in dictionaries, poison is defined as: “mineral, herbal, animal sourced or synthesized substance...
TRANSCRIPT
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)
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Effects of PoisoningDepends on, The structure of the poison,Application way (exposure type),Exposure duration,Exposure repetition,Personal sensitivity
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Dose Definitions Effective Dose (ED) Toxic Dose (TD) Lethal Dose (LD)
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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.
619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
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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.
819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Poisoning ClassificationAccording to;Sources,Duration and frequency of exposure,OriginAffected locations,Toxicological analyze methods,
1019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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,
1119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
According to Duration and Frequency of Exposure
Acute poisoning,Sub-acute poisoning,Chronic poisoning,
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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
1319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
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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.
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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.
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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.
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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.
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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
2019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
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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
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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.
2319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
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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.
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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.
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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)
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Blood and Urine
In internal organs
In addition to internal organs
AlcoholCarbon monoxideHashishOpiate and kinds CocaineAmphetaminesHallucinogens Rodenticides… …
SalicylatesBarbituratesPhenothiazinesBenzodiazepines PyrazoloneTricyclic antidepressantsInsecticidesStrychnine… …
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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.
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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.
3119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
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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
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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
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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
3519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
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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.
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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.
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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.
4019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
4119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
4219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
4319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Methyl alcohol Formaldehyde Acid formic CO2+H2O
1.Alcohol dehydrogenase2.Aldehyde dehidrogenaseIts toxic affect depends on the
accumulation of acid formic.
4419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
4519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
4619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
4719.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
In acute poisoning cases blindness does not occur although in chronic poisoning blindness occur.
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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.
4919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
5019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
5119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
5219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Narcotic substances Morphine, heroin, codeine,
benzodiazepines,.. Stimulant substances Amphetamine, cocaine,.. Hallucinogenic LSD, mescaline, cannabis...
5319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
TCK Madde 188-192
Uyuşturucu ve uyarıcı maddelerin imal
ve ticareti ile ilgili suçları içermektedir.
5519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
İtiyat: Concept of “Habituation”
=Alışkanlık=Habituation Psychological addiction
Tolerance, Physical addiction Ø
5619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
İptila:Concept of “Addiction” İptila = Addiction Physical Addiction
Tolerance (+), Abstinence Syndrome (+)
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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”.
5819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Opium Group Narcotics
I. Natural Alkaloids of Opiuma) Phenanthren Group Opium Alkaloids
MORPHINE TEBAINE CODEINE OXİMORPHONE
b) Izochinoline Group Opium Alkaloids PAPAVER NARCOTINE NARCEINE
5919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Semi-Synthetic Narcotic AnalgesicsII. Phenanthren Group Alkaloids a) Esterification products
HEROIN DIONINb) Oxidation products
DILAUDID DICODIDc) Oxidation and esterification products
PARACHOID PHOLCODINE METOPON LEVORPHANOL
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III. Synthetic Analgesics MEPERIDINE ALFAPRODINE FENAZOSINE PIMINODINE
ANILERIDINE METADON ETANSULPHATE
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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.
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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.
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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.
6519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
6819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
7019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
7219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
GIS Findings:Nausea, vomiting
Dermal Effects:Warm-up sensation, hyperemia, pruritis, sweating, urticariaDifficult urination, reduced urineMyozisSkeletal muscles become flaccid.
Narcotic Substance Effects
7319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
7419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
7519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
OriginAccident
- Dose-out, - tolerance problems ,Suicide
- Golden shotHomicide need to be explored!
7619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
AutopsyNonspecific findings.Needle scars, keloid, abscessPulmonary edema (narcotic A.C.)Signs of organ complications.Material gain is important.
7719.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Death MechanismsRespiratory depressionFood aspiration (5-6%)Anaphylactic reactionsLate complications
* In Istanbul forensic autopsies heroin deaths 60-80 cases per year. (3200 autopsies)
7819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Other Important IntoxicationsCocaineAmphetamines (Ecstasy, captagon,,,)MarijuanaLSD (lysergic acid diethyl amide)Mescaline (Mexican cactus, black mushrooms
)Phencyclidine (angel dust)Volatile and solvent substances (!)
7919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Tremor, tonic-clonic convulsions, hallucinations,
MydriasisSympathomimetic symptoms such
as vasoconstriction, hyperthermia, tachycardia develops symptoms develop.
8219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8619.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
‘Stroke Syndrome’ caused by hyperthermia may result in death.
Long-term use results in hiperexcitation, hallucinations and dangerous psychotic reactions.
8719.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Usage areasIn medicine, when stimulation of CNS is
needed, Narcolepsy,Attention disorders in children, Weight loss cures
8819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
8919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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).
9019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
9319.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
9419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
9519.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Heavy MetalsAluminumArsenicMercuryLead
Thallium NickelCadmiumCopper
Enters to the body by oral, nasal, mucosal, respiratory, parentheral ways and through
eye or skin.96
19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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)
9719.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Systems Affected By Heavy MetalsBlood and circulatory system,GIS.Urogenital SystemSkinHormonal system,Nervous System,Energy Production and EnzymesImmune System.
9819.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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)
9919.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Farm DrugsInsecticides : kill insectsFungicides : kill mushroomsNematicides : kill nematodesHerbicides : kill herbsRodenticides : kill rats* Other substances used in plant protection.
10019.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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
10119.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
Effects of Farm DrugsAcute PoisoningChronic PoisoningAllergic EffectCarcinogenic EffectAccumulation in Various Organs and Tissues
10219.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.
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.
Thank you …[email protected]
10419.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.