Case analysis

Alcohols
Cyanide Arsenic

Case 1

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 50g. How much blood alcohol level?

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

environment or workplace and may contribute to human injury Ninety minutes after ethanol ingestion is the approximate time to the achievement of peak blood levels 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

Toxicology of Alcohol
Alcohol is absorbed through the stomach and

intestine Once absorbed, alcohol is:

Oxidized- in liver by alcohol dehydrogenase Excreted- by breath, perspiration, and kidneysturned

into carbon dioxide and water

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

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

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?

Cyanide
Cyanide is dangerous because it binds to ferric ions

in cytochrome oxidase, an enzyme in the electron transport 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 with severity of poisoning.

Case 3

-What is the abnormality? -What is the cause of that? -Acute / chronic exposure?

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

Arsenic
Acute 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

Arsenic Acute Poisoning

Bodily system affected Systemic Symptoms or signs
Thirst Hypovolemia, Hypotension Garlic or metallic taste Burning mucosa Nausea and vomiting Diarrhea Abdominal pain Hematemesis Hematochezia, melena Rice-water stools Hemolysis Hematuria Lymphopenia Pancytopenia Cough Dyspnea Chest Pain Pulmonary edema Jaundice Fatty degeneration Central necrosis Proteinuria Hematuria Acute renal failure

Time of onset
Minutes Minutes to hours Immediate Immediate Minutes Minutes to hours Minutes to hours Minutes to hours Hours Hours Minutes to hours Minutes to hours Several weeks Several weeks Immediate Minutes to hours Minutes to hours Minutes to hours Days Days Days Hours to days Hours to days Hours to days

Manifestations of acute arsenic poisoning

Gastrointestinal

Hematopoietic system

Pulmonary (primarily in inhalational exposures) Liver Kidneys

Arsenic
Chronic Toxicity
Skin
Diffuse or spotted hyperpigmentation and, alternatively,

hypopigmentation can first appear between 6 months to 3 years with chronic exposure to arsenic
Palmar-plantar hyperkeratosis usually follows the initial appearance of arsenicinduced pigmentation changes within a period of years

Skin cancer is common with

protracted high-level arsenical exposure

Arsenic
Chronic Toxicity Liver
Characteristic of long-term or chronic arsenic

exposure, manifests : jaundice abdominal pain hepatomegaly progress to cirrhosis and ascites even to hepatocellular carcinom

Arsenic
Chronic Toxicity Peripheral neurophathy
Repeated exposure to low levels of inorganic arsenic

can produce This neuropathy usually begins with : sensory changes numbness in the hands and feet painful pins and needles sensation motor nerves be affected muscle tenderness weaknes progressing from proximal to distal muscle groupss

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 and gangrene of the lower extremities (Blackfoot disease).

Reference

Abdul Munim Idries, dkk, 1979 : Ilmu Kedokteran Kehakiman , 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 Chemical Safety, WHO, Geneva.