16 Kuliah Toksikologi Inter

7/29/2019 16 Kuliah Toksikologi Inter

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Forensic toxicology

dr. Idha Arfianti MscDra. Suhartini, MS.,Apt

dr. Beta Ahlam Gizela, SpF.,DFM

Toxicology Forensic DepartmentFaculty Medicine of GMU


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Forensic toxicology

Toxicology = the science of study of poison

Science about an examination of allaspects of toxicity that may have legalimplications.

Forensic Toxicology use three area:

-postmortem forensic toxicology-workplace drug testing

-poisonous material and drugidentification


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1. Post mortem forensic toxicology

To explain whether caused of death bypoison or other cause.

To determine the manner of death whether it

was accidental, suicidal or homicidal for

judicature importance.


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2. Workplace drug testing

This consists of evaluation of biofluids,primarily urine and blood from employees or

job applicant for drug content

It is mean to know drug of abuseor preventive drug of abuse

Over 90 percent of United States

corporations also do workplace drug testing


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3. Poisonous material and drugidentification

The national program to stop drug abuse andprohibited food substance

For example

-to detect body fluid cocain level in asuspected person that used cocain

-to detect formalin contain in child food

Police can determine identification with rapid

and portable test, than can be confirmed inlaboratory


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Elements of Toxicology

Dosage is an important part of toxicity,any factor in drugs or toxin respon:

the chemical or physical form of the

substance how it enters the body

the body weight and physiological

conditions of victim, including age, sex,absorption, distribution, metabolism, and

excretion.

the time period of exposure


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Elements of toxicology (1)

The chemical or physical form of thesubstance

For example, arsenic is a metal, rather

insoluble in the stomach, thus notparticularly poisonous

BUT, the compounds arsenic trioxide

(As2O3) and arsenic pentoxide (As2O5)

are very poisonous


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How it enters the body

poisons can be swallowed

tend to be more toxic when injected

(recreational drugs) absorption through skin (chemical warfare

agents)

inhaling (industrial chemicals, but alsorecreational drugs)


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The body weight and physiologicalconditions of victim, including age, sex,

absorption, distribution, metabolism, and

excretion.

Blood alcohol content (BAC) depends

directly on body weight and sex of

individual Stomach contents can also affect

absorption

Infants and elderly are more susceptible


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The time period of exposure

usually, small amounts ingested over time

will build up a tolerance

chronic exposure large amounts overtime

acute exposure a dose large enough to

cause immediate problems, including

death


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Specimen Collection

Specimen collection:

-blood

-urine

-gastric contents

-bile&liver-CSF

-hair


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Specimen Collection (1)

Blood the most satisfactory methodfor obtaining samples is from venouspuncture (especially femoral vein) An alternate site to collect venous blood is to

incise the jugular

The correlation between blood concentrationand effects of the drug is very high in bloodtesting.


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Urine in pre-employment screeningurine is most often used to test for presenceof drugs (NAPZA, alcohol) The test that can be run easily and cost effective.

Urine should also be collected in post morteminvestigations since some toxins show in higherlevels in urine.

At autopsy, a catheter or suprapubic puncture will

suffice.


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Gastric Contents This istypically done in a sudden death in

which the deceadant has large

quantities of a lethal agent in hisstomach.

In the case of suicide, large amounts of

toxins in the gastric tract may make thispoint apparent.


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Bile&Liver the liver filters the bloodand is most heavily involved in drug

metabolism.

This can be useful in cases where morphine andchlorpromazine are suspected toxins.

These toxins are concentrated by the liver and

excreted into the gall bladder.

Direct collection of bile into a bottle is advisedbecause bile is too viscous to be sucked through

a needle.


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Cerebrospinal Fluid not oftencollected for toxins, but may be

needed for microbiological analysis.

If needed it should be collected by lumbar

or cisternal puncture.

Cisternal puncture = Passage of a hollow

needle through the posterior anto-occipitalmembrane into the cerebellomedullary

cistern


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Hair Not common in forensics for anumber of reasons.

Drugs only present in extremely low

concentrations (commonly in chronicexposure).


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Preservative for toxicology

-Blood-EDTA

-Liquid-freezer, NaF, Nasitrat

-Organ-Alcohol 95%, NaCl absolute


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Info given to toxicology labs

(Lable)

Personal data of deceased (age, sex, occupation)

Brief details of symptoms

Post mortem interval

Name and number of pathologist

List of all samples provided

Nature of preservatives used

Any delays in transporting of samplesAny special risks associated with samples being

handled.


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Analytical methods in Forensic toxicology

Qualitative

Semiquantative

Quantitative


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Screening Tests

Immunoassays Fluorescence chemiluminescence

Thin Layer Chromatography

Ultra-Visible Spectrophotometry

Gas Chromatography Gas Chromatography-Mass Spectrometry

Chemical Ionization

Liquid Chromatography-Mass Spectrometry

Colorimetric Assays

Atomic Absorption Specrophotometry (AAS) Neutron Activation Analysis (NAA)

Inductively Coupled Mass Spectrometry (ICP-MS)


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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 at

the Bodrum State Hospital as doctors

were unable to stabilize her condition,after dringking alcohol. Weight: 70 kg,

Alcohol concentration 500 mg/dl. How

much blood alcohol level?


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Alcohols

Ethanol is beverage alcohol Metanol and isopropanol are also available in the

environment or workplace and may contribute tohuman injury

Ninety minutes after ethanol ingestion is the

approximate 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

0,6 in women); W: body weight in killograms


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Toxicology of Alcohol

Alcohol is absorbed through thestomach and intestine

Once absorbed, alcohol is:

Oxidized- in liver by alcoholdehydrogenase

Excreted- by breath, perspiration, and

kidneysturned into carbon dioxide andwater


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Assessment of Ethanol

Impairment Blood alcohol concentration:

10-50 mg/dL: Impairment detectable byspecial tests

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

90-250 mg/dL: Sensory-motorincoordination; impaired balance

180-400 mg/dL: Increased muscularincoordination; 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: Completeunconsciousness; 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 component

that form that phenomenon?


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Cyanide

Cyanide is dangerous because it binds to ferricions in cytochrome oxidase, an enzyme in theelectron transport system within the mitochondriof cells

Cherry red livor mortis because ofcyanomethaemoglobin formation

Forensic laboratories can tes for cyanide in wholblood and its concentration correlates well with

severity of poisoning.


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Case 3

-What is the abnormality?

-What is the cause of that?

-Acute / chronic exposure?


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Arsen

Industrial processes Semiconductor manufacturing (gallium

arsenide)

Fossil fuels Wood treated with arsenic preservatives

Smelting (copper, zinc, lead) and refining ofmetals and ores

Glass manufacturing


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Arsenic

Acute Poisoning Ingestion of large doses (70180 mg) of

inorganic arsenic can be fatal

Symptoms of acute intoxication include:

FeverAnorexia

Hepatomegaly

Melanosis cardiac arrhythmia

in fatal cases, eventual cardiac failure

A i


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Ma

nifestation

sofacutea

rsenic

po

isoning

Bodily system affected Symptoms or signs Time of onset

Systemic ThirstHypovolemia, Hypotension

MinutesMinutes to hours

Gastrointestinal Garlic or metallic tasteBurning mucosaNausea and vomitingDiarrhea

Abdominal painHematemesisHematochezia, melenaRice-water stools

ImmediateImmediateMinutesMinutes to hoursMinutes to hoursMinutes 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 days

Hours to days

Arsenic

Acute Poisoning


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Arsenic

Chronic Toxicity

Skin Diffuse orspotted hyperpigmentation and,

alternatively, hypopigmentation can first appearbetween 6 months to 3 years with chronic

exposure to arsenic

Skin cancer is common with

protracted high-level arsenical exposure

Palmar-plantar hyperkeratosis

usually follows the initial

appearance of arsenic-induced

pigmentation changes within a

period of years


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Arsenic

Chronic Toxicity

Liver 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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Arsenic

Chronic Toxicity

Peripheral neurophathy Repeated exposure to low levels of inorganic

arsenic can produce

This neuropathy usually begins with :sensory changesnumbness in the hands and feetpainful pins and needles sensation

motor nerves be affectedmuscle tenderness weaknes progressing from proximal to

distal muscle groupss


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Arsenic

Chronic Toxicity

cardiovascular 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 : IlmuKedokteran Kehakiman , cetakan I,Jakarta.

Ariens E.J.,dkk., 1993 : Toksikologiumum (pengantar), Gadjah MadaUniversity Press, Yogyakarta.

Flanagan R.J., dkk., 1995 : AnalisisToksikologi Dasar, InternationalProgramme on Chemical Safety, WHO,Geneva.


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Reference

Knight Bernart, 1996 : Forensik Pathology,second edition, Arnold, London, Sydney,

Auckland. Anonim, 1997 : Ilmu Kedokteran Forensik,

Bagian Kedokteran Forensik FK UI, Jakarta. Steven G. Gilbert, 2004 : A small dose of

Toxicology, The Health Effects of CommonChemicals, CRC Press, Boca Raton, London,

New York, Washington, D.C. John Joseph Fenton, 2005 : Forensic

Toxicology, sit Forensic science, CRC Presspage 61-69.

16 Kuliah Toksikologi Inter

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