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Flashcards in Forensic medical toxicology Deck (35)

What is the long-drawn course of events in heroin death?

  • apnoea may pass
  • later deep sleep/coma
  • positional asphyxia in certain cases
  • often bronchopneumonia (hypostatic pneumonia, accumulation of secretion)
  • relatively low mrophine content, often a little codeine (which is derived from morphine)


How can one determine the manner of death as drug-induced?
Look for...

  • environment
  • information
  • anamnesis
  • bottles
  • smell
  • inspection
  • goodbye letter


What are "soureces" for methanol poisoning?

  • fuel for camping stoves
  • NOT T-red (denatured alcohol)
  • almost never moonshine


Define "modern" poisons and name two examples

Modern poisons do not cause determinalbe pathognomonic (i.e. disease specific) changes, examples are sleeping pills and psychotropic drugs


Name three opioids

  • methadone
  • subutex
  • buprenorphine


Lethal complications in alcohol damages

  • arrythmia
  • left and right chamber failure
  • cardiogenic shock
  • thrombo emboli


What are "sources" of cyanides?

Bitter almond
burning of certain plastics
lab chemicals


What are "sources" of organic solvent poisoning

sniffing and huffing


Which brain areas are stimulated by drug abuse?

  • PFC
  • nucleus accumbens
  • VTA


What CO concentration/binding percentage can cause poisoning and what is the fatal CO content of the blood?

Poisoning: 0,1%

fatal: 50-80%


Why is subutex overdosing so common?

Because it has a slow onset, so you take more and suddenly have an overdose


Which areas of the brain are connected through dopaminergic projections?

  • striatum
  • VTA ventral tegmental area
  • substantia nigra
  • amygdala
  • nucleus accumbens
  • PFC prefrontal cortex
  • (Hippocampus)
  • (BNST)


What are "sources" of carbon monoxide poisoning?

  • motors
  • fires
  • household gas
  • heating appliances


What are the most common things to induce food poisoning?

  • salmonella
  • shigella
  • staphylococcus
  • rhubarb
  • mushrooms
  • clostridium botulinum


At an autopsy you observe that the inside of the stomach is dark brown/red. What could have induced this?

Poisoning with HCl hydrogen cyanide


What are morphological changes after carbon monoxide poisoning seen during the autopsy?

Light-red livor mortis and light-red inner organs


What is prussic acid and what does it do?

  • Hydorgen cyanide
  • forms in the ventricle
  • quickly absorbed
  • blocks cytchrome oxidase


How is heroin metabolised?

Heroin is metabolised in 6-monoacetylmorphine (6-MAM), which is further metabolised into morphine, which is then metabolised into morphine-6-glucuronide or morphine-3-glucuronide


What are the toxic chemical mechanisms behind

  • methanol
  • isopropanol
  • ethylenglycol

  • Methanol is metabolised into formaldehyd (damages the retina) and formic acid (methanoic acid)
  • Isopropanol is metabolised into aceton
  • Ethylenglycol is metabolised into oxalic acid


What are differences between heroin and morphine?

  • heroin is more lipohilic (goes faster into brain)
  • heroin metabolises quickly compared to morphine
  • Heroin is more potent than morphine


At the autopsy you see light-red livor mortis and light-red inner organs; what could have happend to the person?

carbon monoxide poisoning


Define "classic" poisons and name two examples

Classic poisons cause morphological damages, examples are arsenic or phosphorous poisons


What can be found in lung oedema after fast and delayed cases of heroin death?

mast cells


Which parameters determine the effect of the drug?

  • dose
  • form
  • administration
  • age
  • constitution
  • "pure" intoxications
  • combination


Which form of heroin is smoked?

brown powder called brown sugar


What are symptomes of opiate overdosing?

  • miosis (small pupils)
  • coma
  • respiratory depression/paralysis
  • heart frequency decreases
  • allergic shock


What is the fast death mechanism of heroin?

apnoea, which will show 6MAM in blood and lung oedema


What are risk factors for heroin death?

  • low tolerance due to abstinence followed by relapse
  • additive or synergistic affects of alcohol and other drugs


What are effects of opiates?

  • rush after a few seconds
  • body temperature decreases
  • psychomotor skills become slow (walk weak in the knees)
  • euphoria passes into a feeling of well-being (absence of anxiety, pain, hunger, thirst or sexual needs)
  • abstinence follows


Which tissues/fluids can be sampled for poison testing?

  • blood
  • urine
  • eye fluid (corpus vitreum)
  • bile
  • stomach
  • muscle
  • liver
  • lung
  • brain
  • hair


How do organic solvents induce death? (death mechanisms)

  • arrhythmia
  • hypoxia and hypercapnia
  • vagal reflex


Which cyanides induce fatal poisoning?

sodium or potassium cyanide



Which microscopic changes occur with alcohol cardiomyopathy?

  • diffuse interstitial fibrosis
  • perivascular fibrosis, also coronary vessel (most often no plaques)


which form of heroin is watersoluble and injected?

white powder (horse)


What are common causes of death from ethanol poisoning?

  • alcohol cardiomyopathy
  • cirrhosis of the liver
  • ruptured oesophagus varices (vessels)
  • pancreatitis
  • a lot of indirect ones, such as violence, accidens, falls, frostbite