Anatomical Findings External Flashcards
Xenobiotics related deaths
Anatomic findings in many cases are nonspecific
External Examination
Pills in hand
Syringe left in the arm
External insulin pump
Drug patches
Various anatomical findings that can be suggestive of death due to drug overdose
Usual colors or odors
Abnormal physical features
Perforated nasal septum is one of the most commonly though manifestation of cocaine use
1st described in the early 1900s after the practice of “snorting” cocaine became popular
Presumptive indicator – chronic use of nasal sprays containing any vasoconstrictor may cause the same pathology
Meth Mouth
Rampant dental caries associated with methamphetamine abuse
Commonly referred to as “meth mouth”
Risk factors leading to dental caries
Xerostomia [dry mouth]
Frequent ingestion of carbonated drinks [acidic pH] to relieve the dry mouth
Grossly inadequate oral hygiene
Prolong duration of action, especially when binding, methamphetamine abuse leads to sustained reduction in saliva production and will allow rapid bacterial growth
Rampant Dental Carries
Drug abuse in general poor dental hygiene
Heroine abusers
Xerostomia,Poor diet,Increased “palatability” of sweet tasting substances
Fentanyl Similar issues,Actiq [fentanyl lollipop]
2 g of sugar in raspberry-flavored additive
Cannabis
Short-term hyposalivation, Data conflicting
Mee lines
White lines under fingernails
Named after Dutch physician RA Mees
Described in 1919
Attributed to heavy metal poisoning
E.g., arsenic or thallium
Also seen with
Chemotherapy
Renal failure
Foam Cone
Various anatomical findings may be suggestive of death due to or related to a poisoning, toxic exposure, or drug overdose
“Foam cone” over nose and/or mouth – the dried residue
Build-up of pulmonary edema following an anoxic period
Suggestive of narcotic OD
Drowning
Congestive heart failure
Body Color
Cherry red: CN, CO
COHb >30%
“inexperienced eye”
Refrigeration
Normal livor
Drug Induced Skin Pigmentations
Drug-induced pigmentation represents 10 – 20% of all cases of acquired hyperpigmentation
main drugs implicated
nonsteroidal anti-inflammatory drugs, antimalarials, amiodarone, cytotoxic drugs, tetracuclines, heavy metals, psychotropic drugs
clinical features are very variable accounting for the triggering molecule, with a large range of patterns and shares which are sometimes more
Levamisole in a cocaine user
an anthelmintic [dewormer] agent for use in animals, is a common additive in cocaine and is speculated to enhance the euphoric effect
purple facial hair and ears
Unusual odors-alcohol
alcohlic congeners
Unusual odors-fruity
Ketotic odor – ketones
Smell of pear drops
Diabetic ketoacidosis
Unusual odors-others
Ammonia: kidney disease
Maple syrup: defective amino acid metabolism
Unusual odors-Cyanide
Distinctive odor
“Bitter almonds”
“Bleach-like”
Tapioca leaves
40-60% population can smell
Genetically driven
2-5 ppm
Smell is rapidly paralyzed
