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FORENSIC TOXICOLOGY. Associate . Prof. ABDİ ÖZASLAN Istanbul Unıversity , Cerrahpasa Medicine Faculty , Forensic Medicine Department. In dictionaries, poison is defined as: “mineral, herbal, animal sourced or synthesized substance that has destructive or fatal effects on human body.”

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forensic toxicology

FORENSIC TOXICOLOGY

Associate. Prof. ABDİ ÖZASLAN

IstanbulUnıversity,

CerrahpasaMedicineFaculty,

ForensicMedicineDepartment.

slide2

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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

slide3

“The dose makes the poison”

Paracelsus (1493-1541)

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

effects of poisoning
Effects of Poisoning

Depends on,

  • The structure of the poison,
  • Application way (exposure type),
  • Exposureduration,
  • Exposurerepetition,
  • Personalsensitivity

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dose d efinitions
Dose Definitions
  • Effective Dose (ED)
  • Toxic Dose (TD)
  • Lethal Dose (LD)

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evaluation of dose response relationship 1
EVALUATION OF DOSE-RESPONSE RELATIONSHIP -1
  • It is the relationship between the responseof 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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

evaluation of dose response relationship 2
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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

most observed poisoning types according to national poisoning center data 1
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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

most observed poisoning types according to national poisoning center data 2
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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

poisoning classification
Poisoning Classification

According to;

  • Sources,
  • Duration and frequency of exposure,
  • Origin
  • Affected locations,
  • Toxicological analyze methods,

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

poisonings according to source
Poisonings According to Source
  • Herbal sourced; Belladonna, various alkaloids and heart glycosides,
  • Animal sourced; Snake, scorpion, spider and insulin,
  • Mineral sourced; Lead, mercury, arsenic,
  • Synthesized;DDT, parathion, amphetamine,

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

according to duration and frequency of exposure
According to Duration and Frequency of Exposure
  • Acute poisoning,
  • Sub-acute poisoning,
  • Chronic poisoning,

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

according to origin
According to Origin
  • Accident; 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

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

forensic medical examiner s responsibilities in poisoning cases
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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

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 54

Alcohol (ethylene and

methylene) poisonings 21

Medicine poisonings 18

Other poisonings 18

Dead births 21

Child Deaths 497

Pathological Deaths 767

Sending to Commissions 554

Others 365

TOTAL: 3923

Forensic Autopsies-Istanbul 2010

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

in forensic toxicology
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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

autopsy in poisoning cases
Autopsy in Poisoning Cases
  • In 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 autopsy
Before Autopsy
  • Terminal 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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

findings in external examination
Findings in External Examination
  • Usually 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 1
Findings in Internal Examination 1
  • Mouth and nose space; Dust or colourful material artifacts (tablet or capsule artifacts, pestiside or herbiside artifacts and intranasal drug usage)
  • Nasal septumPerforation; Cocain
  • Brainsmell and colour change;Carbolic acid, alcohols, cyanide, methyl salisilate

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

findings in internal examination 2
Findings in Internal Examination -2
  • 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),

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findings in internal examination 3
Findings in Internal Examination -3
  • Kidneys;Hemorrhage (heavy metals, cantharidine), parenchymatoustubulus 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).

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toxicologic analysis examples
Toxicologic Analysis Examples
  • In 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.

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slide24

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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

slide25

Blood samples should be preserved by adding sodium fluoride. Some laboratories might want to add potassium oxalate, EDTA or 5 mg/mL concentrated sodium citrateanticoagulants as well.

  • Samples like urine, bile, vitreous tissuesgenerally needn’t preservative material. However, sodium or potassium fluoride must be added to samples for alcohol analysis.

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slide26

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 termpreservation is the case.
  • Room temperature is proper for hair and nail samples.

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slide27

Rutin Toksikolojik Örnek Toplama Kılavuzu

(Hearn L. PostortemToxicology)

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substances searched in samples
Substances Searched in Samples

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alcohol poisonings

ALCOHOL POISONINGS

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alcohol intoxications
ALCOHOL INTOXICATIONS
  • Alcohol 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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

ethyl alcohol
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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

slide32

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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

factors affecting absorption of alcohol
Factors Affecting Absorption of Alcohol
  • 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, GISblood flow and motility, diabetes, gastrectomy etc. And psychogenic factors are effective) .

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

ethyl alcohol metabolism 1
Ethyl Alcohol Metabolism -1
  • 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
  • Alcohol dehydrogenase
  • Aldehydedehydrogenase (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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

ethyl alcohol metabolism 2
Ethyl Alcohol Metabolism -2
  • 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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

effects of ethyl alcohol
Effects of Ethyl Alcohol
  • 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.

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slide38

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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

slide39

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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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

death
DEATH
  • Person 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.

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autopsy findings in chronic ethyl alcohol intoxication 1
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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

autopsy findings in chronic ethyl alcohol intoxication 2
Autopsy Findings in Chronic Ethyl Alcohol Intoxication -2
  • 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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

methyl alcohol
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.

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slide44

Methyl alcohol Formaldehyde Acid formic CO2+H2O

  • Alcohol dehydrogenase
  • Aldehydedehidrogenase
  • Its toxic affect depends on the accumulation of acid formic.

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slide45

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.

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slide46

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.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

slide47

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.

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slide48

In acute poisoning cases blindness does not occur although in chronic poisoning blindness occur.

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methyl alcohol autopsy findings
Methyl Alcohol Autopsy Findings
  • No 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.

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narcotic substance poisoning

NARCOTIC SUBSTANCE POISONING

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problems with narcotic substance usage
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.

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definition of narcotic substance
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.

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slide53

Narcotic substances 

Morphine, heroin, codeine, benzodiazepines,..

  • Stimulant substances

Amphetamine, cocaine,..

  • Hallucinogenic

LSD, mescaline, cannabis...

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alkol veya uyu turucu madde etkisinde olma tck madde 34
Alkol veya uyuşturucu madde etkisinde olma TCK Madde 34
  • 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.
  • İradî olarak alınan alkol veya uyuşturucu madde etkisinde suç işleyen kişi hakkında birinci fıkra hükmü uygulanmaz.

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tck madde 188 192
TCK Madde 188-192
  • Uyuşturucu ve uyarıcı maddelerin imal ve ticareti ile ilgili suçları içermektedir.

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tiyat concept of habituation
İtiyat: Concept of “Habituation”

=Alışkanlık=Habituation

Psychological addiction

Tolerance, Physical addiction Ø

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ptila concept of addiction
İptila:Concept of “Addiction”

İptila= Addiction

 Physical Addiction

Tolerance (+),

Abstinence Syndrome (+)

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

hashish papaver somniferum
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”.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

opium group narcotics
Opium Group Narcotics

I. Natural Alkaloids of Opium

a) Phenanthren Group Opium Alkaloids

 MORPHINE  TEBAINE

 CODEINE  OXİMORPHONE

b) Izochinoline Group Opium Alkaloids

 PAPAVER  NARCOTINE

 NARCEINE

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

semi synthetic narcotic analgesics
Semi-Synthetic Narcotic Analgesics

II.Phenanthren Group Alkaloids 

a) Esterification products

 HEROIN  DIONIN

b) Oxidation products

 DILAUDID DICODID

c) Oxidation and esterification products

 PARACHOID  PHOLCODINE

 METOPON  LEVORPHANOL

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slide61

III. Synthetic Analgesics

 MEPERIDINE  ALFAPRODINE

 FENAZOSINE  PIMINODINE

 ANILERIDINE  METADON

 ETANSULPHATE

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morphine c 17 h 19 no 3 morphium morphia morphin
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
Intake
  • Subcutaneous intake
  • Sometimes 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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slide64

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.

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heroin diacetyl morphine diamorphine asetomorphine
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.

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heroin
Heroin
  • Contains 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.

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heroin1
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.

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heroin metabolism
Heroin Metabolism
  • Rapidly hydrolyzed in the blood to 6-monoacetylMorphine (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.

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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.

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codeine
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.

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CNS Findings:

  • Analgesia
  • Drowsiness(aggravation in thejoints,body temperature)
  • Mental changes (euphoria, depressive chg.)
  • Blurred conscious

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narcotic substance effects
Narcotic Substance Effects

RespiratorySystem:

  • Respiration is affectedDepression (otherthancodeine)
  • Lungedema

CardiovascularSystem:

  • Indefinite
  • Ortostatichipotention
  • Cyanosis

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narcotic substance effects1
Narcotic Substance Effects

GIS Findings:

  • Nausea, vomitingDermalEffects:
  • Warm-up sensation, hyperemia, pruritis, sweating, 

urticaria

  • Difficult urination, reduced urine
  • Myozis
  • Skeletal muscles become flaccid.

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abstinence syndrome withdrawal symptoms
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

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Anorexia, lacrimation, intensesweating, 

  • GIS symptoms. (Nausea, vomiting, pain, diarrhea)
  • The number of left ()-blood pressure ()
  • Flashing
  • Goose skin appearance (pilomotoractivity)
  • CNShyperexcitability
  • Ejaculation, orgasm.
  • spontaneous recovery after 7-8 days

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origin
Origin
  • Accident    - Dose-out, - tolerance problems ,
  • Suicide    - Golden shot
  • Homicide

 need to be explored!

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autopsy
Autopsy
  • Nonspecific findings.
  • Needle scars, keloid, abscess
  • Pulmonary edema (narcotic A.C.)
  • Signs of organ complications.
  • Material gain is important.

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19.08.2012 Doç. Dr. A.ÖZASLAN: CTF. ADLİ TIP ANABİLİM DALI.

death mechanisms
Death Mechanisms
  • Respiratory depression
  • Food aspiration (5-6%)
  • Anaphylactic reactions
  • Late complications

* In Istanbul forensic autopsies heroin deaths   60-80 cases per year. (3200 autopsies)

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other important intoxications
Other Important Intoxications
  • Cocaine
  • Amphetamines (Ecstasy, captagon,,,)
  • Marijuana
  • LSD (lysergic acid diethyl amide)
  • Mescaline (Mexican cactus, black mushrooms)
  • Phencyclidine (angel dust)
  • Volatile and solvent substances (!)

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cocaine
COCAINE
  • Obtained 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.

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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.

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Tremor, tonic-clonic convulsions, hallucinations,

  • Mydriasis
  • Sympathomimetic symptoms such as vasoconstriction, hyperthermia, tachycardia develops symptoms develop.

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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.

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Cocaine is rapidly inactivatedin the body byhydrolisation.

  • 85-to 90% as much ecgonine methyl ester and benzoyl ecgonine are excreted in the urine.

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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.

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amphetam i ne s
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.

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‘Stroke Syndrome’ caused by hyperthermia may result in death.

  • Long-term use results in hiperexcitation, hallucinations and dangerous psychotic reactions.

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usage areas
Usage areas
  • In medicine, when stimulation of CNS is needed,
  • Narcolepsy,
  • Attention disorders in children,
  • Weight loss cures

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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.

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cannabis
CANNABIS
  • Derived 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 tetrahydrokanabinol(THC).

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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.

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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.

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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.

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lsd lysergic acid diethylamide
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.

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Sympathomimetic effects such as hyperexcitability, ataxia,fear and discomfort, lackof self control, paranoid symptoms,tactile hallucinations, false reasoning, mydriasis, tachycardia, hypertension; psychosis, aggression, selfharm,increased reflexes,murder and suicide tendency are observed.

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heavy metals
Heavy Metals
  • Aluminum
  • Arsenic
  • Mercury
  • Lead
  • Thallium
  • Nickel
  • Cadmium
  • Copper

Enters to the body by oral, nasal, mucosal,respiratory, parentheral ways and through eye or skin.

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products containing heavy metals
Products Containing Heavy Metals
  • Heavy 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)

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systems affected by heavy metals
Systems Affected By Heavy Metals
  • Blood and circulatory system,
  • GIS.
  • Urogenital System
  • Skin
  • Hormonal system,
  • Nervous System,
  • Energy Production and Enzymes
  • Immune System.

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farm drug poisoning
FARM DRUG POISONING
  • To 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)

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farm drugs
Farm Drugs
  • Insecticides :kill insectsFungicides : kill mushroomsNematicides : kill nematodesHerbicides : kill herbsRodenticides : kill rats* Other substances used in plant protection.

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acetylcholine esterase enzyme inhibitors
Acetylcholine Esterase Enzyme Inhibitors
  • Organophosphates insecticides
  • Methyl parathion, Diazinon, Dichlorvos, chlorpyrifos, Malathion, Bromophos.
  • Organochlorous insecticides
    • DDT, Endosulfan
  • Carbamateinsecticides
    • Aldicarb, Carbofuran, Carbosulfan, Methomyl, Dioxacarb, Carbaryl
  • Pyrethrin and pyretroids
    • Cypermethrin, cyhalothrin, Deltamethrin, Permethrin

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effects of farm drugs
Effects of Farm Drugs
  • Acute Poisoning
  • Chronic Poisoning
  • Allergic Effect
  • Carcinogenic Effect
  • Accumulation in Various Organs and Tissues

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organic phosphate poisoning
Organic Phosphate Poisoning

Acetylcholine 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.

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thank you abdioz@istanbul edu tr
Thank you …abdioz@istanbul.edu.tr

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