Forensic medical toxicology Flashcards
What is the long-drawn course of events in heroin death?
- apnoea may pass
- later deep sleep/coma
- positional asphyxia in certain cases
- often bronchopneumonia (hypostatic pneumonia, accumulation of secretion)
- relatively low mrophine content, often a little codeine (which is derived from morphine)
How can one determine the manner of death as drug-induced?
Look for…
- environment
- information
- anamnesis
- bottles
- smell
- inspection
- goodbye letter
What are “soureces” for methanol poisoning?
- fuel for camping stoves
- NOT T-red (denatured alcohol)
- almost never moonshine
Define “modern” poisons and name two examples
Modern poisons do not cause determinalbe pathognomonic (i.e. disease specific) changes, examples are sleeping pills and psychotropic drugs
Name three opioids
- methadone
- subutex
- buprenorphine
Lethal complications in alcohol damages
- arrythmia
- left and right chamber failure
- cardiogenic shock
- thrombo emboli
What are “sources” of cyanides?
Bitter almond
burning of certain plastics
lab chemicals
What are “sources” of organic solvent poisoning
sniffing and huffing
Which brain areas are stimulated by drug abuse?
- PFC
- nucleus accumbens
- VTA
What CO concentration/binding percentage can cause poisoning and what is the fatal CO content of the blood?
Poisoning: 0,1%
fatal: 50-80%
Why is subutex overdosing so common?
Because it has a slow onset, so you take more and suddenly have an overdose
Which areas of the brain are connected through dopaminergic projections?
- striatum
- VTA ventral tegmental area
- substantia nigra
- amygdala
- nucleus accumbens
- PFC prefrontal cortex
- (Hippocampus)
- (BNST)
What are “sources” of carbon monoxide poisoning?
- motors
- fires
- household gas
- heating appliances
What are the most common things to induce food poisoning?
- salmonella
- shigella
- staphylococcus
- rhubarb
- mushrooms
- clostridium botulinum
At an autopsy you observe that the inside of the stomach is dark brown/red. What could have induced this?
Poisoning with HCl hydrogen cyanide
What are morphological changes after carbon monoxide poisoning seen during the autopsy?
Light-red livor mortis and light-red inner organs
What is prussic acid and what does it do?
- Hydorgen cyanide
- forms in the ventricle
- quickly absorbed
- blocks cytchrome oxidase
How is heroin metabolised?
Heroin is metabolised in 6-monoacetylmorphine (6-MAM), which is further metabolised into morphine, which is then metabolised into morphine-6-glucuronide or morphine-3-glucuronide
What are the toxic chemical mechanisms behind
- methanol
- isopropanol
- ethylenglycol
- Methanol is metabolised into formaldehyd (damages the retina) and formic acid (methanoic acid)
- Isopropanol is metabolised into aceton
- Ethylenglycol is metabolised into oxalic acid
What are differences between heroin and morphine?
- heroin is more lipohilic (goes faster into brain)
- heroin metabolises quickly compared to morphine
- Heroin is more potent than morphine
At the autopsy you see light-red livor mortis and light-red inner organs; what could have happend to the person?
carbon monoxide poisoning
Define “classic” poisons and name two examples
Classic poisons cause morphological damages, examples are arsenic or phosphorous poisons
What can be found in lung oedema after fast and delayed cases of heroin death?
mast cells
Which parameters determine the effect of the drug?
- dose
- form
- administration
- age
- constitution
- “pure” intoxications
- combination
Which form of heroin is smoked?
brown powder called brown sugar
What are symptomes of opiate overdosing?
(five)
- miosis (small pupils)
- coma
- respiratory depression/paralysis
- heart frequency decreases
- allergic shock
What is the fast death mechanism of heroin?
apnoea, which will show 6MAM in blood and lung oedema
What are risk factors for heroin death?
- low tolerance due to abstinence followed by relapse
- additive or synergistic affects of alcohol and other drugs
What are effects of opiates?
- rush after a few seconds
- body temperature decreases
- psychomotor skills become slow (walk weak in the knees)
- euphoria passes into a feeling of well-being (absence of anxiety, pain, hunger, thirst or sexual needs)
- abstinence follows
Which tissues/fluids can be sampled for poison testing?
- blood
- urine
- eye fluid (corpus vitreum)
- bile
- stomach
- muscle
- liver
- lung
- brain
- hair
How do organic solvents induce death? (death mechanisms)
- arrhythmia
- hypoxia and hypercapnia
- vagal reflex
Which cyanides induce fatal poisoning?
sodium or potassium cyanide
Which microscopic changes occur with alcohol cardiomyopathy?
- diffuse interstitial fibrosis
- perivascular fibrosis, also coronary vessel (most often no plaques)
which form of heroin is watersoluble and injected?
white powder (horse)
What are common causes of death from ethanol poisoning?
- alcohol cardiomyopathy
- cirrhosis of the liver
- ruptured oesophagus varices (vessels)
- pancreatitis
- a lot of indirect ones, such as violence, accidens, falls, frostbite
