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Timing of symptoms and their character 2. Timing of symptoms related to intake of food, fluid or medicine and the order of appearance 3.

Are symptoms intermittent or increasing severity 4. Previous baseline of pt 5. What was vomited, take a sample 6. Sample of suspected peccant (substance) food fluid or medicine, urine and faeces should be taken for analysis (place in suitable containers sealed and labelled) 7.

If food is suspected, ask if similar food has been eaten previously without ill affect, if others that ate it also got ill 8. Explanations offered or remarks made by pt or informants should be noted 9. If the symptoms do not conform to ordinary illness, or last continue despite appropriate Rx the pt's environment and conduct of caregivers should be observed. Ask for help. (remove a pt if suspicious circumstances exist).

Evidence of signs and symptoms associated with a specific toxic substance 2. Demonstration, by chemical analysis, of the presence of a posion in some food or drug product take by the deceased.

Demonstration, by chemical analysis, of the presence of a particular toxin in the tissues and body fluids of the deceased 4. Demonstration of gross or histological pathological findings associated with a toxic substance in the tissues of the deceased 5. A history of exposure to said toxic substance 6.

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Absence of other cause of death. A: Routine specimens (ingested poison) - 1. Stomach contents 2. The whole liver - absorbed poison 3. Both whole kidneys - poison being excreted 4.

Blood - poison absorbed from stomach/intestine, breakdown products from liver 5. Urine - unchanged poison or metabolites B: Other specimens (case dependant) 1. Specimens indicating the nature of the poison - anything that may have been used to administer the poison 2.

Early vomitus or stomach washings 3. Brain - barbituate poisoing 5. Blood - from femoral with clean needle+syringe - carbon monoxide, olcohol 6. Hair and nails - arsenic can be found in nail roots 1 week after absorption, 7.

Large intestine: when poison enema administered, heavy metals excreted by colon, cause necrosis of mucosa (e.g. Potassium dichromate). Toxicology boxes containing containers are provided by police 2. Containers are chemically cleansed. Sodium Fluoride, anti-enzyme preservative, found in 50ml and 200ml bottles. Make sure seal is intact 4. In small jar - opened stomach + contents in the large jar - liver + kidneys 200ml bottle - urine 50ml bottle - blood (special jar provided for blood alcohol analysis) 100ml jar - hair if arsenic suspected sealed envelope - nails 4.

Preservative - pure spirits (can get from police) i.e. Rectified spirits. Immerse organs completely. Do not add to blood, urine, nail and hair samples. Submit a sample of preservative too.

Labeling - police death registration #, name of police station, name of deceased, date and serial number of post-mortem, nature of specimen contained, medical officers signature 6. Pack containers in box and seal each container with police seal 7. Within the box with the above too + name of policemen to whom the box was handed and number and nature of containers within. Seal the box with police seal by or in presence of M.O.

Label the box -name and adress of lab to recieve box - name and adress of dispactching police station - nature of contents - signature of person who packed and sealed the box 10. It's the M.O. Responsibility until chain of custody is handed over to police 11. Covering report + signature detailing 4, 7 and 9 + summary of clinical info if available (reasons for suspecting poisoning, possible poison, seal numbers, box number, copy of post mortem report sent to lab. CVS- initial vasodilation with reflex arteriolar constriction. Decreased contractility = myocardial depression. Rhythm disorders rare.

Vessel dmge may cause gangrene - Blackfoot disease. GIT - rice water stools, bleeding, protein losing enteropahty KIDNEY - ATN, cortical necrosis, oliguria, proteinuria, haematuria SKIN + APPENDAGES - palmar erythema, local odema, hyperkeratosis, hyperpigmentation and atrophy.

Alopecia, brittle nails, Mees' lines (leukonychia striata) CNS - glove and stocking distal sensory neuropathy resulting in muscle atrophy. Encephalopathy LIVER - central necrosis and cirrhosis. ACUTE: GIT sx 30min - 2hrs post ingestion - vomiting, diarrhoea, abdo. Pain, burning oesophageal pain. Severe poisoning: shock d.t.

Vasodilation and cvs depression. Cerebral odeama - headache, delirium, coma, seizures Death: 24hrs to 4 days Late complications: jaundice, renal failure, peripheral neuropathy CHRONIC - difficult to diagnose Diarrhoea and abdo pain hyperpigmentation + hyperkeratosis - esp. Soles and palms sensory neuropathy localised odeama - face and ankles sore throat, stomatitis, lacrimation, salivation, perspiration, garlic odour, vitiligo, alopecia. ACUTE - Symptom onset depends on route of absorption. Inhalation lead to flushing, headaches, tachypnoea, dizziness in 30sec leading to irregular breathing, coma, seizures death within 10min.