Table Of ContentPoisons
Poisons
An Introduction for
Forensic Investigators
by
David J. George, PhD
Cover: The flowers of the Monkshood plant (Aconitum napellus) resemble the hood of a monk’s robe. It is
extremely toxic due to its content of aconitine which has an estimated human lethal dose of about 2 mg.
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Library of Congress Cataloging‑in‑Publication Data
Names: George, David J., author.
Title: Poisons : an introduction for forensic investigators / by David J.
George.
Description: Boca Raton : CRC Press, [2018] | Includes bibliographical
references and index.
Identifiers: LCCN 2017020197| ISBN 9781498703826 (hardback : alk. paper) |
ISBN 9781315371757 (ebook)
Subjects: LCSH: Poisons. | Poisoning. | Accidental poisoning.
Classification: LCC RA1211 .G465 2018 | DDC 615.9--dc23
LC record available at https://lccn.loc.gov/2017020197
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Cover: The flowers of the Monkshood plant (Aconitum napellus) resemble the hood of a monk’s robe. It is To:
extremely toxic due to its content of aconitine which has an estimated human lethal dose of about 2 mg.
Ashleigh
Betsy
Cary
Catherine
Chase
CRC Press Lauren
Taylor & Francis Group Macy
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742 Nolan
© 2018 by Taylor & Francis Group, LLC Quentin
CRC Press is an imprint of Taylor & Francis Group, an Informa business Rachel
No claim to original U.S. Government works Skylar
Tucker
Printed on acid-free paper
Zachary
International Standard Book Number-13: 978-1-4987-0382-6 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts
have been made to publish reliable data and information, but the author and publisher cannot assume
responsibility for the validity of all materials or the consequences of their use. The authors and publishers
have attempted to trace the copyright holders of all material reproduced in this publication and apologize
to copyright holders if permission to publish in this form has not been obtained. If any copyright material
has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, trans-
mitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter
invented, including photocopying, microfilming, and recording, or in any information storage or retrieval
system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.
com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood
Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and
registration for a variety of users. For organizations that have been granted a photocopy license by the
CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
Library of Congress Cataloging‑in‑Publication Data
Names: George, David J., author.
Title: Poisons : an introduction for forensic investigators / by David J.
George.
Description: Boca Raton : CRC Press, [2018] | Includes bibliographical
references and index.
Identifiers: LCCN 2017020197| ISBN 9781498703826 (hardback : alk. paper) |
ISBN 9781315371757 (ebook)
Subjects: LCSH: Poisons. | Poisoning. | Accidental poisoning.
Classification: LCC RA1211 .G465 2018 | DDC 615.9--dc23
LC record available at https://lccn.loc.gov/2017020197
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Contents
Preface xvii
Author xix
Section I
POISON
1 Poison and Poisoning 3
1.1 Introduction 3
1.2 Poisons 3
1.2.1 Potency 3
1.2.2 Mechanisms 4
1.3 Poisoning 6
1.3.1 Recognition 7
1.3.2 Morbidity and Mortality in Context 7
1.4 Case Studies 9
References and Additional Reading 14
2 Poison Exposure 17
2.1 Introduction 17
2.2 Dose 17
2.3 Blood Levels 19
2.4 Kinetics 20
2.5 Multiple Substance Exposures 20
2.5.1 CNS Depressants 21
2.5.2 Serotonergic Agents 21
2.5.3 Agents That Produce QT Prolongation 21
2.5.4 Effects on Multiple Organ Systems 21
2.5.5 Pharmacokinetic Interactions 22
2.6 Case Studies 22
References and Additional Reading 23
vii
viii Contents
3 Poison Absorption 25
3.1 Introduction 25
3.2 Routes of Administration and Dosage Forms Utilized
in Clinical Medicine 25
3.2.1 Oral 25
3.2.2 Rectal 26
3.2.3 Vaginal 26
3.2.4 Nasal 26
3.2.5 Transdermal 27
3.2.6 Injection 28
3.2.7 Inhalation 28
3.3 Routes of Administration Unique to Substance Abuse 28
3.3.1 Snorting and Injecting Powdered Tablets 28
3.3.2 Inhalation 29
3.3.3 Transdermal Patches 29
3.3.4 Smoking 30
3.3.5 Fad Methods of Substance Abuse 30
3.4 Absorption from Body Cavities 30
3.5 Intentional Poisoning 31
3.6 Case Studies 32
References and Additional Reading 34
4 Poison Biodisposition 37
4.1 Introduction 37
4.2 Metabolism 37
4.3 Excretion 39
4.4 Postmortem Redistribution 40
4.5 Case Studies 40
References and Additional Reading 44
5 Poison Detection 45
5.1 Introduction 45
5.2 Antemortem Toxicology 46
5.3 Postmortem Toxicology 47
5.4 Forensic Chemical Analysis 50
5.5 Case Studies 50
References and Additional Reading 53
Contents ix
6 Poisoning Treatment 55
6.1 Introduction 55
6.2 Assessment 55
6.2.1 Patient History 55
6.2.2 Clinical and Medical Laboratory Evaluation 56
6.2.3 Toxidromes 56
6.2.4 Toxicology Testing 56
6.3 Treatment 57
6.3.1 Life Support 57
6.3.2 Symptomatic and Supportive Care 58
6.3.3 Antidotes 58
6.3.4 Evidence-Based Treatment Guidelines 58
6.4 Removing Ingested Substances and Hastening Their
Elimination 59
6.4.1 Gastric Removal 59
6.4.2 Hemodialysis 59
6.4.3 Intravenous Lipid Administration 59
6.5 Case Studies 60
References and Additional Reading 63
Section II
POTENTIAL POISONS
7 Arsenic 67
7.1 Introduction 67
7.2 Exposure Situations and Circumstances 67
7.3 Symptoms of Poisoning 67
7.4 Case Studies 68
References and Additional Reading 74
8 Carbon Monoxide 75
8.1 Introduction 75
8.2 Exposure Situations and Circumstances 75
8.3 Symptoms of Poisoning 77
8.4 Case Studies 78
References and Additional Reading 82
