Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

FORENSIC TOXICOLOGY AT A GLANCE

Characteristic Features Of Poisons

By Syed Usama Qutbi MBBS KMDC BATCH 25

POISON Characteristic S/S Vomitus /Other PM findings

Sulphuric acid Stomach wash within 1hr Dark brown Chalky white teeth
or contraindicated in all
Oil of vitrol corrosives Charred mucousa with dark brown/black streaks

Nitric acid Xanthoproteic Yellow Stonach stained yellow

reaction( tissue stain
Aqua fortis, red spirit, yellow)
engravers acid

HCL Respiratory symptoms

more pronounced
Muriatic acid , spirit of
salt

Oxalic acid Combines with serum Ca Black Mucousa of tongie , mouth and throat is white.
- forming calcium Stomach has dark brown gelatinous liguid
Acid of sugar oxalates.

Nephrotoxic

Carbolic acid Corrosive and anesthetic Grey white stain at angle of mouth

Phenol Carboluria(green urine) White and swollen tongue

Projecting fibres and prominent rugae

Hydrocyanic acid Protoplasmic poison Use as fumigation HCN converts into cyanomethameglobinemia that form
pink body patches and pink PML.
Cyogens/ prussic acid Bitter almond smell and
jaw may be right Eyes are bright, glistening and dialated
clenched

Death: asphyxia

Phosphorus Protoplasmic poison Use in rat poisons, Garlic smell from body and stomach content,
mostly suicidal necrobiosis of liver
Garlic taste and odour

Phossy jaw

Arsenic A: Persistent vomit and Coffee ground vomit Red velvet appearance of stomach.
diarrhea, intense thurst,
(Hemolysis of RBCs) Liver has fatty degeneration
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

painful cramps in legs, Preserve in body for long time , detect in skin, nails,
urine suppression hair , skin and even burnt bodies

C: Nutrition changws, Long rigor mortis

catarrhal changes, skin
rashes, nervous
disturbance, nettle rash/
rain drop rash

Mercury Metallic taste, grey white Use in dental filling, Tongue is white, grey/black mucousa appears, kidney
mucousa , renal lesion, thermometer, finger lesion, subendocardial hemorrhg
Quick silver hydrargyrism, mercuria print powder, explosive
lentis, erethism, hatters High conc found in kidneys
shake

Lead A: Abdominal colicky Use in medicine, paints, Black faces in large intestine
pain, hemolytic anemia, surma, sindhoor
Shisha neurological symp,

Constipation with black

offensive faeces.

C: Painter's colic,
impotency, Nephritis,
brain edema, wrist &
ankle drop, black
bertonian lines on gums,
lead lines at long bones,
radiopaque spicules in
stomach,
hypothyroidism,
pancreatitis, saturinin
gout

Copper Inky urine Greenish blue vomit Greenish blue froth , gastric mucousa,

Blue vitrol, neela thoda C: green lines on gums, Use in fungicide, coins Hemochromatosis (bronz diabetes) in chronic poison
sunflower cataract and antidote for
(wilson disease) , metal phosphorus
fumes fever.

POISON Active principle FD Signs

RICINUS COMMUNIS Ricin (supertoxic 10 seeds Dust: rhinitis, conjunctivitis, asthama

than cobra
Castor oil/arandi venome) Inhaled: copious painful vomit and bloody purgating
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Croton tiglium Crotin 4 seeds /20 drops Blisters on skin, powerful purging, burning at anus

Jamal ghota (Suicidal, arrow poison)

Abrus precatorius Abrin 1-2 seeds Action resemble viper snake, local painful swelling,
echymosis, arrhythmia and death
Ratti, indian liquorice, (Use by malingeres for
gunchi conjunctivitis, arrow Sui as cattle poison (abrus+onion+opium+water)
poison)

Ergot Ergotoxin 1 gm A: tingling, feeling of coldness, hypoglycemia, abortion and

uterus hemorrhg
Mother of rye Ergotamine
C: convulsions , painful tonic contr, formication
Ergometrine (Use for criminal
abortion, uterus Gangrene formation, Raynauds disease, feeling of intese
(Stimulates contr stimulation and migrain heat (saint anthonis fire)
of blood vessels treat.)
and uterus)

Capsicum Annum Capsaicin Use for torture as Irritation, vesicattion, burning and lacrimation
Hyderabadi goli; cilli
Chilli/ red pepper powder in rectum

Semicarpus Anacardium Semecarpol , 10 gm Skin vesications with Black blisters

Marking nuts Bhilawanol Its black juice used by Painful micturition with brown urine
dhobi
Inhaled: blisters in mouth
Criminal abortifacient
(Blister fluid should preserve in rectified spirit)
Malingeres to produce
artificial bruise

TYPE Toxin Signs Other

Elapids Neurotoxin Fang marks are not distinct, oozing of blood at Head of same size as body, pupil
(cobra) bite site, vomiting headache ،loss of concious, round,
Muscular weakness and ptosis, opthalmoplegia (fixed eyes), bulbar
respiratory paralysis -death paralysis (flaccid quadriplegia) short fangs cannot cross cloths,

death due to respiratory

depression.

Viper Hemotoxin Prominent fang marks, blister formation and Triangular head, vertical pupil,
may involve whole limb or till trunk, bleeding
Oozing of blood and hemorrhages from gums, epistaxis, DIC Long canalized fangs can cross
from natural orrifices -death cloths
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Death- hemorrhages

Sea snake Myotoxin Little swelling, stiffness and immobilization. Death due to respiratory failure

Respiratory failure -death

POISON Signs symptoms PM FINDINGS OTHER

Opium & Morphine Constricted pupil, euphoria, Characteristic smell, emaciated Antidote: nalaxone,
vomiting, stupor, respirat body, black PML, black mucousa, physostigmine for respira
Sominoferous poisons depression, cheyne stokes breathing congestion & edema of lungs reversal
(slow, irregular, 2-4/min) (heroin lungs) and cerebral edema
Accidental death in abusers
Abstinence Syndrome: symp remain MarQuise test +ve (3cc H2SO4 + 3 (death on the needle) , painless
Morphin, codein and
6-8 hrs after withdrawal drops formalin + sample) purple suicide
papaverin are active
appears later changes blue.
principle Morphine mania/Morphism Poppy seeds( khas khas) used as
food

Barbiturates Pupil first constrict and then Signs of asphyxia or comatose AUTONATISM: Person suffering
dialated, respiratory depression, asphyxia ( cyanosis of extremities, from insomnia due to pain,
BULLOUS lesions Bullous lesion, congestion and overdose himself with drug, fail
edema of organs) to sleep and loss fact that he is
Barbiturates Automatism overdose himself and
repeatedly taking drugs.
Abstinence Syndrome

Chloral Hydrate Pear like aromatic odour from Pear like odour around body Knock Out Drops/ Mickey Finn:
mouth, pupil constriction, burning in poison also known as Dry wine,
throat Rapidly detoriates after death, so use to potentiate intoxication
chemical analysis of viscera must be for roberry and helpless rape
urgent

Radio opaque, can he detected in

Xray.

Kerosene Kerosin taste, breath ,vomit and Signs of asphyxia are seen (froth, Stomach wash with 5% sodium
urine cyanosis, congestion) bicarbonate

Pulmonary complication are more; Doble gastric fluid levels seen in Suicidal : burning herself (self
bronchopneumonia, pneumonitis, abdom Xray immolation)
lund edema
Homicidal: Dowry Deaths
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Ethanol Seven Stages of Intoxication: Disulfiram as aversion therapy. Fruity odour, sweetish burning
SEECSCD taste,
Grain Alcohol Congestion of conjunctiva
Sobriety, Euphoria, Excitement, 400-500mg/100ml is fatal
confusion, stupor, coma , death Dry mouth and furred tongue
Absolute acohol: 99% ethanol
A: McEwans sign, Hangover, Pulmonary and cerebral edema
Saturday night palsy. Rectified spirit: 95% ethanol
Blood is fluid and dard
C: physical, mental and moral Use as antidote for methanol
Shrinkage of cerebral cortex
degeneration.
Edema of larynx may lead to cafe
Delirium tremens
coronary syndrom
Korsakoff syndrome
Death due to respiratory failure and
Acute hallucinosis liver failure

Wernicke's encephalopathy and

beriberi

Amblyopia (vision dimness)

Mallory Weiss syndrome

Hepatitis, cirrhosis, pancreatitis,

gastritis, ulcers, cardiomyopathy

Methanol Neck stiffness, photophobia, Cyanosis of upper part of the body Its metabolite: formaldehyde
blindness and formic acid
Wood alcohol, wood Optic atrophy and retinal edema
spirit, wood naphtha, Intestinal contraction resemble thick MLI: liquor tragidies- intentional
carbinol pipe of narrow lumen (diagnostic) Viscera must preserve in sat sol of adulteration to consume
Nacl in all alcohol cases alcohol results in mass deaths

Organophosphate It inhibit cholinesterase, all P Nitrophenol is metabolite of this Atropine is antidote. Oxime for
cholinergic effects are seen poison and detected in the urine AchE reversal.
Insecticides (diagnostic)
Respiratory symp mimics the Nerve gases use as warfare
bronchial asthama attack Kerosin or Garlick like smell.
Stomach contain greenish oily subs. DDT is chlorinated compound,
Chromogenic red tears cheifly act in motor cortex and
Demyelination of ascending and cerebellum.
Kerosin like or Garlick like smell descending tracts.
from victim
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

POISON Active principle Signs PM finding Other

Dhatura (alkaloid) Hyoscine (scopolamine) Anticholinergic effects Sigsn of asphyxia Accidental.

Thorn apple, stink weed, Hyoscyamine Dialated pupil Mydriatic Test: sample Stupifying: mixed in food
road poison forms into solution, one for robery and rape aka
Atropin Carphologia (picking drop in one eye of cat, Road Poison
imaginary objects / bed dialates its pupil in half
clothes) hr. FD: 60mg (adults)
4mg(child)
Seeds resist putrefaction

Atropa Belladona Atropin Same Same Same

Deadly night shade Hyoscyamine

Belladonin

Cannabis Indica (not Tetrahydrocannabinol A: Easy laughter, No characteristics FD in gm/kg of body

alkaloid but oleoresin) THC Hallucination of sexual finfings.
character Charas: 2, Ganja: 8 ,
Bhang /majun/ Ganja/ Bhang: 10
marijuana (pot , weed) / C: Hasish insanity,
charas (hashish) Tolerance, Run amok,
Amotivational synd,
Gynecomastia

Cocain crack , an alkaloid Hallucination of .Nasal ulceration and Use in ENT anesthesia
suitable for smoking lilliputian type (obj seen nasal septum perforation
Coke/snow so small) pain relief for cancer in
Bromptons coctail
Cocainism /
cocainophagia/ As Snuff
cocainomania
Body packer syndrom or
Nymphomania (Inc erotic Body stuffing: overdose
and sexual stimulation in occurs, in person who
females ) smuggle cocain in small
packets, balloons in GIT
Homosexuality in male and they burst

Coke bug/ formication/

Magnan's synd (feeling
of insects crawling under
skin)
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Strychinin Strychinin First clonic then tonic Pt must be treated in FD: 15-30 mg strychinin
seizures quite, dark and less or 1 seed
Nux vomica Brucin stimuli room
Lock jaw Most deadly poison, an
Acts mainly on spinal Rigor early onset and alkaloid obtain from nux
cord Opinsthotonos - disappear vomica seeds.
hyperextension of back &
body arched forward PM caloricuty: body Stimulates all parts of
temp show slight rise for CNS mostly ant horn of
Emprosthotonis- vise a while instead of fall spinal cord
versa
Spinal cord should Antagonize inhibitory NT
Risus sardonicus: preserve glycine - inc excitibility -
Grimacing expression on light, noice or air breez
face cause voilent reflex
action

Nux vomica seeds aka

Dog buttons, use to kill
stray dogs

POISON Active principle Signs PM finding Other

Aconite Aconitin (alkaloid) depress Tingling and numbness No finding, destroy in Whole plant is poison,
myocardium of mouth, tongue, body, cannot be mainky roots are used
Meetha zehar pharynx detected after death
Most viruelnt and ideal
Vagal stimulation homicidal poison

Pupil alternat dialate and Arrow & cattle poison

constrict
Abortifacient

Nicotine Nicotine and Lobeline Brown froth from mouth First stimulates later
and nostril depress the autonomic
Tobacco ganglia
Brownish gastric
mucousa

Dark colour blood

 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Poison

Carbon monoxide Preseve lungs in Kunkel's test (tannic acid test) Cherry pink colour PML Accidental and homicidal
airtight container AND Hoppe seyler test for cases from fires, heaters
Diagnosis In cyanide: Brick red ē room suffocation
Blood test tube
must always cover
with layer of liquid
paraffine

Hydrogen Sulphide Sources: caves, Signs of asphyxia Accidental in sewer

sewage, volcano, workers, well digging and
Gutter gas decay fush and also Rotten egg like smell tunnel workers
PM gas
Greenish viscera and
grey matter of cortex

Coins in pocket of victim

may become blackened

POISON

Aspirin Poison due to idiosyncrasy or Irritates gastric mucousa, Aspirin in urine + ferric chloride
overdose hematemesis, hemorrhages, -> turns voilet indicate positive
hyperopnea (characteristic) aspirin test
Affect acid base balance -
Acidosis PM: petechiae hemorrhages Reye syndrome if given to
seen all over the body due to children under 15 for viral
Salicylates gag restlessness hypoproteinemia + congested infection
stomach
Aceton breath

Paracetamol Doesn't affect acidbase balance, FD: 20 tablet of 500mg

respir centre or cvds like aspirin.

KEY POINTS AND PAST PAPERS:

1. Arsenic, mercury and copper combines with sulfhydryl 8. Polyvalent antivenome against: cobra, krait, russel viper
enzymes 9. Morphism: Dysphoria, problem with sexual identification
2. Arsenic is used as lover philter and aphrodisiacs. towards homosexual or heterosexual, pale face, wrist/ankle
3. Phosphorus and hydrocyanic acid is protoplasmic poisons drop and insomnia
4. Black lines on gums : lead poisoning (bertonian lines) and 10. McEwans sign: pinch on neck cause dialation of constricted
mercury Poisoning pupil
5. Most of snakes are non venomous and person goes into 11. Hangover: recovery after few hours of sleep, still some residual
Neurogenic shock due to fear. after effects of alcohol
6. Signs and symp of venomous snake bite appears in half hour. 12. Saturday night paralysis: persin receive salary, enjoy
7. Jacobson's organ: cavity in roof of mouth in snake contain weakened with alcohol, and drunken on chair in such a hanging
olfactory cells to smell prey. hand position that his radial nerve compressed.
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

13. Delirium tremens (feeling of rats crawling around) , Korsakoff 47. Most common metal involves in acute syndrome of metal fume
syndrome (psychotic personality), Mallory Weiss synd (tearing fever…...
of lower esophageal) 48. Phossy jaw seen in chronic poisoning of …. phosphorus
14. POISONS RESIST PUTREFACTION (ABCD,NOS,ML) 49. Sui needle used to kill animals are made of …. rati seeds
Arsenic, Barbiturates, CO, Cyanides, Dhatura, Nicotine, 50. Cobra poison…. Neurotoxic
Organophosphate, strychinin, Mercury, Lead 51. Pin point pupils are seen in ……
15. Dhatura and Atropa belladona: antidote for Organophosphate 52. PM of CO is …. Cherry red hypostasis
poison 53. Chemical warfare agent: nerve gas, used as a weapon of mass
16. Extream of age delay the action of poison destruction….
17. Venom of sea snake is mostly………...myotoxic 54. Death caused in suicide by house hold things in japan is due to
18. Farmers son brought er complaining restlessness, agitation, the production of …. Acidic sol, H2S, HCN gas, CO?
flushed face, dilated pupils and temp 105 55. Flushed face, slurred speech, markedly dilated pupils….
F………...organophosphate poisoning 56. Dead body found at an automobile garage, pm shows cherry
19. Active agent of ganja……tetra hydro cannabinol red …...
20. Body packer syndrome is observed in traffickers of ……cocaine 57. Anaemia, pale skin, blue line at gum margin, decreased hand
21. The major quantity of circulating lead after absorption is grip strength and abdominal pain….
deposited into…… 58. Naloxone is an antidote of……
22. The most devastating toxic effect of paracetamol toxicity…… 59. Ingesting white powder, that was given by his friend,
23. The earliest manifestation of chronic arsenic poisoning is…… developed weakness, vomiting and diarrhoea…..
24. Gastric lavage is preferably done in……Trendelenburg position 60. Muscle twitching, facial grimacing, and tonic clonic seizure
25. Person taking hydrocyanic acid dies due to……. activity….
26. Lead inhibits which enzyme in haem synthesis pathway…… 61. Male presents to er. Mom is concerned bcz he is very
27. Yellow fatty liver is characteristics of which poison…… aggressive, anxious, and paranoid over last week. Mom says he
28. In CO poisoning, the er treatment is… is an intense athlete and that coach has convinced him he can
29. Antidote of benzodiazepine poisoning is……... flumazenil become a professional athlete….. anabolic steroids??
30. The mucosa of stomach becomes hard and leathery in 62. Perforation of nasal septum occurs due to local distruction of
poison…. tissues in…cocaine snuffer
31. Condition of RUN AMOK is seen in 63. Colour of mucus mem in nitric acid poisoning is…
32. abstinence syndrome in opium eater exhibit…... 64. Antidotes are the remedies that…counteract the effect of
33. toxic doses of barbiturate cause……. poison
34. In case of unknown ingested poison, the best possible fluid 65. The gastric lavage is carried out under which action…
given in er……. 66. Abrus precatorius in combination with opium, and dhatura and
35. Garlic odour from oro-fecal orifices indicates poisoning by……. onion is …… sui poisoning
Malathion 67. Investigating team reach culprit, after looking dry clean mark
36. Acute hallucinosis, causes hallucinations chiefly being…… on wrapping sheet in infanticide case. Which poison used for
37. After absorption, alcohol gets distributed in all the body producing such mark?
tissues, except…. bone? 68. Chromogenic tears are seen in….
38. The blood alcohol conc considered dangerous for public safety 69. Christian sayings…...
is…... 70. Grasp imaginary objects, picks at his clothing, tries to pull
39. Opium alkaloids have narcotic effects… imaginary threads from the tips of his fingers in poisoning by….
40. Subcutaneous parenteral use of morphine is termed as…. 71. Diagnosis of poisoning can be done best by….? Circumstantial
41. Cocaine addicts prefer to use it by…. evidence, exp on animals, pm appearance, chemical analysis?
42. Absolute contraindication of gastric lavage is …. Corrosive 72. Combination of cocaine and heroin is …. speedball
poisoning 73. Phosphorus poisoning…. protoplasmic poison?
43. Antidote which produce effects opposite to that of poisons are 74. Compounds that are powerful inhibitors of cholinesterase…
called… 75. Barbiturate poisoning is characterized by ….
44. Bluish grey pigmentation of conjunctiva, mucous membrane, 76. Poison caused strong contraction of back muscles along with
nails, and tachycardia …. poison? typical posture of arched back is in….
45. Poison which is luminous translucent cylindrical and waxy….. 77. The main culprit in wood alcohol poisoning is…
46. A poisonous sublimate used to kill germs and fungi and in 78. Cholinesterase is seen in venom of….
photography….. 79. Sugglation in case of opium poison is…
80. Chemical nature of active principle of dhatura ….
 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

81. A feeling of crawling foreign body beneath or upon the skin is 96. Which poison retard putrefaction…..
associated with…. 97. Vitriolage means…
82. Pupils dilated, power of an accommodation paralysed, and 98. Brownish oral tongue, brown and constricted pupil, greenish
blind as bad is in… brown urine , poison is?
83. Potent form of cannabis indica …. hashish 99. Cyanide acts by inhibiting …
84. About morphine…. belongs to phenanthrene group of alkaloids 100. Activated charcoal used in ….
85. Excretion of alcohol through body as…. 101. Antidote to methanol is… ethanol
86. Most offences associated with alcohol poisoning are 102. Narcotic abuse with jet black tongue the cause is….
committed during which stage? 103. Imp sign and symptom in vegetable acid poisoning is ….
87. McEwan’s sign…. 104. Diagnostic feature of co poisoning on autopsy is…..
88. Workers in plastic factory died due to fire in a factory, blood 105. 2014 class test
analysis shows that along CO gas there is one more gas involve, 106. Antidote of choice in insecticide poisoning is….. atropine? /
which is? 107. Chemically heroin is….
89. SLUD is sign and symptoms of which poison? 108. 9D’S feature of …. Dhatura poison
90. Conc of CO2 causes dysnea is…. 109. Ideal suicidal poison is….
91. Which investigation is more diagnostic in chronic phosphorus 110. Breathalyzer is used to diagnose the consumption of….
poisoning…. Alcohol?
92. Death in chronic heavy metal poisoning, diagnostic sample 111. Most suitable sample for alcohol estimation in a decomposed
is,,,,plugged scalp hair body is… vitreous fluid
93. Lead toxic compound of lead is 112. The stage of under influence correspond to BAC of…
94. Basophilic stripling is seen in which cells… RBCS. 113. Fatal dose of nicotine ….
95. Most imp feature to diff between poisonous and non-
poisonous snake is …. Fang?
ACUTE POISON ( VOMIT INDICATOR)
• Copper sulfate: bluish green vomit
• Phosphorus: garlic smell vomit
• Sulphuric acid: Black vomit
• Arsenic: coffee ground vomit

CHRONIC POISON SYMPTOMS

Carbolic acid Ochronosis ( brown yellow ring around cornea)

Salicylates poison Tinnitus, eczema eruption, peptic ulcer

Mercury Mercuria lentis, ptyalism, hatter shakk, mercuria erythism

Arsenic Rain drop skin appearance, Mee's line on nails

Copper Sunflower cataracts, metal fume fever, brown black lines on teeths

Lead Wrist / ankle drop, black line on gums, impotence, painters colic

Silver Argyria (skin deposit)

Phosphorus Phossy jaw

 Forensic toxicology - By Syed Usama Qutbi MBBS BATCH 25

Ergot Ergotism (sant Anthony fire)

Opium Morphism

Barbiturates Barbiturates automatism

Alcohol Korsakoff psychosis

Canabis Run amok

Cocain Magnan's syndrome (feeling of insect crawling)

POSTMORTEM LIVIDITY:

• CO: cherry red/pink • Hydrogen sulfide: Greenish

• HCN: Pink • Opium: Black
• Phosphorus: Dark brown
PUPIL CONDITION:

Dialated: Dhatura, belladona, aconite, cocain, nicotin , DDT

Constricted: Opium, carbolic acid, pilocarpine

MUCOUSA:

• Arsenic: red velvet appearance • Nicotine: Brown

• Cantharide: Shiny green particles • Mucousa is soft in all poisoning except Hardening in
• Copper sulphate: Bluish green carbolic acid
• Opium: Black • Perforation: Sulphuric acid
•