Post on 29-Nov-2014
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Medical Faculty of Trisakti University
Jakarta
Many substances that may cause someone experiencing a poisoned until it brings a death.
Substances that active chemically and physiology in one body, at the point of certain dose (toxic) will bring an unhealthiness or may cause a death.
Forensic discuss about toxic substance from its varies, symptoms caused, and method forensic examination to handle either for alive or dead victims.
Toxicology definition and factors that affect toxicity
Epidemiology, signs and symptoms, pharmacokinetic, laboratory examination, and treatment/therapy of cyanide poisoning
Forensic examination of patient that experiencing common poison and cyanide poison
medikolegal aspects of deliberate poisoning or unintentionally
Example case of cyanide poisoning
As a part of medical science that focused on toxic
Study about nature and mechanism of toxic effect, varies substance towards living things and other biologic system
A study about source, characteristic and a savor from toxic, indication and treatment against poisoning and other abnormality found in dead victim
A substance that may cause bad effect when it gets into a body of a living things, either intentionally or unintentionally
Origin: Plants (opium, cocaine, curare, aflatoxin) Animals (poison/snake toxin,
spider/marine animals) Mineral (arsenic, plumbum, and things
that made from synthetic) Heroin
Venue: Nature-free (poison gas in nature, household) Poison agriculture (insecticides, herbesida, p
esticides) Toxic industrial laboratories and industry
(acid and strong base, heavy metals) Toxic food(CN in cassava, botulinus toxic,
preservative, additives substance and toxic in the form of medicine e.g. sedative hypnotic)
Organs that affected:• Hepatotosik• Nephrotoxic
Work mechanism:• Toxic that bind sulfhydryl group (Pb)• Effect on ATP-ase• Forming methemoglobin (nitrate and nitrite)
The effects:• Local• Systemic• local-systemic
Exposure to toxic substances on humans andliving things:
regular consumption exposure from work environmental exposure and
poisoning, either intentionally or unintentionally
How to enter: Age Body condition Habits Idiosinkrasi and allergic to vitamin E,
penicilin, streptomycin dan procaine Time delivery
A deadly toxic substance• Effects are very fast and can cause death within a few minutes• Hydrogen cyanide (formonitrile)• In the form of liquid -> prussit acid and hydrocyanic acid• Liquids can also be colorless or pale blue at the temperature of normal room• volatile and flammable• diffuse either by air and explosives• Very easy to mix with water• Otherforms: sodium cyanide and potassium cyanide (powder and white)
• a major contributor to morbidity and mortality, observed in approximately 5,000 to10,000 deaths occur from inhaling fog each year in the united states
• Exposure suicide rarely reported to poison centers and 18 of 242 (in 2007) and 25 of238 (in 2008) cases of cyanide poisoning is deliberate exposure as reported to the American Association of Poison Control Centers
• fatal suicide in adult patients may easily be associated with sudden death from myocardial infarction, pulmonary embolism, or ventricular dysrhythmias
Low-dose in nature and in every product that we usually eat or use
Cyanide can be produced by bacteria, fungi and algae
Cyanide is found in cigarettes, motor vehicle fumes, and food and the synthetic product
Cyanide in seed plants,especially grains (cassava wild, wild tubers, Intersection buffoonery, wild cherry, plum, apricot, wild amigdalin, jetberry bush, etc.)
Fog Inhalation Intentional poisoning (suicide) Industry exposure Iatrogenic exposure Consumption
of Supplements Containing Cyanide (Uncommon)
Cyanide in the body will inactive some oxidative enzymes radically the whole system, especially cytochrome oxidase by binding to the ferric heme group from the oxygen carried by blood
The process of oxidation and reduction occurs as follows:
Cytochrome oxidase Fe + + Fe + + + cytochrome oxidase+ CN /---- Fe + + + cytochrome oxidase-cyanide-
Oxidize cyanide d in the body get into cyanates and sulfosianat and expelled from the body through urine. Toxic dose orally for HCN is 60-90 mg, while doses toxic to KCN or NaCN is 200 mg.
Main effects: hypoxia system arise progressivelySymptoms and physical signs that found are depend on the• The dose of cyanide• Number of exposures• Type of exposure• Types of cyanide component
symptoms in the body:• blood pressure, vision, lung, central nerve, heart, endocrine system, autonomic system and metabolic system• sore eyes because of irritation and difficulty breathing due to irritate the respiratory tract mucosa• high concentrations only within 15 seconds hiperpnea, 15 seconds to lose consciousness. 3 minutes of apnea is a period of 5-8 minutes will cause the heart muscle activity is hampered due to hypoxia and ends with death
• Exposure of hydrogen cyanide may cause irritation against eyes and skin immediately after exposure or at least 30 to 60 minutes
In low concentrations, the effects of cyanide emerging about 15-30 minutes later
Early signs of cyanide poisoning:• Temporary hiperpnea• Headache• dyspnea• Anxiety• Changes in behavior such as agitation and restlessness• Sweating a lot, reddish skin color, body feels weak and vertigo
• cyanosis of the face, the foam out from the mouth, rapid and weak pulse, rapid breathing and sometimes irregular, dilated pupils and slower reflex, air breathing smells tonsil, the vomit also smells • By the death, cyanosis more real and arise twitch muscles and convulsions with urinary incontinence and alvi
•Inhalation: palpitations, difficulty to breath, nausea, vomiting, headache, salvasi,lakrimasi, mouth and throat irritation, dizziness and weakness of extremities arise quickly and then collapse, convulsions, coma and death• Chronic poisoning victim looks pale, cold sweats, dizziness, discomfort in the stomach, nausea and colic, feel pressed on the chest and shortness of breath.• Signs the end: coma and dilated pupils, tremors, arrhythmias, convulsions, coma emphasis on the respiratory center, respiratory failure until the heart stop beating• color skin looks "cherry-red"
Paper filter test Reaksi Schonbein – Pagenstecher
( Reaksi Guajacol) Prussian Blue reaction Micro Method Gittler & Golabaum
• Poisoned by CN inhalation:->move victim to the place where clean air is available, give-amyl nitrite with inhalation, 1 ampoule (0.2 ml) every5 minutes, stop giving when the systolic blood pressure is less than 80 mmHg-> give artificial respiration with 100% oxygen->Antidotum in the form of sodium nitrite 3% IV-> vary the dose of sodium nitrite and sodium thiosulfate with Hb
CN poisoning ingested• do an emergency action with inhalation of amyl nitrite, one ampoule (0.2 ml, within 3minutes) every 5 minutes• Give artificial respiration with 100% oxygen.• Besides nitrite, methylene blue 1% 50 mL IV can be used as antidotum
cases of deaths due to poisoning:• Examination at the place of incident• Outdoor examination- smell- Clothes- Bruises corpse- Changes in skin color- Nails- Hair- sclera
Open chest and abdominal cavity, specify whether there is an unusual smell (smell of poison)• Consider the color of blood and the color of organs is brownreddish • In lung, there is an acute damming
Taking blood from the heart separately from the right and left respectively for about 50 ml• Blood side for about 30-50 ml, taken from of iliac vein• Urine and gastric washings all of taken from the bladder• Organ liver should be taken after reserved for pathology anatomy examination
• Kidneys should be taken both• Brain, lipoid system inside• another way to take samples:Get the place where toxic gets in (stomach, the injection site)BloodOut point (urine, bile)
• pemeriksaan bagian luar jenazah tercium bau amandel
• Sianosis pada wajah dan bibir, busa keluar dari mulut, dan lebam mayat berwarna terang
• pemeriksaan bedah jenazah tercium bau amandel yang khas pada waktu membuka rongga dada, perut dan otak serta lambung, darah, otot dan penampang tubuh dapat berwarna merah terang
Examination of the exterior of the body wafted of tonsils
Cyanosis of the face and lips foam out of the mouth and bruised corpse light colored
Surgical examination of the corpse wafted of the spesific tonsils distinctive when opening the chest cavity stomach, brain and also blood, muscle, and body sections color seems red bright
KUHP :
Article 205Article 359Article 360
KUHAP
Article 133
Law Number 8 Year 1999 About Consumer Protection:
Article 19 Article 60 Law Number 7 Year 1996 About
Food: Article 21 Government Regulation Number 28
Year 2004About Safety, Quality and Nutritional
Food : Article 25
Six People is being poisoned by Cyanide Acid in Tiwul (a food from cassava flour)( Tue, January 18 2011 )
TEMPO Interaktif, Jepara - Substance Acid cyanide (HCN) became the major cause the death of six victims, children of J (45) by SJ (40): L (24), AA (3), AK (5), MH (13) , F (15) and SK (8) residents of Desa Jebol, District Mayong, Jepara, Central Java, where HCN poisoning their food named tiwul(food from cassava flour)
Leaf and
Cassava Tuber
Be poisoned
Case Discussion
Toxicology can be defined as a substance that can cause bad effect when it gets into a living body, either accidentally or with intent.• One type of poisoning that occurs is cyanide poisoning, because the cyanide salt in a small dose is enough to cause death in someone quickly like a suicide.• Poisoning can through parenteral administration, inhalation, ingestion or skin absorption (dermal).• Signs and symptoms depend on the mechanism, source and quantity of cyanide that gets into the body.
• Forensic through the post-mortem examination and toxicology tests can prove the existence of cyanide in the body, or any changes and abnormalities consistent with cyanide poisoning.• Aspect medikolegal about cyanide poisoning regulated in KUHP articles 205, 359, 360; KUHAP 133, Law No. 8 of 1999 about consumer protection Article 19 and 60.
Budiyanto A, Widiatmaka W, Sudiono S,et al. Ilmu Kedokteran
Forensik. Jakarta : Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia. 1997, hlm 71-72
Ernest H. A Textbook of Modern Toxicology Third Edition. New Jersey : A John Wiley & Sons, Inc, 2004, hlm 3-8
Budiyanto A, Widiatmaka W, Sudiono S, et al. Ilmu Kedokteran Forensik, 1997. Jakarta : Bagian Kedokteran Forensik Universitas Indonesia ; 95 – 100.
Leybell I, Borron SW. Cyanide Toxicity. June 2nd 2010. Cited from : http://emedicine.medscape.com/article/814287
Budiyanto A, Widiatmaka W, Sudiono S, et al. Ilmu Kedokteran Forensik, 1997. Jakarta : Bagian Kedokteran Forensik Universitas Indonesia ; 73 – 86
Kitab Undang-undang Hukum Pidana Kitab Undang-undang Hukum Acara Pidana Undang-undang Nomor 8 tahun 1999 Tentang Perlindungan
Konsumen Undang-undang Nomor 7 tahun 1996 Tentang Pangan Centers for Disease Control and Prevention. The Facts About
Cyanides. New York State Department Of Health. New York. 2004. Available from: www.health.state.ny.us/nysdoh/bt/chemical_terrorism/docs/cyanide_general.pdf. Access on: November 29, 2006
http://gresnews.com/ch/Regional/cl/hisyam-alie/id/1810889/Enam-Tewas-Keracunan-Asam-Sianida-Pada-Tiwul