2 Toxicology

General Diagnosis of Poisoning
History and circumstantial:

1. History of trouble, failure, or having enemies.
2. History of recent brought of poison.
3. Presence of bottle off sleeping pills or insecticide beside victim.
4. Sudden appearance of toxic manifestations on a healthy person,

or in a group of persons after taking certain food or drink.
Signs and symptoms (Clinical Toxicology):

1. Characteristic smell of the mouth and breath in case of phenol,
alcohol, opium, kerosene and cyanide poisons.
2. Patches or eschars around the mouth in corrosive poisons.
3. Gastro-intestinal irritation as nausea, vomiting and diarrhea
will suspect metallic poisons.
4. Pupillary signs: pin point pupils in morphine
poisoning, constricted pupils in organophosphorus
poisoning. Dilated pupils in atropine and cocaine
poisonings and McEwans pupil in toxic alcoholic coma.
5. Skin changes: red in CO and cyanide poisoning, dry
hot f lushed in atropine poisoning, cold f lushed in alcohol
poisoning.
6. Pulse: rapid in atropine and slow in morphine
poisonings.
7. Respiration: rapid and shallow in atropine, slow and
deep in morphine poisoning.
Postmortem signs (Forensic Toxicology):
A careful postmortem examination of the stomach can
give many information in diagnosis of poisoning:
1. Smell of the stomach e.g. bitter almond in cyanide
poisoning.
2. The condition of the gastric mucosa: destroyed and
discolored in corrosive poisoning (black in sulphuric, and
yellow in nitric acid).
3. Presence of poisonous seeds (datura seeds) or crystals
(arsenic).
Laboratory investigations
In living persons:
Specimens are taken from blood, vomit, urine and other
excretion. Clothes are also sent for analysis.
In a dead body:
- Blood is collected from the heart or the femoral vein.
- Gastric content should be examined, first by the naked
eyes for presence of tablets, seeds or pesticides, then the
stomach, the gastric content and the intestine are
examined.
- Parts of liver, kidney, brain, lung and spleen are
analyzed.
- CSF is collected by a lumbar puncture.
- Vitreous humor, hair and nails are also collected.
CLASSIFICATION OF POISONS
Poisons have local action only:
s
Poisons have remote action only:

s .
Poisons have both local and remote

actions (double action):
s irritant metallic poisons
CORROSIVE POISONS
Mineral acids: e.g. sulphuric acid, nitric acid and
hydrochloric acid.
Organic acids: e.g. carbolic acid (phenol), oxalic acid
and acetic acid.
Vegetable acid: e.g. hydrocyanic acid.
Alkalies: e.g. caustic potach ( KOH),
caustic soda (NaOH) and ammonium
hydroxide(NH4OH).
Corrosive salts: some mineral salts e.g. mercuric
chloride and antimony trichloride.
Sulphuric Acid
Characters: Pure sulphuric is a colourless, odourless,
hygroscopic, oily, non-fuming liquid. The commercial acid is dark
in colour due to presence of some impurities.
Uses: In industry, in house cleaning liquids and painting dyes.
Mode of poisoning:
Accidental
It is not common. It usually occurs amongst those who use it in
their work. Also children may swallow the acid, because
commercial acid is dark as cola.
Homicidal
Sometimes, it is criminally thrown on the face for vengeance to
produce disfigurement or permanent infirmity.
Action: The acid i s hygroscopic, i.e. it has a great affinity for
absorbing water. It damages the tissue by dehydration, the tissues
appear black due to charring and conversion of haemoglobin into
acid haematin.
Cause of death:
1. Death within 12 hours will result from shock due to local
burning pain of the acid.
2. Death from 1-2 days may result from dehydration from
vomiting, or from peritonitis due to perforation of the stomach.
3. Death within 2-3 weeks may be due to exhaustion and
general weakness.
4. Death after few years may result from stricture of the
oesophagus or stomach.
Postmortem picture:
1. The lips, the adjacent cheeks, chain and neck all are corroded
with streaks of dark eschars as a result of dribbling of the acid and
saliva.
2. The clothes may show stains of dark brownish colour or they
may be destroyed in spots.
3. The corrosions may extend through the mouth and throat to
the oesophagus and its mucosa may be stripped off.
4. The stomach is usually severely affected. The whole mucous
membrane may be corroded and stained black, with streaks of
altered blood.
5. The stomach may be perforated with escape of the gastric
contents into the peritoneal cavity.
6. Evidence of chemical peritonitis may be present.
Corrosive Alkalies
Examples: NaOH, KOH and ammonium hydroxide
Uses:
NaOH and KOH are used in the manufacture of soap.
Ammonium hydroxide is used in the ice industry.
Sodium and potassium carbonates are used by washer
women in the form of washing powder or milk white slimy
solution.
Mode of poisoning: (accidentally)

- Accidental ingestion amongst children.
- Accidental inhalation of the fumes in the industry.
Action:
Caustic soda and potash exert their actions by the
rapid absorption of water from the tissues and
combination with fats and proteins forming soaps and
protenates, respectively.
Ammonium hydroxide is a liquid containing 25%
ammonia and it differs from the caustic potash and
soda that gives off ammonia in the form of a gas. It
injuries the cell directly by an alkaline caustic action
and causes extremely painful irritations of all the
mucous membranes especially that of the respiratory
passage.
Postmortem picture:
- Lips, mouth and throat are corroded, stained with
greyish colour and are soapy in appearance and touch.
- The caustic effects are observed about the corners of
the mouth and running down to the chin.
- The gastric mucosa is swollen, hyperaemic and shows
areas of corrosion. Its colour is greyish and the contents
of the stomach are coffee coloured (alkaline haemtin)
- Perforation of the stomach is not common.
- The small intestine may show congestion.
- In case of ammonia poisoning, in addition to the
P.M.P. of the alkaline corrosives, the followings may
be present:
- Characteristic odour of ammonia in the tissues.
- Perforation of the stomach.
- Inhalation of the ammonia fumes may lead to an
inf lammed swollen glottis.
- Inflammation of the mucous membranes of the
respiratory passage with evidence of
bronchopneumonia and pulmonary oedema.
Organic Acids
Carbolic acid (phenol)
Source: Carbolic acid is a coal tar derivative.
Physical and chemical characters: The pure acid is colourless,
prismatic needle-like crystals. It has intense characteristic odour
(phenolic odour). The commercial acid is a brown liquid.
It is readily soluble in alcohol and glycerine and slightly soluble in
water.
Although phenol is known as an acid, it has no acidic reaction i.e.,
it does not turn a blue litmus paper into red. However, it is called
an acid because it forms carbonate (salt) when acted upon by a
strong base.
Uses: Carbolic acid enters in the composition of most disinfecting
agents e.g. dettol.
Action: It has double action (local and remote)
Local action:
-It is a coagulant of the tissue protein. It causes
coagulative necrosis of all the tissues with which it comes
in contact.
The gastric wall is thickened and its ruga are exaggerated
without any deep ulceration.
- It acts as a mild corrosive accompanied with tingling,

numbness and even complete anesthesia upon the skin and
mucous membrane. When applied to the skin
and prevented from evaporating, it may
cause gangrene even in a weak solution.
Remote action:
- Initial stimulation of the C.N.S. rapidly
followed by depression.
- Depression of the myocardium.
- On the kidney: acute glomerulonephritis with

tubular and glomerular degenerations.
Absorption It is rapidly absorbed from the
alimentary tract, respiratory tract, rectum, vagina,
wounds and even through the intact skin.
Mode of poisoning:
- Commonly suicidal, because it can be easily
obtained (extensively used), well known to have a
rapid fatal effect and it is painless (local anesthetic
effect).
- Accidental during its use in the industry or for
disinfection of houses.
- It cannot be used homicidal due to its characteristic
odour.
Postmortem picture:
External and internal signs of asphyxia.
Smell of phenol may be detected at the mouth.
Greyish-white stains may be present at the angles of the mouth and

on the chin.
Oesophageal and gastric mucosa are greyish-white or brown. It

appears swollen and its mucous folds are prominent with superficial
erosions
The kidneys are slightly swollen and show haemorrhagic spots. The
urinary bladder contains little amount of
urine, which become dark in colour after
exposure to air.

2 Toxicology

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2 Toxicology

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General Diagnosis of Poisoning

History and circumstantial:

4. Sudden appearance of toxic manifestations on a healthy person,

Signs and symptoms (Clinical Toxicology):

Poisons have remote action only:

Poisons have both local and remote

Mode of poisoning: (accidentally)

- It acts as a mild corrosive accompanied with tingling,

- Depression of the myocardium.

- On the kidney: acute glomerulonephritis with

Smell of phenol may be detected at the mouth.

Greyish-white stains may be present at the angles of the mouth and

Oesophageal and gastric mucosa are greyish-white or brown. It

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