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Case analysis

Alcohols

Cyanide

Arsenic

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Case 1

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Question 1

One man, Alexander Zhbckov, 28, died atthe Bodrum State Hospital as doctors were

unable to stabilize her condition, afterdringking alcohol. Weight: 70 kg, Alcoholconcentration 50g. How much blood

alcohol level?

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Alcohols

Ethanol is beverage alcohol

Metanol and isopropanol are also available in theenvironment or workplace and may contribute tohuman injury

Ninety minutes after ethanol ingestion is theapproximate time to the achievement of peak bloodlevels

Cp (blood concentration) = D(g)/(Vd(L/kg)xW(kg))

D: dose; Vd: Volume of distribution (0,7 in man and 0,6in women); W: body weight in killograms

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Toxicology of AlcoholAlcohol is absorbed through the stomach and

intestine

Once absorbed, alcohol is: Oxidized- in liver by alcohol dehydrogenase

Excreted- by breath, perspiration, and kidneysturnedinto carbon dioxide and water

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Assessment of Ethanol Impairment Blood alcohol concentration:

10-50 mg/dL: Impairment detectable by special tests

30-120 mg/dL: Beginning of sensory-motor impairment

90-250 mg/dL: Sensory-motor incoordination;impaired balance

180-400 mg/dL: Increased muscular incoordination;apathy; lethargy

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Assessment of Ethanol Impairment Blood alcohol concentration:

250-400 mg/dL: Impaired consciousness; sleep; stupor

350-500 mg/dL: Complete unconsciousness; coma 450 and greater mg/dL: Death from respiratory arrest

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Case 2

-What is the name of this phenomenon?-What is the name of poison?

-In cyanide poisoning, what is the componentthat form that phenomenon?

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Cyanide

Cyanide is dangerous because it binds to ferric ionsin cytochrome oxidase, an enzyme in the electrontransport system within the mitochondria of cells

Cherry red livor mortis because of

cyanomethaemoglobin formation Forensic laboratories can tes for cyanide in whole

blood and its concentration correlates well withseverity of poisoning.

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Arsen Industrial processes Semiconductor manufacturing (gallium arsenide)

Fossil fuels

Wood treated with arsenic preservatives Smelting (copper, zinc, lead) and refining of metals and

ores

Glass manufacturing

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ArsenicAcute Poisoning Ingestion of large doses (70180 mg) of inorganic

arsenic can be fatal

Symptoms of acute intoxication include:Fever

Anorexia

Hepatomegaly

Melanosis

cardiac arrhythmia

in fatal cases, eventual cardiac failure

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nifestation

sofacutearsenic

poisoning

Bodily system affected Symptoms or signs Time of onset

Systemic ThirstHypovolemia, Hypotension

MinutesMinutes to hours

Gastrointestinal Garlic or metallic tasteBurning mucosaNausea and vomitingDiarrhea

Abdominal pain

HematemesisHematochezia, melenaRice-water stools

ImmediateImmediateMinutesMinutes to hoursMinutes to hours

Minutes to hoursHoursHours

Hematopoietic system HemolysisHematuriaLymphopeniaPancytopenia

Minutes to hoursMinutes to hoursSeveral weeksSeveral weeks

Pulmonary(primarily in inhalationalexposures)

Cough

DyspneaChest PainPulmonary edema

Immediate

Minutes to hoursMinutes to hoursMinutes to hours

Liver JaundiceFatty degenerationCentral necrosis

DaysDaysDays

Kidneys ProteinuriaHematuria

Acute renal failure

Hours to daysHours to daysHours to days

rsen cAcute Poisoning

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ArsenicChronic ToxicitySkin Diffuse or spottedhyperpigmentation and, alternatively,

hypopigmentation can first appear between 6 months to 3

years with chronic exposure to arsenic

Skin cancer is common with

protracted high-level arsenical exposure

Palmar-plantar hyperkeratosis usuallyfollows the initial appearance of arsenic-induced pigmentation changes within a

period of years

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ArsenicChronic ToxicityLiver Characteristic of long-term or chronic arsenic

exposure, manifests :jaundice

abdominal pain

hepatomegalyprogress to cirrhosis and ascites

even to hepatocellular carcinom

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ArsenicChronic ToxicityPeripheral neurophathy Repeated exposure to low levels of inorganic arsenic

can produce This neuropathy usually begins with :

sensory changes

numbness in the hands and feetpainful pins

and needles sensationmotor nerves be affected

muscle tenderness

weaknes progressing from proximal to distal

muscle groupss

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ArsenicChronic Toxicitycardiovascular disease Peripheral vascular disease has been observed in

persons with chronic exposure to inorganic It is manifested :

acrocyanosis

progress to endarteritis andgangrene of the lower extremities

(Blackfoot disease).

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Reference

Abdul Munim Idries, dkk, 1979 : Ilmu KedokteranKehakiman , cetakan I, Jakarta.

Ariens E.J.,dkk., 1993 : Toksikologi umum

(pengantar), Gadjah Mada University Press,Yogyakarta. Flanagan R.J., dkk., 1995 : Analisis Toksikologi

Dasar, International Programme on ChemicalSafety, WHO, Geneva.