Forensic medical toxicology

Question 1

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

Answer 1

• 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)

Question 2

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

Answer 2

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

Question 3

What are “soureces” for methanol poisoning?

Answer 3

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

Question 4

Define “modern” poisons and name two examples

Answer 4

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

Question 5

Name three opioids

Answer 5

• methadone
• subutex
• buprenorphine

Question 6

Lethal complications in alcohol damages

Answer 6

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

Question 7

What are “sources” of cyanides?

Answer 7

Bitter almond
burning of certain plastics
lab chemicals

Question 8

What are “sources” of organic solvent poisoning

Answer 8

sniffing and huffing

Question 9

Which brain areas are stimulated by drug abuse?

Answer 9

• PFC
• nucleus accumbens
• VTA

Question 10

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

Answer 10

Poisoning: 0,1%

fatal: 50-80%

Question 11

Why is subutex overdosing so common?

Answer 11

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

Question 12

Which areas of the brain are connected through dopaminergic projections?

Answer 12

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

Question 13

What are “sources” of carbon monoxide poisoning?

Answer 13

• motors
• fires
• household gas
• heating appliances

Question 14

What are the most common things to induce food poisoning?

Answer 14

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

Question 15

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

Answer 15

Poisoning with HCl hydrogen cyanide

Question 16

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

Answer 16

Light-red livor mortis and light-red inner organs

Question 17

What is prussic acid and what does it do?

Answer 17

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

Question 18

How is heroin metabolised?

Answer 18

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

Question 19

What are the toxic chemical mechanisms behind

• methanol
• isopropanol
• ethylenglycol

Answer 19

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

Question 20

What are differences between heroin and morphine?

Answer 20

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

Question 21

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

Answer 21

carbon monoxide poisoning

Question 22

Define “classic” poisons and name two examples

Answer 22

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

Question 23

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

Answer 23

mast cells

Question 24

Which parameters determine the effect of the drug?

Answer 24

• dose
• form
• administration
• age
• constitution
• “pure” intoxications
• combination

Question 25

Which form of heroin is smoked?

Answer 25

brown powder called brown sugar

Question 26

What are symptomes of opiate overdosing?

(five)

Answer 26

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

Question 27

What is the fast death mechanism of heroin?

Answer 27

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

Question 28

What are risk factors for heroin death?

Answer 28

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

Question 29

What are effects of opiates?

Answer 29

• 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

Question 30

Which tissues/fluids can be sampled for poison testing?

Answer 30

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

Question 31

How do organic solvents induce death? (death mechanisms)

Answer 31

• arrhythmia
• hypoxia and hypercapnia
• vagal reflex

Question 32

Which cyanides induce fatal poisoning?

Answer 32

sodium or potassium cyanide

Question 33

Which microscopic changes occur with alcohol cardiomyopathy?

Answer 33

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

Question 34

which form of heroin is watersoluble and injected?

Answer 34

white powder (horse)

Question 35

What are common causes of death from ethanol poisoning?

Answer 35

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