Intoxication Case

Analysis
Dra. Suhartini, Apt., SU
dr. Idha Arfianti Msc

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 kidneys

turned 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

Manifestations of acute
arsenic poisoning

Arsenic
Acute Poisoning
Bodily system affected

Symptoms or signs

Time of onset

Systemic

Thirst
Hypovolemia, Hypotension

Minutes
Minutes to hours

Gastrointestinal

Garlic or metallic taste

Burning mucosa
Nausea and vomiting
Diarrhea
Abdominal pain
Hematemesis
Hematochezia, melena
Rice-water stools

Immediate
Immediate
Minutes
Minutes to hours
Minutes to hours
Minutes to hours
Hours
Hours

Hematopoietic system

Hemolysis
Hematuria
Lymphopenia
Pancytopenia

Minutes to hours
Minutes to hours
Several weeks
Several weeks

Pulmonary
(primarily in
inhalational
exposures)

Cough
Dyspnea
Chest Pain
Pulmonary edema

Immediate
Minutes to hours
Minutes to hours
Minutes to hours

Liver

Jaundice
Fatty degeneration
Central necrosis

Days
Days
Days

Kidneys

Proteinuria
Hematuria
Acute renal failure

Hours to days
Hours to days
Hours to days

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 arsenic-induced
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.