Lec Forensic Toxicology PDF - Prelims 2024-2025

LEC FORENSIC TOXICOLOGY made by: Chloe Julia Y. Macias 1st Semester | A.Y. 2024-2025 ➔ Determines the drug overdoses COURSE OUTLINE ➔ Investigatio...

LEC FORENSIC TOXICOLOGY made by: Chloe Julia Y. Macias 1st Semester | A.Y. 2024-2025 ➔ Determines the drug overdoses COURSE OUTLINE ➔ Investigation of cases involving drug facilitated I. Definition and Scope of Forensic Toxicology sexual assault II. Branches of Toxicology ➔ Post-mortem investigations DEFINITION AND SCOPE OF FORENSIC TOXICOLOGY - Importance of Toxicology? —---- ETYMOLOGY ➔ To verify if it is a case of poisoning ➔ To be able to treat as the occasion demands ☆ Toxico - Poison ➔ To forward justice ☆ Ology - study or science Note: the reason for the application of Toxicology is to ☆ Toxicology - science dealing with properties, actions, determine the presence of volatile, and non-volatile and toxicity, detection of poison metallic poison in case of alleged poisoning. ☆ Poison - any substance producing ill health or death by HISTORY AND DEVELOPMENT OF FORENSIC TOXICOLOGY its action 50, 000 BCE ☆ Drug - any substance modifying physiological systems or pathological systems or pathological states ➔ Poisonous plants and animals for hunting or as warfare agents Note: many definitions of toxicology have been proposed, but generally all emphasize that toxicology is the study of 1500 BCE adverse effects produced by drugs and chemicals. ➔ Written evidence indicated that hemlock, opium, curare, and certain metals were used for poisoning BRANCHES OF TOXICOLOGY 460 - 370 BCE ➔ Hippocrates ☆ Clinical Toxicology - - first describe many diseases including poisoning with fungi, herbs, plants and ☆ MedicalToxicology - prevention and diagnosis foods - Defined effective doses of toxin ☆ Forensic Toxicology - ➔ Aristotle (384-322 BCE) ☆ Industrial Toxicology - - De Historia Animalium ☆ Environmental Toxicology - ➔ Theophrastus (370-286 BCE) - De Historia Plantarum ☆ Biochemical and Molecular Toxicology - ➔ Socrates ☆ Product Development Toxicology - - Hemlock products like cosmetics 69 - 30 BCE ☆ Regulatory Toxicology - (DNR) regulates the purpose of purchasing the chemicals ➔ Poisons as Suicidal and Murder Weapons ➔ Cleopatra and Marc Antony (spouse/partner) ➔ Cleopatra FORENSIC TOXICOLOGY - tested toxicity notably of strychnine on prisoner and slaves What is Forensic Toxicology? ➔ Mithridates - Used it on animals ➔ Branch of forensic medicine dealing with medical - Poisoning trials on prisoners and legal aspects of the harmful effects of - Developed ingredient antidote chemicals on human beings - Suicide after many tries ➔ It analyzes the samples collected 1600s BCE ➔ A forensic toxicologist must consider any physical symptoms recorded, and any evidence collected at ➔ Marchioness de Brinvilliers a crime scene such as pill bottles, powders, trace - Toxic mixtures tested on men and children residue, and any available chemicals - Described onset, potency, specificity, signs, symptoms and recovery Application of Forensic Toxicology? —--- ➔ Catherine Monvoisin Deshayes ➔ Presence and quality of illegal and legal drugs - Midwife/Sorcerer - “LaVoisin” killed ; 2000 babies ➔ Presence of poison and hazardous chemicals - Executed 1680 ➔ Chemical composition of substances found during ➔ Paracelsus investigation LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY - “All substances are poisons. There is none that is not a poison. The right dose - He ran many weight tests for arsenic and differentiates poison from a remedy”. tried to calculate the amount of arsenic - Mercury use for syphilis (+300 years); that was found in each of the victim’s ether (oil of Vitriol) as analgesic organs 1700s ➔ 1918 - Medical Examiners office and Toxicology ➔ Convictions associated with homicidal poisoning Laboratory was established in New York were based only on circumstantial evidence, not the identification of the actual toxicant ➔ Alexander O. Gettler - Chief Forensic Toxicologist ➔ Mary Blandy (1752) - Father of American Toxicology - First trial recorded with the use of chemical tests to detect the element arsenic ➔ Erik M.P Widmark (1932) - Corresponded blood alcohol ➔ Joseph Plenic (1781) concentrations to intoxication, which later - Stated that the detection and lead to the Harper Drunkometer identification of the poison in organs of the deceased was the only true sign of 1900’s - Caroline Grills poisoning ➔ Caroline Grills (1953) ➔ Johann Daniel Metzger (1787) - 63 year old great grandmother - Detecting arsenic in solutions - Charged with poisoning 4 distant relatives using untraceable thallium - Sentenced to a life in prison and known as 1800’s “Aunt Thally” by the inmates ➔ Humphry Davy (early 1800s) Late 1900’s - Nitrous oxide can be used as an anesthetic ➔ 1975 - American Board of Forensic Toxicology was created ➔ John Bodle (1832) - Arrested for lacing his grandfather’s coffee ➔ 1982 with poison - unknown criminal killed seven (7) people by lacing Tylenol tablets with cyanide ➔ James M. Marsh (1836) - The incident resulted in the introduction of - Developed a test for the presence of tamper-proof packaging for medicines * arsenic in tissue - The test used zinc and sulfuric acid which reacted with the arsenic to form arsine 2000s - Present gas * ➔ Modern innovative techniques - It is highly sensitive to even the smallest ➔ Modern Analytical Techniques traces of arsenic, and it was leaps ahead - Spectroscopy and Chromatograms of any other tests of its time * ➔ Analysis of blood for alcohol and/or drug content for purposes of death investigation ➔ Ernst Wilhelm Heinrich Gutzeit (1860s) ➔ Chemical spot tests which by color production - “Gutzeit Test” ➔ Ultraviolet Absorption (UV), Infrared Absorption (IR), Radioimmunoassay (RIA), Thin-Layer ➔ Lydia Sherman Chromatography (TLC), High Performance Liquid - “Arsenic Poisoning” Chromatography (HPLC), and Gas Chromatography (GC) * ➔ Mathieu Orfila - A Spanish chemist and physician In the Philippines - 1813: performed tests on animals. If arsenic is ingested it is distributed throughout the ➔ Manual de Medicina Domestica (1858) body - Medico-legal practice by Spanish - 1814: wrote the first toxicology book “Traite Physicians Dr. Rafael Genard y. Mas Des Poisons”. (poisons favored by ➔ 1871 criminals) - Teaching of legal medicine at University of - Father of Toxicology Sto. Tomas ➔ 1839: used Marsh’s test to identify arsenic extracted ➔ March 3, 1879 from human tissues - The King of Spain, by virtue of the Royal Decree No. 188, created the position of 1800’s - Famous Cases “Medico Titulares” ➔ The Lafarge Affair (1839): Orfila’s Participation ➔ December 15, 1884 - Creation of a committee to study mineral ➔ The Bocarme Cas waters of Luzon by Gen. Joaquin Jovellar, - murdered Gustave Fougnies Anacleto del Rosario as the chemist - Isolation of an alkaloid poison by Jean Servials Stas ➔ September 13, 1887 - Friedrich Otto, the StasOtto method - Laboratorio Municipal de Manila - Functions: Analyses of food, water, History and Development of Forensic Toxicology materials from standpoint of Public Health ➔ Dr. William Willcox (1911) and Legal Medicine, and Specimens for - Developed the first method for measuring Clinical arsenic while solving a murder case LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY ➔ June 17, 1888 Medico-legal as part of the division and Dr. - Appointment of Anacleto del Rosario as Gregorio T. Lantin as Chief Director; Creation of Laboratorio Medico-legal, under the Judicial branch of ➔ March 31, 1938 government; under the direction of a - Department of Legal Medicine was physician; assisted by a abolished and was turned over to the pharmacist-chemist; Ulpiano Rodriquez as medico-legal section of the DI first chemist ➔ 1895 ➔ July 4, 1942 - Antonio Luna established a clinical - The late president Jose P. Laurel laboratory. Paralyzed in 1896 because of consolidated all different law-enforcing the Revolution Function: Chemical Analysis agencies by Executive order (EO) ➔ 1898 ➔ May 8, 1944 - American Civil Government preserved the - Creation of the Bureau of Investigation system of Spanish Forensic Medicine (NBI) on May 8. 1944 under RA 157. ➔ 1899 ➔ 1945 - First Crime Detection Laboratory. First - Provost Marshal of the United States Army Scientific Laboratory on the banks of Pasig created the Criminal Investigation River. Lt. R. Strong, an American soldier, Laboratory (CIL) with Dr. Mariano Lara as took charge for 2 years the chief medical examiner ➔ 1901 ➔ Manila Police Department had its own criminalistic - The Philippine Commission created the facilities and equipment several years back Provincial Insular and Municipal Board of Health under Act Numbers 157, 307, and ➔ 1947 308. Assigned to the respective inspectors - Ballistics, photography and fingerprint and presidents of the same, medico-legal record unit was changed to Criminal duties of the “Medico Titulares” of the Laboratory Branch of the constabulary Spanish Regime with Capt. Agapit Figueroa as the chief ➔ July 1, 1901 ➔ January 1951 - Bureau of Government Laboratories (BGL) - Medico-legal section was created under was created by virtue of Act No by the Civil Col. Jesus T, Mendoza. Commission; Dr. Paul C. Freer became the ➔ 1959 1st director on June 21 but assumed - Philippine Constabulary Laboratory position on September 21 became the PNP Crime Laboratory with the abolition of the PC - Purpose of BGL: Performing biological and chemical analyses; Reproduction on ➔ At Present vaccines and sera; and Philippine - Two (2) distinct crime laboratory in the Constabulary had its own Crime Philippines: Forensic Chemistry Division of Laboratory the NBI and PNP Crime Laboratory ➔ 1904 ROLE OF FORENSIC TOXICOLOGY IN CRIME INVESTIGATION - Analyses of counterfeit coins, poison tests, ➔ perform analysis of drugs and alcohol in biological and bloodstain analyses were performed samples, typically blood and urine, and in other matrices such as oral fluid, and hair, to determine ➔ March 11, 1915 the timing, extent, and impairment resulting from - The Department of Legal Medicine was different patterns of drug and alcohol use. created with Dr. Sixto de los Angeles as the head. ➔ uses those analytical methods to determine the identity and amount of drug present ➔ March 10, 1922 - The Philippines Legislature enacted Act No. ➔ drug testing cases 1043 which then incorporated in the Administration Code as Section 2465 and ➔ testify in court to both their findings and to their provided that the Department of Legal interpretation and can be an evidence in solving Medicine of the University of the Philippine crimes (UP) became a branch of the Department of Justice (DOJ) TOXIC SUBSTANCES AND THEIR EFFECTS: understanding effects and mechanisms ➔ October 14, 1924 - Legal Medicine as branch of the DOJ and POISON at the same time an integral part of UP; Act No. 3043 ➔ A substance that when introduced into or absorbed by a living organism causes death or ➔ 1924 injury. - All medico-legal functions were ◆ Anything which when used internally or on consolidated under the Department of the body surface, Justice (DOJ) ◆ In a dose or repeated doses, if acts chemically and physiologically ◆ Causing disturbance of body functions ➔ December 10, 1937 and leading to disease or death - Creation of the Diversion of Investigation (DI) under the Department of Justice SOURCES OF POISON under the Commonwealth Act No. 181. ➔ Domestic or Household Source LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY - Available at home - Detergents, disinfectants, cleaning agents, f. Glucosides - ex. Digitalis antiseptics, cooking gas insecticides, rodenticides, and common drugs. ACCORDING TO PHYSIOLOGICAL ACTION ➔ Agricultural and Horticultural Sources 1. Corrosives - Insecticides, pesticide, fungicides, and - Highly irritant poisons weed killers. - Can cause local distribution of tissues and characterized by nausea, vomiting and ➔ Industrial Sources great local distress - In factories, where poisons are - Ex. strong acids and alkalis manufactured, or poisons are produced as by products. 2. Irritants - One that produces irritation or ➔ Commercial Sources inflammation of the mucus membrane - Store-houses, distribution centers, and - Characterized by pain in the abdomen selling shops. and purging - Ex. arsenic ➔ Food and Drink - Contamination in the use of preservatives 3. Narcotics of food grains or other food materials - One that produces stupor, complete additives like cooring and odor agents or insensitivity, or loss of feeling other ways of accidental contamination. - Ex. opium, demerol, and cocaine 4. Neurotics ➔ Use as Drugs and Medicines - Targets the nervous system producing - Wrong medication, overmedication and delirium, convulsion, and respiration as the abuse of drugs. outstanding symptoms. - Ex. alcohol, opium, and strychnine. ➔ Plants - Plants that are toxic to human beings and 5. Tetanic other animals if they are ingested. - Substance that acts chiefly upon the - Poison ivy, poison oak, poison sumac, spinal column producing such spasmodic stinging nettle, poison hemlock, castor and continuous contraction of muscles as bean, manchineel tree etc. a result of stiffness or immobility of the parts to which they are attached. CLASSIFICATION OF POISON 6. Depressants or Sedatives BASED ON ITS ORIGIN - Agents that retard or depress the 1. Animal/Toxin - produced by living organism physiological action of an organ. stimulating antibodies. - Ex. nicotine and cocaine 2. Vegetable - poison ivy and jimson weed plants 7. Asthenic or Exhaustive - Agents that produce exhaustion, marked 3. Mineral - hydrochloric acid, caustic alkali loss vital or muscular power. - Ex. hydrocyanic acid 4. Microbial - produced by microscopic organisms (ex. Bacteria, fungi) ACCORDING TO THEIR EFFECTS ON THE BODY/TARGET SITES ➔ Those which cause local destruction (skin) - 5. Synthetic - manufacture by Chemists such as phenol, HCI drugs, pesticide as well as chemical purified from natural sources such as metals from ores and ➔ Blood Poisons - Carbon Monoxide, Hydrogen solvents from gasoline. Cyanide ACCORDING TO CHEMICAL PROPERTIES A. Inorganic Poison ➔ Nervous Poisons (nervous system) - alcohol, - Inorganic compounds, which include tobacco, opium metals, minerals, and organometallic compounds ➔ Cardiac Poisons (cardiovascular system) - stop the - Poison without carbon heartbeat, digitalis, antipyrine a. Volatile - ex. Bromine, Chlorine and Iodine TYPES OF POISON b. Non-volatile - ex. Sulfuric acid c. Mineral Acid - ex. Hydrochloric ➔ True Poison - one that is still poison no matter how acid diluted it is. (ex. Hydrogen cyanide HCN) d. Mineral Alkalis - ex. Sodium Hydroxide ➔ Corrosive Poison - one which by contact with it e. Metallic - ex. Lead, mercury, chemically produces local destruction of tissues. arsenic (Ex. Nitric Acid, Mercuric Chloride-Acid) B. Organic Poison ➔ Cumulative Poison - one that increases suddenly in - Poison that contains carbon its intensity of action after gradual additions of it. a. Volatile - ex. Alcohol, Chloroform (Ex. Arsenic) b. Alkaloid - ex. Strychnine, Nicotine c. Animal Poison - ex. Snake Venom TYPES OF POISON d. Bacterial - ex. Ptomaine e. Organic Poison - ex. Salicylic acid LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY ➔ Any substance (other than food) that is used to ➔ Your body temperature to go up - leading to heat prevent, diagnose, treat, or relieve symptoms of a exhaustion or een heat stroke. disease or abnormal condition. ➔ Reduced appetite, agitation, sleeplessness. ➔ A chemical that is used for a beneficial medical ➔ You can feel more awake, alert, confident, or purpose. energetic. ➔ Larger doses can cause anxiety, panic, seizures, ➔ A finished dosage form. (ex. Tablet, capsule, stomach cramps, and paranoia. solution) ➔ Ex. amphetamines, caffeine, cocaine, ecstasy (MDMA - methylenedioxymethamphetamine), and ➔ It contains active ingredients intended to furnish nicotine (tobacco) pharmacological activity or other direct effect in the diagnosis, cure, mitigation, treatment, or ANALGESICS prevention of disease, or to affect the structure or ➔ Painkillers, relieves the symptoms of pain any function of the body of man or other animals. ➔ Ex. aspirin, paracetamol, and ibuprofen ➔ legal ➔ Drugs can be categorized by how they affect our bodies. INHALANTS ➔ Legal drugs are known as over-the-counter (OTC) ➔ Inhalants are substances that you breath in and Prescription (Rx) drugs. (Ex. alcohol, nicotine, through the nose (sniffing) or mouth. and caffeine are all legal drugs as well) ➔ Volatile solvents - paint thinners and removers, glues, petrol ➔ Illegal drugs refer to drugs that are not prescribed ➔ Aerosol sprays - spray paints, deodorants and by a licensed medical hairsprays professional, and their ability to addiction can not ➔ Gasses - nitrous oxide (laughing gas), propane, be marketed and whose consumption is prohibited butane by law. ➔ Nitrites - room deodorizers and leather cleaners. INHALANTS PRESCRIPTION DRUGS ➔ Painkillers that can be made from poppy plants ➔ Medicines prescribed by a doctor. (heroin) or produced synthetically (fentanyl). Also ➔ Also known as pharmaceuticals. canned opiates or narcotics, they are addictive as ➔ If not used appropriately can cause harm, both they can give you a feeling of well-being or short and long term. euphoria. ➔ People assume that all prescribed medicines are ➔ Ex. codeine, heroin, methadone, oxycodone. safe, but not following instructions or combining them with other medicines, drugs, and/or alcohol PSYCHOACTIVE DRUGS can be dangerous. ➔ Psychoactive drugs affect the way you think, feel, and behave. They act mainly on the central nervous system (CNS), changing brain functions and DEPRESSANTS temporarily changing your consciousness. ➔ Depressants slow down the messages between the ➔ Ex. caffeine, cannabis, psilocybin (magic brain and the body. mushrooms), and LSD. ➔ Affects your concentration and coordination. ➔ Affects your ability to respond to what’s happening LESSON 2 PART 2 around you. ➔ Small doses of depressants can make you feel ELEMENTS OF POISONING relaxed, calm, and less inhibited. ➔ Larger doses can cause sleepiness, vomiting and 1. Poison nausea, unconsciousness, and even death 2. The poisoned organism ➔ Ex. benzodiazepines (minor tranquilizers such as 3. The injury to the cells valium), cannabis, GHB (gamma-hydroxybutyrate), 4. The symptoms and the signs of death ketamine, and opioids (heroin, morphine, codeine). From a Medical Point of View HALLUCINOGENS a. Acute Poisoning ➔ Can change your sense of reality - There is prompt and marked disturbance ➔ You can have hallucinations of function or death within a shorter period ➔ Your senses are distorted and the way you see, of time and is due to: hear, taste, smell, or feel things is different. 1. Taking a strong poison ➔ Ex. you may see or hear things that are not there, or 2. Excessive single dose you may have unusual thoughts or feelings. 3. Several doses; small but frequent ➔ Small doses can cause a feeling of floating, numbness, confusion, disorientation, or dizziness. b. Chronic Poisoning ➔ Larger doses may cause hallucinations, memory - There is a gradual deterioration of loss, distress, anxiety, increased heart rate, functions of tissues and may or may not paranoia, panic and aggression. result in death. It may be produced by: ➔ Cannabis, ketamine, LSD (lysergic acid 1. Taking several small doses at diethylamide), psilocybin (magic mushrooms), PCP long intervals (phencyclidine). STIMULANTS 2. Taking only toxic doses of the drug ➔ Speed up the messages between the brain and the body. From Legal Point of View ➔ Heart to beat faster, blood pressure to go up. a. Accidental - the poison was taken without intention. LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY b. Homicidal Poisoning - the poison was given with 10. Cyanosis - Nitrobenzene, Aniline, Acetanilide and intent to cause death to the victim. Opium c. Suicidal Poisoning - the victim voluntarily for the EFFECTS OF BLOOD ALCOHOL (ETHANOL) CONCENTRATION purpose of taking his/her own life. Storage of % of Alcohol in Clinical SOLUBILITY AND DILUTION OF POISON Intoxication Blood Manifestation SOLUBILITY OF THE DRUGS Stimulation 0.01 - 0.10 Normal by - Solubility: For a substance to act as a poison, it must be capable of forming a solution and readily ordinary absorbed by the blood. observation - Ex. Barium Chloride: readily soluble and extremely toxic (Barium Sulfate: insoluble) Apparent 0.05 - 0.20 Decreased - Dilution: generally, when a poison is diluted, the Stimulation inhibition, absorption is rapid, thus, resulting in intense toxic Emotional effects. An exception to this is the case of corrosive Instability in poisons. Corrosive poisons produce less toxic coordination, effects when diluted. Slowing reaction ENTRANCE AND ELIMINATION OF POISONS to stimuli POISON MAY ENTER THE BODY THROUGH: Confusion 0.10 - 0.30 Disturbance of - Mouth, skin, nose, eyes, rectum, vagina, Sensaation, hypodermically, intravenously. Decrease pain THEY MAY BE ELIMINATED BY: sense, - Emesis, respiration, feces, uring, milk, sweat, saliva, Staggering gait, tears. slurred speech POISONING AND DISEASE Stupor 0.25 - 0.40 Marked decrease to stimuli and DIAGNOSIS OF POISONING FROM DISEASE: DIAGNOSIS OF approaching POISONING BEFORE DEATH IS VERY DIFFICULT BECAUSE OF: 1. The large number of poisons and the factors paralysis modifying them. 2. Some of the symptoms observed incases of Coma or Death 0.35 - 0.50 Complete poisoning are also seen in certain diseases. unconsciousness DISTINGUISHING POISONING FROM DISEASE: , subnormal 1. Symptoms of poisoning come suddenly to a person temperature, who previously has been in good health, while impairment of disease is usually preceded by several hours, days, circulation, or even weeks. stertorous SYMPTOMS CAUSE BY POISONING breathing 1. Vomiting (frequently associated with purging and abdominal pain) WHAT HAPPENS WHEN WE DRINK TOO MUCH ALCOHOL? - Poisons: arsenic, antimony, corrosive acid and alkali, barium, cantharides, digitalis, ➔ Increased cancer risk in oral cavity, larynx and copper, iodine, mercury, phosphorus, throat phenols and wood alcohol. ➔ Fatty liver, liver cirrhosis, shrink liver, liver cancer ➔ Overweight, mucosal inflammation (gastritis), 2. Convulsion Poisons - cyanide and strychnine pancreatitis, esophageal cancer, stomach cancer, beer belly 3. Coma Poison - opium and most of its derivatives, ➔ Bloated skin, muscle damage, gynecomastia paraldehyde, CO2, chloroform ➔ Memory loss, lack of concentration, depression, phobias, korsakov syndrome 4. Dilation of Pupils - belladonna, cocaine, and ➔ Hypertension, heart failure, arrhythmia, nicotine cardiomyopathies ➔ Erection problems, impotence 5. Contraction of pupils - opium and its derivatives, ➔ Numbness, neuritis, damage to the nerve tracts, physostigmine and its derivatives. wemicke;s encephalopathy 6. General and Partial Paralysis - Cyanides, CO2 and INVESTIGATION OF FATAL CASES Botulism It will be of great help if the investigator knows the following: 7. Slow Respiration - Opium and its derivatives 1. Symptoms of various kinds of poisoning; 2. The lethal dose of the poison; 8. Rapid Respiration - Atropine Group, Cocaine and 3. The length of time that may elapse after the poison CO2 has been taken before death occurs; 4. Where the poison was obtained; 9. Delirium - Atropine Group, Cannabis and Cocaine 5. The chemical formula of the poison; 6. Other names it is known in the market; LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY 7. Uses of poison; and important proof of poisoning is the 8. Antidote for the poison detection of the poison within the body. EVIDENCE OF POISONING EVIDENCE OF POISONING IN THE DEAD a. Circumstantial or moral evidence - Evidence deduced from occurrence of facts or circumstances. - Ex. motives for poisoning, purchasing the poison, keeping the materials. - This is not strong evidence. b. Symptomatic Evidence - This includes the symptoms observed during the poisoning. This is not conclusive because some diseases may show similar symptoms as those of poisoning. - Ex. Arsenic poisoning is like cholera, alcoholic coma may stimulate diabetic coma. c. Chemical Evidence - Obtained by chemical analysis of the suspected substance. d. Post Mortem Evidence - This evidence is obtained from an examination of the tissues and organs after death. e. Experimental Evidence - Is obtained by administering the suspected substance to some living animal and noting the effect or symptoms. This alone is also not conclusive because the tolerance may not be of a man. EVIDENCE OF POISONING EVIDENCE IN SEARCH ➔ On the Scene: containers with drugs or not, HOW LONG DOES COCAINE STAY IN YOUR SYSTEM powders, waste, and substances chemical tools to draw the poison (test tube, beakers, distillation ➔ Hair: up to few years flask), chemical bills, mark footprints, fingerprints. ➔ Blood: up to 2 days ➔ Saliva: up to 2 days ➔ The Victim: Background: suicide attempt, suicide ➔ Urine: up to 3 days note, symptoms of an intoxicated person, if toxic element residues, fingerprints, and blood, urine, What factors affect cocaine in the system? stool, and tissues. - Weight - Frequency ➔ The Offender: toxic water or container elements. - Dosage - Person’s metabolism ➔ Depends upon whether the poisoning is acute or chronic. METHODS OF EXAMINATION ➔ In acute poisoning the symptoms appear suddenly while the individual is in good health. The person is a. Isolation usually affected with a group of symptoms of - submitted specimen is in pure form, the definite characteristics out of consonance with his poison must be first isolated. Thus, poison previous state of health. may be classified according to their method of isolation as; ➔ In chronic poisoning, the onset of symptoms is more gradual and insidious due to the small 1. Volatile: isolated by extraction with alcohol and quantity of poison that has been administered on chloroform. such occasions since the intention is to kill his victim slowly in order to avert suspicion. 2. Non-Volatile: isolated by extraction with organic solvents and alkaloids. ➔ The presence of poison must be proven and proofs 3. Metallic Poisons: poisons such as arsenic, mercury of poisoning in the dead may be obtained from: and lead. 1. Hair – an examination of a dead body b. Identification especially to determine the cause of - method employed for the identification of death. specific poison like Spectrophotometer and Gas Chromatograph. 2. Evidence from the chemical analysis of the organs from the body – the most LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY INTERPRETATION OF TOXICOLOGICAL ANALYSIS rapidly effective. The rate of absorption and the effect is quicker when a poison is taken in liquid form than when taken in Reasons for Negative Results of the Toxicological solid form. Examination: 1. Some poisons may be altered in the body to a form 3. Chemical Form that is not detectable by the methods of analysis - Chemically pure metallic arsenic and employed. mercury are not poisonous because these are insoluble and 2. Some poisons with or without previous chemical change may be rapidly excreted although its toxic - are not absorbed. However, white arsenic effect remains and may only be detectable in the (arsenious oxide) and mercuric chloride are urine but not in the body tissue or organ. poisonous. - Barium sulfide is deadly toxic, but barium sulfate is 3. Sometimes symptoms of poisoning may appear, non-toxic. which may be fatal following the administration of even small and ordinarily harmless quantities of a 4. Concentration substance classed as poison. - In concentrated form, poisons are absorbed more rapidly and are also fatal FORENSIC QUESTIONS FOR THE TOXICOLOGIST TO more rapidly. But this is not true with some ANSWER/EXPLAIN poisons. 1. Forensic Questions for the Toxicologist to - A dilute solution of oxalic acid is less Answer/Explain corrosive but more rapidly absorbed and 2. Was the death or illness of the subject caused by hence may be more rapidly fatal. the poison? 3. What poison produced the illness or death? 5. Condition of the Stomach 4. When and how was the poison administered? - Food content. Presence of food-stuff in the 5. Could the substance administered cause illness or stomach acts as diluent of the poison and death? hence protects the stomach wall from the 6. Was the poison found by the toxicologist in the corrosive and irritating action of the body the poison that caused death? poison. 7. Is the substance given in minute quantities a - Fatty food usually delays the process of poison? absorption. 8. Was the poison taken in sufficient quantity to - But, for phosphorus, the presence of fatty produce death? food accelerates the process of its 9. May the poisoning have occurred and the poison absorption. either be or become undetectable? - Abnormal condition of the stomach 10. May the poison extracted from the body have an - Empty stomach absorbs poison most origin other than that of poisoning? rapidly. CONDITIONS MODIFYING THE ACTION OF POISONS 6. Route of Administration 1. Those attributed to the individual - Through some routes poisons are a. Age and sex absorbed very rapidly and exerts their b. Health actions equally rapidly. c. Habit d. Idiosyncrasy 7. Age e. Diseases - Some poisons are tolerated better in some f. Food ages and badly in some other ages g. Sleep - Opium and its alkaloids are tolerated h. Exhaustion better by elderly subjects but badly by children and infants. 2. Those attributed to the poison itself - Belladona group of drugs, on the other a. Physical state or form of the poison hand, are better tolerated by children than b. Dilution by adults c. Solubility of the poisons d. Mode of administration 8. State of Body and Health e. Chemical combination - A well-built person with good physique f. Mechanical combination and health will tolerate the action of a g. Dose poison better than a weak subject. FACTORS INFLUENCING THE ACTIONS OF A POISON IN THE 9. Presence of any disease BODY - In certain diseased conditions some drugs are tolerated exceptionally well, e.g., sedatives and tranquilizers are tolerated in 1. Quantity very high doses by maniac and deliriant - High dose of a poison acts quickly and patients. more severely. - Moderate dose causes acute poisoning 10. Idiosyncrasy which also may be fatal - Some persons are idiosyncratic to some - Low dose may have sub-clinical effects, drugs and react most adversely though but if introduced repeatedly at intervals, it the general population tolerates the drug may have subacute or chronic effects, well particularly if the poison is cumulative in - Ex. Some serum preparations, aspirin. nature 11. Tolerance 2. Physical Form - Due to prolonged use, persons may - Gaseous or volatile poisons are very develop tolerance to certain drugs and quickly absorbed and are thus most LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY may not show any alarming sign even - The smaller the ED50 value, the lower the when they consume a high dose of drugs. dose required to achieve the same effect, - A person addicted to opium may tolerate indicating a higher potency of the drug. such a dose of the drug which can cause - The smaller the ED50, the more potent the death to even two or more persons. drug 12. Posology ➔ Median Lethal Dose (LD50) refers to an estimate of - Posology is the branch of medical science the amount of poison that, under control conditions, that deals with the determination of the will be a lethal dose to 50% of a large number of appropriate doses of drugs and test animals of a particular species/ medications. - The value is expressed in milligrams of the - It involves the study of how different doses substance being tested per kilogram of of a drug affect patients and how these animal body weight (mg/kg). doses should be adjusted based on - A chemical with a small LD50 (like 5 various factors such as the patient's age, mg/kg) is very highly toxic. weight, sex, and overall health condition. - A chemical with a large LD50 (1,000 to - Posology also considers the frequency of 5,000 mg/kg) is practically non-toxic. dosing (how often a drug should be - It is incorrect to say that chemicals with taken), the route of administration (oral, small LD50s are more dangerous than intravenous, etc.), and the duration of the chemicals with large LD50s, they are treatment. simply more toxic. - Ex. A pesticide with a lower LD50 is more 13. Dose toxic than a pesticide with a higher - Dose refers to the specific amount of a number because it takes less of the drug or medication that is administered to pesticide to kill half of the test animals a patient at one time. - The dose is typically measured in units ➔ Toxic Dose (TD) is used to indicate the dose such as milligrams (mg), micrograms (exposure) that will produce signs of toxicity in a (µg), or milliliters (mL), depending on the certain percentage of animals. form of the drug. - The TD50 is the toxic dose for 50 percent of - The dose is critical in ensuring that the the animals tested. patient receives enough of the drug to be - The larger the TD the more poison it takes effective without causing harm. to produce signs of toxicity. - The toxic dose does not give any DOSE information about the lethal dose because toxic effects (for example, nausea and ➔ Its concept is important. Whether a drug acts as vomiting) may not be directly related to therapy or poison, it will depend on the dose. Even the way that the chemical causes death. water is poisonous if too much is ingested. - When using the toxic dose designation, it is useful to precisely define the type of toxicity measured, Safe Dose/Therapeutic Dose - the amount of a drug - required to achieve the desired therapeutic effect. It does not cause harmful effects. the animal species tested, and the dose and route of administration Minimum Effective Dose - the smallest amount of medicine that can produce the desired therapeutic effect without causing harm. Maximum Dose - the largest amount of a drug that can be safely administered without causing significant adverse effects. Toxic or Poisonous -one that is harmful both to the healthy and the sick. Lethal or Fatal Dose - The amount of a drug that can cause death if taken at one time (commonly ANTIDOTES used in toxicology studies). ➔ Neutralizes or counteracts or opposes effects of DOSE-RESPONSE RELATIONSHIP IN TOXICOLOGY poison. - To act as an antidote, it may: 1. Remove the poison from the MEASURE OF EXPOSURE: body. 2. It may mechanically prevent its absorption. 3. It may change the physical state chemical composition. 4. It may act upon the functions of DOSE-EFFECT RELATIONSHIP the body so as to overcome the ➔ Median Effective Dose (ED50) - is a metric effects of its absorption. representing the dose of a medication that produces the intended pharmacological effect in KINDS OF ANTIDOTES 50% of the patient population studied during clinical trials - This value is derived from clinical studies 1. Chemical or true or specific and is used to help clinicians determine - One that makes the poison harmless by the optimal initial dose for their patients. chemically altering it. LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY 2. Mechanical or Antidotal Measure - an agent that removes the poison without c. Physiological Antidote – sometimes called changing it; coats the surface of the organ “antagonist”. An agent that acts upon the so that absorption is prevented. system to counteract the effect of the - Ex. stomach tube and pump, precipitants, poison. It merely masks the symptoms ligatures, washes, injections, poultries. produced. 3. Physiological antidote, symptomatic 3. Elimination of Poisons by Exertion - An agent that acts upon the system to - poisons are eliminated through excretory counteract the effects of the poison. organs. Made by intravenous infusion of - Ex. chloral for strychnine convulsions saline solution, dilute alkali solution or dilute solution of glucose. The poison is 4. Emetics generally excreted through the urine, - An agent that causes vomiting. feces, vomitus, or saliva. 5. Cathartic 4. Stimulation and other symptomatic treatment - An agent that produces intestinal a. For excessive pain – morphine or another evacuation. analgesic. b. For convulsion – chloroform 6. Demulcent c. For shock – oxygen inhalation - An agent that forms a protective film, soothes and protects the parts where 5. Special treatments demulcent is applied. a. if the poison is gas – the immediate need is fresh air and artificial respiration. 7. Precipitants b. if poisoning is external (like a burn on the - Substances that prevent absorption of hand by concentrated acid) – wash with poisons by precipitating them and plenty of water rendering them insoluble. c. if alkali burns – flowing water for 10 to 15 minutes d. if the poison has come from a bite or injection – the poison can be checked GENERAL TREATMENT OF POISONING from spreading through the body by applying a tourniquet or a restricting band 1. Removal of poison from the stomach tightly above the wound. This delays the - if the poison is taken orally the removal of absorption of poison by the blood. the poison is brought about by: COMMON VOLATILE, NON-VOLATILE AND METALLIC POISONS a. Inducing vomiting using emetics Emetics – are substances or agents that produce vomiting 1. Benzene – This refers to a solvent for rubber gums, b. Use of stomach pump or stomach tube resins, and fats. It is also called Benzol. - if poison is applied or instilled – 2. Acetone – This refers to a colorless liquid that is wash characterized by a fruity odor. It is used as a solvent - if the poison is injected – for cellulose acetate and nitrocellulose. ligatures and bleeding. 3. Caffeine – This refers to a bitter alkaloid found especially in coffee, tea, cacao, and kola nuts and 2. Administration of antidotes used medicinally as a stimulant and diuretic. a. Mechanical Antidote – an agent that 4. Formalin – This refers to a clear aqueous solution removes the posing without changing it or of formaldehyde and methanol used especially as coats the surface of the organ so that a preservative or most commonly utilized as an absorption is prevented. E.g. Stomach embalming liquid. tubes or pumps; emetics; Cathartics; 5. Salicylic Acid – This refers to a crystalline phenolic demulcents and precipitants acid that is used medicinally especially as a skin exfoliant and in the form of salts and other derivatives as an analgesic and antipyretic. 6. Cocaine – This refers to a bitter crystalline alkaloid Classes of Emetics: obtained from coca leaves that is used especially 1. Local Emetic in the form of its hydrochloride medically as a - produce their effects by their irritation of topical anesthetic and illicitly for its euphoric effects the terminal nerve filaments of the and that may result in a compulsive psychological pharynx, esophagus or stomach need. 7. Ethyl Alcohol or Ethanol – This refers to a colorless 2. System or General Emetics volatile flammable liquid that is the intoxicating - produce their effects through the medium agent in liquors and is also used as a solvent and in of circulation fuel. a. Cathartics – agents that produce 8. Ergot – This refers to the black or dark purples intestinal evacuation sclerotium of fungi (genus Claviceps) that occurs b. Demulcents – substances that as a club – shaped body replacing the seed of a soothe and protect that part grass (such as rye). which they are applied. 9. Barbiturates – This refers to any of various c. Precipitants – these are derivatives of barbituric acid (such as substances that prevent Phenobarbital) that are used especially as absorption of poisons by sedatives, hypnotics and antispasmodics and are precipitating them and rendering often addictive. them insoluble 10. Strychnine – This refers to a bitter poisonous alkaloid that is obtained from nux vomica and b. Chemical Antidote – substance that make related plants (genus Strychnos) and is used as a the poison harmless by chemically poison (as for rodents) and medicinally as a altering it. stimulant of the central nervous system. LECTURE #1 | TOXICOLOGY – INTRODUCTION TO FORENSIC TOXICOLOGY 11. Nicotine – This refers to a poisonous alkaloid that is the chief active principle of tobacco and is used as an insecticide. 12. Morphine – This refers to a bitter crystalline addictive narcotic base that is the principal alkaloid of opium and is used in the form of a soluble salt (such as a hydrochloride or a sulfate) as an analgesic and sedative. 13. Arsenic – This refers to a poisonous trivalent and pentavalent solid element that commonly occurs in a brittle, metallic, steel–gray, crystalline form and is used especially in wood preservatives, allots, and semiconductors. Arsenic is used especially as an insecticide or weed killer. 14. Methyl Alcohol or Methanol – A light volatile flammable poisonous liquid alcohol used especially as solvent, antifreeze, or denaturant for ethanol and in the synthesis of other chemicals. If it is consumed by humans it will cause blindness and even death. 15. Chloroform – This refers to a colorless, volatile, sweet-smelling liquid that has a suffocating odor used as a solvent formerly as a general anesthetic. 16. Hydrogen Cyanide – This refers to a poisonous usually gaseous compound that has the odor of bitter almonds that is locally found in “Kamoteng Kahoy”. It is also called hydrocyanic acid or prussic acid. 17. Acetic Acid – This refers to a colorless pungent liquid acid that is the chief acid of vinegar and that is used especially in synthesis (as of plastic). 18. Aspirin – This refers to a white crystalline derivative of salicylic acid used for relief of pain and fever. 19. Cannabinoids – This refers to any of various naturally – occurring, biological active, chemical constituents (such as cannabidiol or cannabinol) of hemp or cannabis including some (such as THC) that possess psychoactive properties. 20. Methamphetamine Hydrochloride – This refers to the hydrochloride salt form of methamphetamine, an amphetamine and sympathomimetic amine with central nervous system-simulating properties. It is locally called as “Shabu”. 21. Heroin – This refers to a light brown powder that is a strongly physiologically addictive narcotic made by acetylation but is more potent than morphine that is prohibited for medical use but is used illicitly for its euphoric effects. It is also called diacetylmorphine. 22. Potassium Cyanide – This refers to a very poisonous crystalline salt used especially in gold and silver extraction from ore. 23. Opium – This refers to a bitter brownish addictive narcotic drug obtained from immature seed capsules of the opium poppy. 24. Cyanides – This refers to a rapidly acting, potentially deadly chemical that can exist in various forms. It can be a colorless gas, such as hydrogen cyanide (HCN) or cyanogen chloride (CNCI), or a crystal form such as sodium cyanide (NaCN) or potassium cyanide (KCN). It is sometimes described as having a “bitter almond” smell, but it does not always give off an odor 25. Codeine – This refers to a morphine derivative that is found in opium, is weaker in action than morphine, and is used especially as an analgesic and antitussive. 26. Cantharides – This refers to a preparation of dried beetles (such as Spanish flies) used in medicine as a counterirritant and formerly as an aphrodisiac. 27. Carbon Monoxide – This refers to a colorless, odorless, and very toxic gas that is formed as a product of the incomplete combustion of carbon or a carbon compound that is found in the exhaust of automobiles. HOW LONG DOES COCAINE STAY IN YOUR SYSTEM