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Intoxication Case AnalysisDra. Suhartini, Apt., SUdr. Idha Arfianti Msc

1Case analysis

AlcoholsCyanideArsenic2Case 1

3Question 1One 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? 4AlcoholsEthanol is beverage alcoholMetanol and isopropanol are also available in the environment or workplace and may contribute to human injuryNinety 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

5Toxicology of AlcoholAlcohol is absorbed through the stomach and intestineOnce absorbed, alcohol is:Oxidized- in liver by alcohol dehydrogenaseExcreted- by breath, perspiration, and kidneysturned into carbon dioxide and water6Assessment of Ethanol ImpairmentBlood alcohol concentration:10-50 mg/dL: Impairment detectable by special tests30-120 mg/dL: Beginning of sensory-motor impairment90-250 mg/dL: Sensory-motor incoordination; impaired balance180-400 mg/dL: Increased muscular incoordination; apathy; lethargy7Assessment of Ethanol ImpairmentBlood alcohol concentration:250-400 mg/dL: Impaired consciousness; sleep; stupor350-500 mg/dL: Complete unconsciousness; coma450 and greater mg/dL: Death from respiratory arrest8Case 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?9CyanideCyanide is dangerous because it binds to ferric ions in cytochrome oxidase, an enzyme in the electron transport system within the mitochondria of cellsCherry red livor mortis because of cyanomethaemoglobin formationForensic laboratories can tes for cyanide in whole blood and its concentration correlates well with severity of poisoning.

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-What is the abnormality?-What is the cause of that?-Acute / chronic exposure?11 ArsenIndustrial processes Semiconductor manufacturing (gallium arsenide)Fossil fuelsWood treated with arsenic preservativesSmelting (copper, zinc, lead) and refining of metals and oresGlass manufacturing

12 ArsenicAcute PoisoningIngestion of large doses (70180 mg) of inorganic arsenic can be fatalSymptoms of acute intoxication include: FeverAnorexiaHepatomegalyMelanosiscardiac arrhythmiain fatal cases, eventual cardiac failure

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Manifestations of acute arsenic poisoningBodily system affectedSymptoms or signsTime of onsetSystemicThirstHypovolemia, HypotensionMinutesMinutes to hoursGastrointestinalGarlic or metallic tasteBurning mucosaNausea and vomitingDiarrheaAbdominal painHematemesisHematochezia, melenaRice-water stoolsImmediateImmediateMinutesMinutes to hoursMinutes to hoursMinutes to hoursHoursHoursHematopoietic systemHemolysisHematuriaLymphopeniaPancytopeniaMinutes to hoursMinutes to hoursSeveral weeksSeveral weeksPulmonary (primarily in inhalational exposures)CoughDyspneaChest PainPulmonary edemaImmediateMinutes to hoursMinutes to hoursMinutes to hoursLiverJaundiceFatty degenerationCentral necrosisDaysDaysDaysKidneysProteinuriaHematuriaAcute renal failureHours to daysHours to daysHours to days ArsenicAcute Poisoning14 ArsenicChronic ToxicitySkinDiffuse or spotted hyperpigmentation 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 usually follows the initial appearance of arsenic-induced pigmentation changes within a period of years

15 ArsenicChronic ToxicityLiverCharacteristic of long-term or chronic arsenic exposure, manifests :jaundiceabdominal painhepatomegalyprogress to cirrhosis and asciteseven to hepatocellular carcinom

16 ArsenicChronic ToxicityPeripheral neurophathyRepeated 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 sensationmotor nerves be affected muscle tenderness weaknes progressing from proximal to distal muscle groupss

17 ArsenicChronic Toxicitycardiovascular diseasePeripheral vascular disease has been observed in persons with chronic exposure to inorganic It is manifested :acrocyanosisprogress to endarteritis and gangrene of the lower extremities (Blackfoot disease).

18ReferenceAbdul 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.

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