerve atrophy, areas of hemorrhagic necrosis of the pancreas, CNS degenerative changes, fatty infiltration of the liver and kidneys, fatty degeneration of heart muscle.


Problems with Narcotic Substance Usage One of the most important health issues!Insufficiency of the public education

especially child and young people education.Education of physicians is also insufficient!Preventive health services are insufficient!There exist concept confusion.


Definition of “Narcotic Substance” Real Meaning Includes only narcotic

materials obtained from hashish such as morphine, opium.

Expanded meaning Includes all stimulant,

hallucinogen…psychothropic drug/not drug chemical substances in addition to real meaning.

* Legally valid meaning is the expanded meaning.


Narcotic substances Morphine, heroin, codeine,

benzodiazepines,.. Stimulant substances Amphetamine, cocaine,.. Hallucinogenic LSD, mescaline, cannabis...


Alkol veya uyuşturucu madde etkisinde olma TCK Madde 34

(1) Geçici bir nedenle ya da irade dışı alınan alkol veya uyuşturucu madde etkisiyle, işlediği fiilin hukukî anlam ve sonuçlarını algılayamayan veya bu fiille ilgili olarak davranışlarını yönlendirme yeteneği önemli derecede azalmış olan kişiye ceza verilmez.

(2) İradî olarak alınan alkol veya uyuşturucu madde etkisinde suç işleyen kişi hakkında birinci fıkra hükmü uygulanmaz. 54


TCK Madde 188-192

Uyuşturucu ve uyarıcı maddelerin imal

ve ticareti ile ilgili suçları içermektedir.


İtiyat: Concept of “Habituation”

=Alışkanlık=Habituation Psychological addiction

Tolerance, Physical addiction Ø


İptila:Concept of “Addiction” İptila = Addiction Physical Addiction

Tolerance (+), Abstinence Syndrome (+)


Hashish (Papaver somniferum) A flower of the female cannabis plant When its immature capsule is

scratched, a milk white sticky liquid flows. Then, it turns to brown with the effect of the air "Cannabis resin”.


Opium Group Narcotics

I. Natural Alkaloids of Opiuma) Phenanthren Group Opium Alkaloids

MORPHINE TEBAINE CODEINE OXİMORPHONE

b) Izochinoline Group Opium Alkaloids PAPAVER NARCOTINE NARCEINE


Semi-Synthetic Narcotic AnalgesicsII. Phenanthren Group Alkaloids a) Esterification products

HEROIN DIONINb) Oxidation products

DILAUDID DICODIDc) Oxidation and esterification products

PARACHOID PHOLCODINE METOPON LEVORPHANOL


III. Synthetic Analgesics MEPERIDINE ALFAPRODINE FENAZOSINE PIMINODINE

ANILERIDINE METADON ETANSULPHATE


MORPHINE (C17H19NO3) =Morphium, Morphia, Morphin

Comes from Morpheus who is the god of sleep and dream in Greek mythology.

However, it is found in the years 1804-1805. It is the prototype of this group and the

most important alkaloid of opium.


Intake Subcutaneous intakeSometimes it is taken at IV. In solution It can

also be taken through nasal way in solution form.

Absorption: Depends on absorption way SC 60%is absorbed in first 30 min. Nasal intake quicker.


Excretion: 90% is excereted in the first 24 h by glomerular filtration. Excretion may extend up to 3-6 days.

Metabolits; Morphine-3-glucronide, Morphine-6-Glucronide,Morphine-3,6-diglucronide, Morphine sulphate.

Lethal Dose (Adult): 200 mg. 10 times more can be tolerated at addicted people.

Morphine passes to bile, feces and fetus.6419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

HEROIN: Diacetyl morphine, Diamorphine, Asetomorphine

First synthesized in 1898.Is the most common and

inexpensive in all narcotic substances.2-3 times more effective than morphine.Purity is at most 87% in the market.


HeroinContains different additives.- Diluents: lactose, fructose, carbonate , …

- Additives: quinine, procaine, amphetamine, acid salicylic, strychnine,..

Used for the treatment of Tbc cough seen very common in morphine addicted for the first time. 6619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

HEROIN Used in the treatment of morphine

addiction. After 8-10 years was renounced as it was found to create stronger addiction than morphine.

In 1936 in Turkey , it was emerged with ads "It's great medicine! Opens the mind, gives joy.”

The lethal dose of 200 mg, but addicts can use 10 times more the amount.

Quick absorption. 6719.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

Heroin MetabolismRapidly hydrolyzed in the blood to 6-

monoacetyl Morphine (6-MAM), and gradually turns into morphine.

Half-life is less than 20 min.80% is excreted in the urine in the form of

Morphine-3 glucronid, free morphine, 6-MAM, heroin within first 24 hour.


CODEINE (C18H21NO3)=

Methyl morphine, morphine monomethyl ether, 3-methyl ether of morphine codicept

Have been isolated for the first time in 1832.

Intake into the body: Usually taken orally. Also taken SC and IV . Found in expectorants and analgesics. 69


Codeine Excretion: 84% is excreted in the urine within

24 h. 40-70 % conjugated codeine, 5-10 % conjugated morphine, 10-20 % norcodeine. Lethal dose (adult): 800 mg. 10 times more at addicted person 40 mg. toxic effect in children.


CNS Findings:AnalgesiaDrowsiness (aggravation in the

joints, body temperature)

Mental changes (euphoria, depressive chg.)

Blurred conscious7119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

Respiratory System:Respiration is affected Depression

(other than codeine)Lung edema Cardiovascular System:IndefiniteOrtostatic hipotentionCyanosis

Narcotic Substance Effects


GIS Findings:Nausea, vomiting

Dermal Effects:Warm-up sensation, hyperemia, pruritis, sweating, urticariaDifficult urination, reduced urineMyozisSkeletal muscles become flaccid.

Narcotic Substance Effects


Abstinence Syndrome (Withdrawal Symptoms)

Symptoms begin a little time before the substance should be taken .

After 8-12 hours: lacrimation, rhinorrhea, sweating 36-72 hours later () Increased irritability, insomnia


Anorexia, lacrimation, intense sweating, GIS symptoms. (Nausea, vomiting, pain, dia

rrhea) The number of left () -

blood pressure () Flashing Goose skin appearance (pilomotor activity) CNS hyperexcitability Ejaculation, orgasm. spontaneous recovery after 7-8 days


OriginAccident

- Dose-out, - tolerance problems ,Suicide

- Golden shotHomicide need to be explored!


AutopsyNonspecific findings.Needle scars, keloid, abscessPulmonary edema (narcotic A.C.)Signs of organ complications.Material gain is important.


Death MechanismsRespiratory depressionFood aspiration (5-6%)Anaphylactic reactionsLate complications

* In Istanbul forensic autopsies heroin deaths 60-80 cases per year. (3200 autopsies)


Other Important IntoxicationsCocaineAmphetamines (Ecstasy, captagon,,,)MarijuanaLSD (lysergic acid diethyl amide)Mescaline (Mexican cactus, black mushrooms

)Phencyclidine (angel dust)Volatile and solvent substances (!)


COCAINEObtained from the leaves

of Erythroxylum coca plant that grows in South America.

Is taken in ways such as cigarette smoking, i.v. injection, mucosa (nose, rectum, vagina), or taken by mouth.


Stimulation of the cortex of the brain creates euphoria, anxiety, agitation, delirium, psychosis, paranoid delusions, hallucinations, sense of fear.

Following a psychotic reaction, delirium and aggression may occur.

They can form wounds by attacking their bodies.


Tremor, tonic-clonic convulsions, hallucinations,

MydriasisSympathomimetic symptoms such

as vasoconstriction, hyperthermia, tachycardia develops symptoms develop.


Death due to high doses of CNS depression and degeneration of vital centers,

In people with heart failure, intracerebral and subarachnoid hemorrhages, especially in people with an aortic and Berry aneurysm-rupture related deaths may occur.


Cocaine is rapidly inactivated in the body by hydrolisation.

85-to 90% as much ecgonine methyl ester and benzoyl ecgonine are excreted in the urine.


If taken before 8 h or longer period of time, search for cocaine in blood is meaningless in practice.

It can be found in the urine until after approximately 24-48 hours with the use of immunoassay methods.

Mean lethal dose is 1,2 gram on average. It varies according to and type of intake.


AMPHETAMINES

Causes sympathetic stimulation in CNS.Improves physical performance,

increases systolic-diastolic pressure, stimulates respiration,

As a result of high fever and hypertension, leads to fatal intracranial hemorrhage and cardiac arrhythmias.


‘Stroke Syndrome’ caused by hyperthermia may result in death.

Long-term use results in hiperexcitation, hallucinations and dangerous psychotic reactions.


Usage areasIn medicine, when stimulation of CNS is

needed, Narcolepsy,Attention disorders in children, Weight loss cures


Difference between effective and lethal doses is large.

Amphetamine metabolites in general, can be detected in urine up to 2-3 days.

Even though tolerance develops in a short time, physical addiction like opium types does not occur.


CANNABISDerived from plants hemp and hempen

grown in temperate climates.It is present at branches, flowers and

leaves of these plants in different amounts.It is known as ‘Marijuhana’ as well.Its active ingredient is tetrahydro

kanabinol (THC).


Cannabis usage as cigarette is widespread.Intake by water pipe, fluid, injection or

orally mixing with honey and sweeties is also possible.

Its effect is 3 times more when taken orally.

Its effect lasts up to 2-4 h when taken through respiratory ways, up to 5-12 h when taken through oral ways. 9119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

80% of it is absorbed from lung when smoked and all is absorbed when taken orally.

THC itself is present in the blood just for a couple of hours.

In the first 2 days, Delta-9-THC-9-COOH can be found in urine sample..

THC accumulates in fat tissue.9219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

Excretion of a dose is completed in 30 days.

Although death due to marijuana intoxication is not the case, it has an undeniable relationship with criminal events.


LSD (LYSERGIC ACID DIETHYLAMIDE)A semi-synthetic substance derived from

ergot, a grain fungus that typically grows on rye.

Affects serotonin and dopamine mechanisms, stimulates 5HT2 receptors.

Its effect lasts up to 4-10 h.


Sympathomimetic effects such as hyperexcitability, ataxia, fear and discomfort, lack of self control, paranoid symptoms, tactile hallucinations, false reasoning, mydriasis, tachycardia, hypertension; psychosis, aggression, selfharm, increased reflexes, murder and suicide tendency are observed.


Heavy MetalsAluminumArsenicMercuryLead

Thallium NickelCadmiumCopper

Enters to the body by oral, nasal, mucosal, respiratory, parentheral ways and through

eye or skin.96


Products Containing Heavy MetalsHeavy metals are used frequently in the

production of industrial products. (Mercury amalgam fillings, paints with lead and water pipes, processed foods, cosmetics, toothpastes, shampoos, hair products etc)


Systems Affected By Heavy MetalsBlood and circulatory system,GIS.Urogenital SystemSkinHormonal system,Nervous System,Energy Production and EnzymesImmune System.


FARM DRUG POISONINGTo destroy diseases, harmful and strange

herbs which cause damage and loss of agricultural products,

Usage as chemical weapon (nerve gas, sarin, somon),Contact effect (skin, mucosa, eye) Systemic effect (Mouth, Respiration)


Farm DrugsInsecticides : kill insectsFungicides : kill mushroomsNematicides : kill nematodesHerbicides : kill herbsRodenticides : kill rats* Other substances used in plant protection.


Acetylcholine Esterase Enzyme InhibitorsOrganophosphates

insecticides Methyl parathion,

Diazinon, Dichlorvos, chlorpyrifos, Malathion, Bromophos.

Organochlorous insecticides DDT, Endosulfan

Carbamate insecticidesAldicarb, Carbofuran,

Carbosulfan, Methomyl, Dioxacarb, Carbaryl

Pyrethrin and pyretroidsCypermethrin, cyhalothrin,

Deltamethrin, Permethrin


Effects of Farm DrugsAcute PoisoningChronic PoisoningAllergic EffectCarcinogenic EffectAccumulation in Various Organs and Tissues


Organic Phosphate PoisoningAcetylcholine esterase enzyme inhibition

The rise of acetylcholine

Muscarinic, Nicotinic and CNS findings appear due to the activation of cholinergic system.

DEATH due to respiratory depression

IN AUTOPSY: Smell of garlic is present.10319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

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forensic toxicology

Documents

adl tip anablm dali

evaluation of dose

threshold dose

single dose

chronic poisoning

observed poisoning types

national poisoning center

exposure duration