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Medical Faculty of

Trisakti University
Jakarta

Many substances that may cause someone


experiencing a poisoned until it brings a
death.
Substances that active chemically and
physiology in one body, at the point of
certain dose (toxic) will bring an
unhealthiness or may cause a death.
Forensic discuss about toxic substance
from its varies, symptoms caused, and
method forensic examination to handle
either for alive or dead victims.

Toxicology definition and factors that affect


toxicity
Epidemiology, signs and symptoms,
pharmacokinetic, laboratory examination,
and treatment/therapy of cyanide poisoning
Forensic examination of patient that
experiencing common poison and cyanide
poison
medikolegalaspectsofdeliberatepoisoning
or unintentionally
Example case ofcyanidepoisoning

As a part of medical science that focused


on toxic
Study about nature and mechanism of
toxic effect, varies substance towards
living things and other biologic system
A study about source, characteristic and
a savor from toxic, indication and
treatment against poisoning and other
abnormality found in dead victim

A substance that may cause bad effect


when it gets into a body of a living things,
either intentionally or unintentionally

Origin:
Plants (opium, cocaine, curare, aflatoxin)
Animals (poison/snake toxin,
spider/marine animals)
Mineral (arsenic, plumbum, and things
that made from synthetic)
Heroin

Venue:
Nature-free(poisongasinnature, household)
Poisonagriculture(insecticides,herbesida,pe
sticides)
Toxicindustriallaboratoriesandindustry
(acidand strong base,heavymetals)
Toxic food(CN in cassava, botulinus toxic,
preservative, additives substance and toxic in
the form of medicine e.g. sedative hypnotic)

Organsthataffected:

Hepatotosik
Nephrotoxic
Work mechanism:
Toxicthatbindsulfhydryl group(Pb)
EffectonATP-ase
Formingmethemoglobin(nitrateandnitrit
e)
The effects:
Local
Systemic
local-systemic

Exposure
totoxicsubstancesonhumansand
living things:
regular consumption
exposure from work
environmental exposure and
poisoning,either intentionally
orunintentionally

How to enter:
Age
Body condition
Habits
Idiosinkrasi and allergic to vitamin E,
penicilin, streptomycin dan procaine
Time delivery

deadly toxic substance


Effectsare
veryfastandcancausedeathwithina
fewminutes
Hydrogencyanide(formonitrile)
Inthe form ofliquid ->
prussitacidandhydrocyanicacid
Liquidscan also becolorlessorpale blueat
the temperature of normal room
volatileandflammable
diffuseeitherbyairandexplosives
Veryeasy tomixwithwater
Otherforms:sodiumcyanideandpotassiumcy
anide
(powderandwhite)

a major contributor
tomorbidityandmortality,observedinapproximately
5,000 to10,000
deathsoccurfrominhalingfogeachyearin theunited
states
Exposuresuiciderarelyreported
topoisoncentersand 18of242(in 2007)and
25of238(in 2008)cases
ofcyanidepoisoningisdeliberateexposureasreporte
dto the American Association
ofPoisonControlCenters
fatalsuicideinadult patientsmayeasilybe
associatedwithsudden deathfrom
myocardialinfarction,pulmonaryembolism,orventric
ulardysrhythmias

Low-doseinnatureandineveryproductthat
we usuallyeatoruse
Cyanidecan
beproducedbybacteria,fungiandalgae
Cyanideis foundincigarettes,motor vehicle
fumes,andfoodandthesynthetic product
Cyanideinseedplants,especiallygrains(cassa
vawild,wildtubers,Intersection buffoonery,
wildcherry,plum,apricot,wildamigdalin,
jetberrybush,etc.)

FogInhalation
Intentionalpoisoning(suicide)
Industry exposure
Iatrogenic exposure
Consumption
ofSupplementsContainingCyanide
(Uncommon)

Cyanideinthe
bodywillinactivesomeoxidativeenzymesradicallythe
whole system,especiallycytochromeoxidaseby binding
totheferrichemegroupfrom the oxygencarriedbyblood
The process ofoxidationandreductionoccursasfollows:
CytochromeoxidaseFe++Fe++ +cytochromeoxidase
+
CN
/----Fe+++cytochromeoxidase-cyanideOxidize cyanidedin the bodyget into
cyanatesandsulfosianatandexpelledfrom the body
throughurine.
ToxicdoseorallyforHCNis60-90mg,
whiledosestoxictoKCNor NaCNis200mg.

Main effects:hypoxiasystem arise progressively


Symptomsandphysicalsignsthat found aredepend on the
The doseof cyanide
Number ofexposures
Type ofexposure
Typesofcyanidecomponent

symptomsin thebody:
bloodpressure,vision,lung,central nerve, heart,
endocrinesystem, autonomicsystemandmetabolic system
sore eyesbecause ofirritationanddifficultybreathingdue
toirritate therespiratory tractmucosa
high
concentrationsonlywithin15secondshiperpnea,15second
sto lose consciousness.3minutes ofapneaisa period of58minuteswillcausethe heart muscleactivityis
hampereddue tohypoxiaandendswithdeath

Exposure of hydrogencyanide
maycauseirritationagainsteyes
andskinimmediatelyafter exposureorat
least30to 60minutes

Inlow concentrations,the
effectsofcyanideemergingabout 1530minuteslater

Early signsofcyanidepoisoning:
Temporary hiperpnea
Headache
dyspnea
Anxiety
Changes inbehaviorsuch
asagitationandrestlessness
Sweatinga
lot,reddishskincolor,bodyfeelsweakandve
rtigo

cyanosisofthe face, the foamout from


the mouth,
rapidandweakpulse,rapidbreathing
andsometimesirregular,dilatedpupilsa
ndslowerreflex,air breathingsmells
tonsil,thevomit also smells
By thedeath, cyanosismorereal
andarisetwitchmuscles
andconvulsions withurinary
incontinenceandalvi

Inhalation:palpitations,difficultyto
breath,nausea,vomiting,
headache,salvasi,lakrimasi,mouthandthro
atirritation,dizzinessandweakness
ofextremities arise quickly andthen
collapse, convulsions, comaanddeath
Chronicpoisoningvictimlookspale,cold
sweats,dizziness, discomfortin the
stomach,nauseaandcolic,feel pressed on
thechestandshortness ofbreath.
Signsthe end:
comaanddilatedpupils,tremors,arrhythmi
as,convulsions,coma emphasisonthe
respiratorycenter,respiratoryfailureuntil
the heart stop beating
color skin looks"cherry-red"

Paper filter test


Reaksi Schonbein Pagenstecher ( Reaksi
Guajacol)
Prussian Blue reaction
Micro Method Gittler & Golabaum

Poisoned by CNinhalation:
->movevictimtothe place where cleanair is
available,give-amylnitrite
withinhalation,1ampoule(0.2ml)every5minu
tes,stopgivingwhen
thesystolicbloodpressureis lessthan
80mmHg
->give artificial respirationwith100%oxygen
->Antidotumin the form ofsodiumnitrite3%IV
-> vary thedose
ofsodiumnitriteandsodiumthiosulfatewithHb

CNpoisoningingested
doan
emergencyactionwithinhalationofamyl
nitrite, one ampoule(0.2ml,
within3minutes)every5minutes
Giveartificial
respirationwith100%oxygen.
Besidesnitrite, methyleneblue1%50
mLIVcan be used asantidotum

cases ofdeathsdue topoisoning:


Examinationat the place of incident
Outdoor examination
-smell
-Clothes
-Bruisescorpse
-Changes inskincolor
-Nails
-Hair
-sclera

Open
chestandabdominalcavity,specifywhet
herthere isan unusualsmell (smell
ofpoison)
Considerthe color ofbloodandthe
color of organs isbrown
reddish
In lung, there isan acute damming

Takingbloodfrom
theheartseparatelyfromthe
rightandleftrespectively for about50ml
Bloodside for about 30-50ml,taken
fromofiliacvein
Urineandgastric washingsallof taken
from thebladder
Organlivershould be taken
afterreserved forpathology
anatomyexamination

Kidneysshould betakenboth
Brain,lipoidsystem inside
another way totakesamples:
Get the placewhere toxic gets
in(stomach,the injection site)
Blood
Out point(urine,bile)

pemeriksaan bagian luar jenazah


tercium bau amandel
Sianosis pada wajah dan bibir, busa keluar
dari mulut, dan lebam mayat berwarna
terang
pemeriksaan bedah jenazah tercium bau
amandel yang khas pada waktu membuka
rongga dada, perut dan otak serta
lambung, darah, otot dan penampang
tubuh dapat berwarna merah terang

Examination of the exterior of the body


wafted of tonsils
Cyanosis of the face and lips foam out of
the mouth and bruised corpse light
colored
Surgical examination of the corpse
wafted of the spesific tonsils distinctive
when opening the chest cavity stomach,
brain and also blood, muscle, and body
sections color seems red bright

KUHP :

Article 205
Article 359
Article 360
KUHAP

Article 133

Law Number 8 Year 1999 About


Consumer Protection:
Article 19
Article 60
Law Number 7 Year 1996 About
Food: Article 21
Government Regulation Number 28
Year 2004
About Safety, Quality and Nutritional
Food : Article 25

Six People is being poisoned by Cyanide


Acid in Tiwul (a food from cassava flour)
( Tue, January 18 2011 )
TEMPO Interaktif, Jepara - SubstanceAcid
cyanide(HCN)became the majorcausethe
death ofsix victims, children of
J(45)bySJ(40):
L(24),AA(3),AK(5),MH(13),F(15)and
SK(8)residents of Desa
Jebol,DistrictMayong,Jepara,CentralJava,w
hereHCN poisoningtheir food named
tiwul(foodfromcassavaflour)

Case
Discussion

Leaf
and
Cassava
Tuber

Be
poisoned

Toxicologycan bedefined as
asubstancethatcancausebadeffectwhen it
getsinto aliving
body,eitheraccidentallyorwithintent.
Onetype
ofpoisoningthatoccursiscyanidepoisoning,bec
ause thecyanidesaltina smalldoseis
enoughtocausedeathinsomeonequicklylike a
suicide.
Poisoningcanthroughparenteraladministration,
inhalation,ingestionorskin absorption(dermal).
Signsandsymptomsdepend onthemechanism,
sourceandquantityofcyanide thatgets into the
body.

Forensicthroughthe postmortemexaminationandtoxicology
testscanprovethe existence
ofcyanideinthe
body,oranychangesandabnormalitiesc
onsistent with cyanide poisoning.
Aspectmedikolegalaboutcyanidepoiso
ningregulatedinKUHParticles
205,359,360;KUHAP133,Law No.8of
1999aboutconsumer protection
Article19and60.

Budiyanto A, Widiatmaka W, Sudiono S,et al. Ilmu Kedokteran


Forensik. Jakarta : Bagian Kedokteran Forensik Fakultas Kedokteran
Universitas Indonesia. 1997, hlm 71-72
Ernest H. A Textbook of Modern Toxicology Third Edition. New
Jersey : A John Wiley & Sons, Inc, 2004, hlm 3-8
Budiyanto A, Widiatmaka W, Sudiono S, et al. Ilmu Kedokteran
Forensik, 1997. Jakarta : Bagian
Kedokteran Forensik Universitas
Indonesia ; 95 100.
Leybell I, Borron SW. Cyanide Toxicity. June 2 nd 2010. Cited from :
http://emedicine.medscape.com/article/814287
Budiyanto A, Widiatmaka W, Sudiono S, et al. Ilmu Kedokteran
Forensik, 1997. Jakarta : Bagian
Kedokteran Forensik Universitas
Indonesia ; 73 86
Kitab Undang-undang Hukum Pidana
Kitab Undang-undang Hukum Acara Pidana
Undang-undang Nomor 8 tahun 1999 Tentang Perlindungan
Konsumen
Undang-undang Nomor 7 tahun 1996 Tentang Pangan
Centers for Disease Control and Prevention. The Facts About
Cyanides. New York State Department Of Health. New York. 2004.
Available from:
www.health.state.ny.us/nysdoh/bt/chemical_terrorism/docs/cyanide_g
eneral.pdf. Access on: November 29, 2006
http://gresnews.com/ch/Regional/cl/hisyam-alie/id/1810889/EnamTewas-Keracunan-Asam-Sianida-Pada-Tiwul

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