Dr.

Abhishek Karn
A.P., Dept. of
Forensic
Medicine &
Toxicology

a psychostimulant that is
known to produce
increased wakefulness
and focus in association
with decreased fatigue
and appetite.

Initially, amphetamine was more popularly

used to
i. Diminish the appetite
ii.control weight.

commonly used to treat

i..Attention-Deficit Hyperactivity Disorder (ADHD)
in children,
ii. Daytime drowsiness symptoms of narcolepsy.
iii.Chronic fatigue syndrome.

The drug is also used illegally as a

i. Recreational drug
ii. Performance enhancer.

reduced appetite, insomnia,

hyperactivity, restlessness,
dilated pupils, blurred vision,
dry mouth, impaired speech,
erectile dysfunction,
headache,
fever, sweating,
diarrhoea/ constipation,
increased BP, HR, RR,
palpitations,
arrhythmia.

anxiety and/or general nervousness

euphoria,
feeling of power or superiority,
creative or philosophical thinking,
increased confidence,
increased sense of well being,
talkativeness
increased goal-orientated thoughts/ organized
behaviour,
increased concentration/mental sharpness,
alertness,
Increased aggression,
emotional liability, excitability,

anxiety,
depression,
agitation,
fatigue,
excessive sleeping,
increased appetite,
short temper,
Psychosis,
suicidal thoughts.

FATAL DOSE: 120-250mg

FATAL PERIOD: Death has followed 5

days after ingestion of 140mg.

1) Chlorpromazine for sedation &

amphetamine psychosis.
2) B-adrenergic blockers antagonizes
peripheral sympathomimetic action.
3) Acidification of urine increases renal
excretion of methamphetamine.
4) Supportive measures as per circumstances

Particles of unabsorbed drugs may be

found in the stomach.

Generalised oedema of lungs.

Pulmonary petechial haemorrhages.

Adrenals may show haemorrhagic reaction.

1. Synthetic amphetamines (Designer drugs) are

abused by youngsters:
i. Love drugmethylenedeoxyamphetamine (MDA)
ii. Ecstasy methylenedeoxymethamphetamine (MDMA)
iii. Eve-- methylenedeoxyethamphetamine (MDEA)

2. Suicide / Homicide uncommon.

3. Intermittent abuse characteristically seen in
athletes who wish to enhance their
performance & endurance.
4. Common cause of poisoning is overdose.

Used as antidepressant for

treatment of clinical
depression.

acts primarily as serotoninnorepinephrine reuptake

inhibitor.

Features of poisoning starts within an hour after

ingestion.

MILD POISONING:
i. Tachycardia
ii. Dry-mouth
iii. Dilated pupils / blurred vision
iv. urinary retention
v. Extensor-planter response

SEVERE INTOXICATION: Arrhythmia, Convulsions,

Respiratory depression & Coma.

1. Gastric lavage.
2. Oral administration of Activated charcoal.
3. Sodium Bicarbonate i.v to correct
Acidosis.
4. Sedation with oral / i.v Diazepam
controls convulsions & delirium.
5. Supportive treatment.

Cocaine is a white crystalline

powder made from the dried
leaves of the cocoa plant .

Crack, named for its crackle

when heated, is made from
cocaine. It looks like white or
tan pellets.

Even after one use, cocaine

and crack can create both
physical and psychological
cravings that make it very,
very difficult for users to
stop.

a stimulant that rocks the central nervous system,

giving users a quick, intense feeling of power and
energy.

Some users combine cocaine powder or crack with

heroin in a speedball.

Snorting highs last between 15 and 30 minutes;

smoking highs last between 5 and 10 minutes.

elevates heart rate, breathing rate, blood pressure,

and body temperature.

Large amounts (several hundred mg or

more):
i. intensify the users high
ii. bizarre, erratic, and violent behaviour
iii. itching, hallucinations and paranoid
delusions.

In rare instances, sudden death can occur on

the first use of cocaine or unexpectedly
thereafter.

Cocainism, cocainophagia, Cocainomania.

Anorexia, wt. loss, weakness, tremors.

impotence & sexual perversions in male,

nymphomania in female.

Insanity delusions of persecution &

hallucinations (tactile & visual)

Magnans symptom

FATAL DOSE: 1-1.5gm orally.

application.

30mg by mucous membrane

FATAL PERIOD: few minutes to few hours (usually 2

hrs)

Cocaine-related deaths are often a result of

cardiac arrest or seizures followed by
respiratory arrest.

If oral ingestion:- gastric lavage with lukewarm water

containing charcoal, tannic acid or potassium
permanganate.

If applied to nose / throat:- wash-out the mucous

membrane with water.

If injected:- apply a ligature above the part.

Place the patient in a calm environment.

Moderate doses of diazepam may be administered

for convulsions or severe agitation.

Amyl nitrite(inhalational) is antidote.

Thiamine 100mg i.v.

Naloxone hydrochloride 2mg i.v.

Monitor cardio respiratory functions carefully.

X-rays may show packets of cocaine in the stomach,

as in the case of Body-packer smugglers.

i. no specific findings.
ii. Signs of intense asphyxia.
iii. Heart may have foci of scarring (fatal
dysarrhythmia)
iv. Blood should be preserved by adding fluoride.
v. cocaine can be recovered from recent injection
site or by swabs from nasal mucosa.

Rarely used for homicide/ suicide.

Highly addictive drug.

Death is usually accidental, due to

overdose.

found naturally in coffee, tea and to

a lesser degree in chocolate.

is included in many soft drinks,

particularly energy drinks.

world's most widely used psychoactive drug and by

far the most common stimulant.

also included in some medications,

i. usually for the purpose of enhancing the effect of
the
primary ingredient, or
ii. reducing one of its side effects (especially
drowsiness).

Caffeine is a physically addictive drug.

Low Doses: 50-250mg (Oral Doses) Increase mental

alertness, decrease drowsiness, Lessen fatigue

Larger Doses: 250-600mg Irritability, restlessness,

tremor, insomnia, headache, palpitations,
hyperesthesia, GIT upset.

Large Doses: 1000 mg Overt excitement, delirium

and clonic seizures.

FATAL DOSE: 8-10gm (cardiorespiratory arrest)

gastric decontamination by lavage or

induced vomiting if the caffeine overdose
was recent.

Activated charcoal.

Maintain the airway and provide

ventilation.

Treat any seizures and hypotension that

occurs, and monitor the vital signs.

Death from caffeine is extremely

difficult as the fatal dosage is
equivalent to 40 cups consumed in a
short period of time.