diana maría gonzález. maría angélica palencia. andrea jimena santamaría. may 2010 xi semester
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Diana María González.María Angélica Palencia.
Andrea Jimena Santamaría.
May 2010 XI Semester
METHANOL AND CYANIDE
INTOXICATION
THIS WEEK !!!!!!Half of the suicidal deaths
are younger than 30!!!!!
The majority of suicides are MEN
Beteween 20 and 24 years. Many had drug problems or
ALCOHOL DEPENDENCEPOISONING 465 CASES
http://www.eltiempo.com/archivo/documento/MAM-3951687
Articles
I. General AspectsII. EpidemiologyIII. Materials and MethodsIV. PhysiopathologyV. ResultsVI. DiscussionVII.ConclusionsVIII. Questions
Table of Contents
• Intoxication : the state of being affected by one or more psychoactive drugs. It can also refer to the effects caused by the ingestion of poison or by the overconsumption of normally harmless substances.
General Aspects
• Methanol: A colorless, toxic, flammable liquid, used as an antifreeze, a general solvent, a fuel, and a denaturant for ethyl alcohol. Also called carbinol, methyl alcohol, wood alcohol, wood spirits.
General Aspects
• Cyanide: Any of various salts or esters of hydrogen cyanide containing a CN group, especially the extremely poisonous compounds potassium cyanide and sodium cyanide.
General Aspects
METHANOL INTOXICATION CYANIDE INTOXICATIONWorld-wide problem, and in some regions it is connected with high morbidity and mortality.
The major routes are:• Inhalation• Topical exposure• Oral
Methanol is found commonly in:• Antifreeze• Perfumes• Solvents• Commercial formaldehyde• Ilegal alcohol
Deaths due to cyanide poisoning are relatively rare.
•Smoke inhalation.•Industry, particularly in the metal trades, mining, electroplating, jewelry manufacturing, and x-ray film recovery, fumigation .
• Used as suicidal agents, particularly among healthcare and laboratory workers.
•Potentially terrorist attack.
Epidemiology
Materials and Methods
17 methanol poisoning cases.
The brains of 17 cases after being fixed for 2 weeks in 10% formalin.
The samples were embedded in paraffin and then were stained with hematoxylin.
All samples are sent to the toxicology section of the Council of Forensic Medicine to determine drugs and ethanol/methanol.
Ante-mortem samples.
Postmortem specimens
Sample preparation for neuropathology
Sample preparation for analysis of methanol levels
Chemicals and reagents
Instrumentation and chromatographic conditions
Data processing
Validation of the analytical method
Determination of cyanide was performed by a spectrophotometric method after microdiffusion.
5 cases report: cases 1 through 4 were analyzed in Bon and case 5 was analyzed in Duesseldorf.
PHYSIOPATHOLOGY
Physiopatology MethanolEarly stage poisoning
Formaldehyde
Formate ACIDOSIS
OCULAR TOXICITY
GENERAL TOXICITY
ACIDOSIS
Late stage poisoning
Inhibition of the mitochondrial respiration
Methanol
Increased formate toxicityCirculatory Failure
Circulatory Failure
CIRCULUS HIPOXICUS
TISSUE HYPOXIA
CYANIDE (HCN)LUNGS
GASTROINTESTINAL TRACTSKIN
INACTIVATION OF CYTOCHROME OXIDASE
INHIBITS CELLULAR RESPIRATION
NauseaVomitingAcidosisConvulsionDEATH
Physiopatology Cyanide
RESULTS
CASE AGE CLINICAL Treatment
1 39 Deep ComaBrain death diagnosis
EthanolFolic Acid
BicarbonateHemodialysis
2 34 Deep Coma
EthanolFolic Acid
BicarbonateHemodialysis
3 44 Death None
Metanol Intoxication
Macroscopic changes
Brain Stem
Cerebel-lum
heart-blood
Femoral vein
blood
Urine Vitreous humor
Liquor Lung Bile Kidney Liver Gastric contens
Synovial fluid
Case 1 738 1828 5 5 25 8 0 0 12 0 0 95 0
100
300
500
700
900
1100
1300
1500
1700
1900
Case 1
Met
hano
l con
cent
rati
ons
Mg/
L or
g/K
g
Metanol concentrations
Brain Stem
Cerebellum
heartblood
Femoral vein blood
Urine
Vitreous humor
Liquor
Lung
Bile
Kidney
Liver
Gastric contens
Synovial fluid
Case 2
1008
0254
228
247
201
351
249
256
230
238
248
268
100
300
500
Case 2
Met
hano
l con
cent
ratio
ns M
g/L o
r g/K
g
Metanol Intoxication
Brain Stem
Cerebellum
heartblood
Femoral vein blood
Urine
Vitreous humor
Liquor
Lung
Bile
Kidney
Liver
Gastric contens
Synovial fluid
Case 3
2213
1811
2130
2074
2488
2122
2289
02180
01808
2200
0
250
750
1250
Case 3
Met
hano
l con
cent
ratio
ns M
g/L o
r g/K
g
Metanol concentrations
Cyanide Intoxication: Case 1
AGE External Examination Internal Examination Toxicology38 year old
•Livor mortis of inconspicuous coloration
•Petechiae and purpura
•Intense congestion of the face
•Fatty liver
• Visceral congestion
•Stomach: Viscuous brown fluid
•Cyanide:Blood: 80,9 Mg/LGastric: 1,26 g/LLung: 46,3Brain: 4,8 mg/Kg
AGE External Examination
Internal Examination
Toxicology
71 years old
• Both corpses revealed no major
injury• Livor mortis of purple coloration
• Non performed Cyanide:•Blood: 6,1 Mg/L• and: 8,6 Mg/Ml
Cyanide Intoxication: Cases 2 & 3
AGE External Examination
Internal Examination
Toxicology
70 year old
• Coloration of livor mortis
•Severe atherosclerosis with fibrofatty plaques and 2 surgical aortocoronary bypass vessels
Cyanide:•Blood: 42,5 Mg/L
Cyanide Intoxication: Case 4
Cyanide Intoxication: Case 5
AGE External Examination
Internal Examination
Toxicology
29 year old
• Coloration of livor mortis
• Atherosclerosis with fibroftty plaques and 2
surgical aortocoronary bypass vessels
Cyanide:Blood: 42,5 Mg/Land: 8,6 Mg/Ml
Macroscopic changes
Macroscopic changes
DISCUSSION
Cyanide salts are generally colorless solid or colorless gas at room temperature.
The ability to smell cyanide is a genetically determined trait absent in 50%.
Each pack of cigarettes releases 250 to 10,000g of cyanide
Faint, bitter almond odor. May be released by pyrolysis.
Discussion
Cyanide Intoxication
CLINICAL PRESENTATIONS TOXICOLOGICFINDINGS
Symptoms in seconds of inhalation and within minutes after the ingestion.
Lightheadedness, giddiness, tachypnea, nausea, vomiting, suffocation, confusion, restlessness, anxiety, slow heart rate.
Hypoventilation, apnea and myocardial depression.
<0.2 mg/L do not cause symptoms.
Smokers may reach 0.4 mg/L without symptoms.
0.5 and 1.0 mg/L: conscious, flushed, and tachycardic.
Stupor and agitation can appear with peak blood levels between 1.0 and 2.5 mg/L.
Discussion
INDICATIVE CIRCUMSTANCES OF CYANIDE POISONING PATHOLOGIC FINDINGS
Acrylate or nitric manufacturers andusersBlacksmithsOyeingElectroplatingMetal heat treatment processesMineral refiningPaper manufacturesPest controlPhotographyPlastic manufacturesPrintingTanning
Nonspecific
The bright pink or lilac coloration is difficult or impossible to detect
• Hemorrhagic appearance ofthe gastric mucosa.
• Vacuolation of the basal mucosal cells, desquamation of surface epithelial cells, inflammatory infiltration of the submucosa.
Discussion
Discussion
METHANOL
Nausea, vomiting, abdominal pain, visual disturbances, and mental status changes after a 12 to 24 hours latent period.
Severe intoxication: delirium, convulsions, coma, cardiopulmonary failure, and death.In our cases, death occurred from the unwitting ingestion of methanol. Eight cases /visual disorder.In acute methanol intoxication the brain is swollen and congested and there may be petecchial hemorrhages. (putaminal hemorrhage)
• Petecchial hemorrhages in the occipital, temporal and parietal cortex, and basal ganglia.
• Hemorrhagic necrosis: thalamus, putamen, and globus pallidus in 5 cases, and at cerebral cortex in 3 cases.
• While 3 of the cases with cerebral edema were accompanied by herniation of the brain, 2 cases had pons hemorrhages.
• Two of the cases with hemorrhagic necrosis around basal ganglia ventricular compression .
• Survival times from few hours to 10 days.
Discussion
DISCUSSION
Concentration of methanol in postmortem specimens
1. Hemodialysis can effectively reduce toxic blood methanol concentrations.
2. Determination of blood levels does not reliably reflect brain methanol concentrations.
3. If a patient presents in a coma, the narcotic properties of methanol should be kept in mind before starting brain death diagnosis
4. if fatal methanol intoxication is suspected, brain methanol analysis should be performed after autopsy, and blood analysis to avoid that cases with longer survival times escape detection.
Conclussions
5. Sporadic or epidemic accidental use of methyl alcohol, is one of the major forensic problems.
6. Cases susceptible to methyl alcohol poisoning, many topographic sampling should be carried out primarily at the cerebral cortex and from various parts of the brain, and the same should be analyzed by an experienced neuropathologist.
Conclussions
• Diagnosis of cyanide intoxication cannot reliably be established at autopsy recognize or may even be completely missing.
• considerable caution should be exercised in an attempt to smell cyanide, because this procedure is associated with the risk of inhaling cyanide fumes.
Conclussion
Congratulations new interns, this was our final magazine club!!! THX Dr. Hernandez!!!
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