brain changes are seen - hyaline thrombi, degeneration in the lenticular nuclei and neuronal degeneration.
This is the most notorious of homicidal poisons, not only in detective novels, but in real life. It is tasteless and odourless and can be readily concealed in food. Acute poisoning can lead to death in hours with vomiting, diarrhoea, convulsions and circulatory failure, but homicidal poisoning is usually of the chronic type (small doses over weeks or months) resulting in general debility, nausea, anorexia, weight loss, chronic G.I. disturbances, irritability, alopecia, skin rashes, brittle nails, peripheral neuropathy and intercurrent infections. Often the patient may seem to just waste away. This clinical picture can be confused with anorexia nervosa, symptoms of malignancy, and in today's world – AIDS!
These inhibit cholinesterases with acetylcholine accumulation and are commonly used as insecticides e.g. parathion and malathion. They are often used in suicide, but homicidal usage and accidental incidents are frequent. They are well absorbed from the G.I. tract, airways and skin. There is a constellation of symptoms, many of which are mediated by acetylcholine - nausea, headache, blurred vision, vomiting, sweating, dizziness etc. Therapy includes atropine and PAM (2-pyridine aldoxine methiodide) administration. There are no specific autopsy findings.
This is an infamous poison in the West Indies, especially in Trinidad. This very good herbicide (Gramoxone, Weedol) is lethal in small doses and is well absorbed via all routes, although toxicity has largely been secondary to ingestion. Death is due to respiratory, renal or hepatic failure, or a combination of all. Lipid peroxidation by free radical formation is proposed as the explanation for the pulmonary pathology.
There is no specific antidote. Treatment is by emesis, lavage, forced diuresis, peritoneal dialysis, artificial respiratory support etc. Autopsy findings in death occurring soon after poisoning include congestion or ulceration of the lips and mouth, upper G.I. tract or airway, and marked pulmonary oedema. In longer survival before death, the characteristic feature is striking pulmonary fibrosis.
Ethanol is the most commonly abused drug and self-poisoning by ethanol is a way of life in the modern world! Death is usually accidental rather than suicidal. Acute poisoning occurs when a relatively large amount is imbibed rapidly leading to acute toxicity and paralysis of the medullary respiratory and cardiovascular centres. Chronic poisoning is more common with variable end organ damage - fatty change and cirrhosis of the liver, alcoholic hepatitis, cardiomyopathy, cerebral atrophy etc.
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