Clinical Toxicology Laboratory

EXPERIMENT 1-9

ACETONE ANILINE
Synonyms: Synonyms:
 2-propanone  Benzenamine
 Dimethyl ketone  Phenylaminme
Characteristics:  Amino benzene
 volatile fluid  Blue oil
 density : 0.791 g/Ml  C6H5NH2
 vapor : mildly irritating to the eyes and respiratory tract Characteristics:
 Highly flammable, miscible with water  aromatic amino compound
Uses:  mildly irritating to the eyes upon direct contact, and could cause conjunctival
 solvent and reagent damage
 nail polish remover  Potent producer of methemoglobinemia
Identification test:  absorbed via inhalation and dermal routes
 Sodium nitropruside test-(+) heavy purple mass Uses:
 Ferric chloride test- (+)black  to manufacture dyes, photographic materials and rubber
 Benzoldt, Gunning- (+) Indigotine  drug precursor
 Reynold’s test- (+) black zone  Explosive
 Herbicide
Acetone poisoning  Synthetic dyes
Mode of toxic action Identification test:
 Travel through the blood stream until they are broken down in the liver  Bromine water (+) flesh colored precipitate of tribromoaniline
Signs and symptoms:  Hypochlorite test- (+) blue
Acute:  Phenylisocyanide test- (+) repulsive odor
 Headache  Chromic acid test- (+) deep blue
 Slurred speech Aniline poisoning
 Lethargy Mode of toxic action
 Lack of coordination  Toxicity to erythrocytes results in scavenging of damaged red blood cells by the
 A sweet taste in the mouth spleen, initiating a series of events which may contribute to the development of
Severe: spleen tumors
 Ketoacidosis Signs and symptoms:
 Deep stupor  Blue finger nails, lips and skin
 CNS depression  Lassitude
 Cardiorespiratory failure  Cyanosis
 Death  Labored breathing
Fatal dose:  Convulsion
 100ml/150lb Fatal dose:
Antidote:  50-500mg/kg
 Milk (neutralize and coats stomach) Antidote:
 Lavage  Methylene blue
 Emesis  Flush the affected area with plain water
 Orotracheal or nasotracheal intubation for airway control
 IV administration of D5W
Acetone vs aniline Fatal dose:
CHARACTERISTICS ACETONE ANILINE  10,000 ppm
Color Colorless Pale brown  2000mg/kg
Odor Aromatic Peculiar Antidote:
 Methylene blue
Taste Pungent Burning
Boiling point 57ᵒC 185ᵒC
Vapor pressure 266 mmHg @ 25ᵒC 0.6 mmHg @ 20ᵒC
CHLOROFORM
Synonyms:
 CHCl3 (Trichloromethane)
 Methyl thrichloride
CARBON DISULFIDE Characteristics:
Characteristics:  chlorinated hydrocarbon solvent
 colorless inflammable liquid, with a characteristic odor  colorless with aromatic odor
 Boiling point: 42 degrees Celsius  Boiling point: 61 degrees Celsius
 high index of refraction Uses:
 highly soluble in water, miscible with alcohol, ether and fatty oils  raw material for the production of Freon
 CNS and cardiovascular toxicity. It can cause peripheral neuropathy with cranial  solvent in extraction processes
nerve damage. Identification Tests:
Uses:
 Phenylisocyanide: (+) very penetrating repulsive odor
 solvent for oils, resins and rubber
 exterminating mice (pesticide), Fumigant
 Schwartz’s resorcinol test: (+) yellowish-red ppt
 metal rust remover  Reduction test:
Identification test:  Fehling’s test: (+) red ppt
 Lead acetate test: (+) black ppt but w/ HCl: white ppt  Tollen’s test: (+) silver mirror
 Sulfocyanate test: (+) deep red color
 Xanthogenate test: (+) yellow ppt Chloroform poisoning
Mode of toxic action:
Carbon disulfide poisoning  can act as a CNS depressant and could possibly potentiate cardiac arrhythmias by
MOTA: sensitizing the myocardium to catecholamines. It can cause renal and hepatic
 Disruption of enzymes, especially in dopamine-dependent systems toxicity caused by its metabolism in the liver due to the presence of a free radical.
 Neurotoxic effect: Chloroform is also embryotoxic to mammals.
 Reacts to amino or thiol groups that leads to formation of Sign and symptoms:
dithiocarbamates or GSH conjugates
 Hepatic and renal damage
 Inhibits dopamine beta-hydroxylates
 CNS depression
 Hepatotoxic effect:
 Oxidative metabolism to two reactive sulfur atoms that bind covalently to
 Arrythmia
cell macromolecules Fatal dose:
Signs and Symptoms:  10ml
Acute: Antidote:
 Eye and skin irritation  N-Acetylcysteine
 CNS depression
Severe:
 Delirium and psychosis PHENOL
 Parkinsonism Synonyms:
 Optic neuritis  C6H6O
 Peripheral neuropathy  Carbolic acid
 atherosclerosis  Hydroxybenzene
Characteristics: Identification tests:
 colorless pink crystalline solid, has a distinct, acrid and aromatic odor as being  Pellerin’s test: (+) Blue-green color
sweet or tarry.  Bertholet’s test: (+) aromatic odor
Uses:  Methyl salicylate test: (+) wintergreen odor
 Drug precursor  Ethyl acetate test: (+) plastic balloon odor
 Disinfectant (Protoplasmic poison) Ethanol poisoning
 Hexachlorophene is a chlorinated biphenol which is widely used as a topic Fatal dose:
anesthetic, preservative scrub until its neurologic effects were detected. Other  300-400ml pure ethanol
phenolic compounds included cresols, hydroquinone, eugenol and phenylphenol,  1.5 pint whiskey
the active ingredient of Lysol. Signs and symptoms:
Identification test:  Nausea
 Hypochlorite test: (+) Blue  Headache
 Bromine water test: (+) Yellowish white ppt  Vomiting
 Millon’s test: (+) Red  Dizziness
 Ferric chloride test: (+) Blue violet  Nervous system depression
 Confusion
Phenol poisoning  Loss of consciousness
Mode of toxic action:  CNS depression
 causes protein denaturation and can cause tissue damage upon contact. Skin burns Antidote:
may also occur. It is usually absorbed intradermally, or through vapors, which may  Fomepizole
be irritating to the eyes and the respiratory tract.  Disulfiram
Fatal dose:
 2g METHANOL
Signs and symptoms: Synonyms
 Burning sensation  Methyl alcohol
Antidote:  Wood alcohol
 Gastric lavage Characteristics
 Activated charcoal  Methyl alcohol is a colorless liquid which boils at approximately 65 degrees Celsius.
Similar to ethanol, it has a characteristic odor and a burning taste. It is polar,
making it a good solvent. It is also highly flammable and highly toxic.
ETHANOL Uses
Synonyms:
 Denaturant
 C2H5OH
 Paint remover
 Ethyl alcohol
 Solvent
 Grain alcohol
 Windshield washer fluid, ‘canned heat’, 95% concentration works as antifreeze
 Wine or Neutral or rectified spirit
 Model airplane fuel
Characteristics:
 Industrial production of synthetic organic compounds
 inflammable, low molecular weight hydrocarbon that is slightly soluble in water
Identification Test
and lipid
 Pellerin Test – Green Color
 colorless liquid having a characteristic pleasant odor and burning taste
 Bertholet Test – Pleasant smell, fruit of the Feijoa tree
 Boiling point: 78 degrees Celsius
 Methyl Salicylate Test – Oil of Wintergreen Odor
 can be derived from fermentation of sugar in fruits, cereals and vegetables. It can
 Ethyl Acetate Test – glue/ nail polish- like odor
be found in colognes, perfumes, mouthwashes, flavorings, pharmaceutical
 Redox Test – Formalin- like odor
preparations and many other products
Methanol Poisoning
Uses:
Mode of Toxic Action
 for the treatment of methanol and ethylene glycol poisoning
 Metabolized into formaldehyde and formic acid
 Wine
 Formic acid causes ‘snowstorm blindness’ after a latent period of about 6- 30 hours
 Disinfectant
Fatal Dose
  >50 mg/dL Fatal Dose
Signs and Symptoms  Ingestion of 1- 2g
 Sedation  Inhalation of 660 to 1,330 mg/m3 for 30 minutes, assuming a breathing rate of 50
 Inebriation and gastritis liters per minute and 100% absorption
 Formaldehyde- odor in breath and in urine Signs and Symptoms
 Metabolic acidosis  Sensitization dermatitis and edema
 Osmolar gap  Weakness and myalgia
 CNS depression  Hepatic injury
 Seizures  Yellow skin and hair discoloration
 Bradycardia, rapid respiration  Dark yellow or port wine- colored urine; anuria or polyuria; hematuria,
 Ocular toxicity albuminuria; nephritis
 Coma Antidote
Antidote  Washing with an amphoteric salt solution (e.g., Diphoterine), which is standard
 Ethanol competes with alcohol dehydrogenase for metabolism; Fomepizole blocks protocol for topical exposure to an acid or alkali
the enzyme.
 Hemodialysis if the toxic metabolites are already formed, for removal.
 NaHCO3 for the treatment of metabolic acidosis
PICROTOXIN
Synonyms
 Folic acid as a cofactor to increase metabolism to nontoxic metabolites
 Fish berry, Cocculus
 Diazepam for the treatment of seizures
Characteristics
 Toxin derived from the seeds of the shrub Anamirta cocculus (contains an
PICRIC ACID equimolar mixture of picrotoxinin and picrotin)
Synonyms  Pure picrotoxin occurs as shiny leaflets with an intensely bitter taste or as an
 2,4,6 Trinitrophenol odorless, lustrous, microcrystalline powder.
 Carbazotic acid Uses
 Phenol trinitrate  Stimulant
Characteristics  Used in the past as a treatment for phenothiazine and barbiturate poisoning
 Toxic, yellow rhombic crystalline phenolic derivative that is odorless with a very  Bitter tonic, stomachic, beer adulterant
bitter taste (derived from the Greek word pikros meaning bitter) Identification Test
Uses  Fehling’s Test – Green suspension and red ppt.
 Explosives and matches, in the anhydrous state (similar to other highly nitrated  Oxidation Test – Violet color that becomes brown on standing (H2SO4 + K2Cr2O7);
organic compounds) Red color (H2SO4 + HNO3)
 Oxidant for rocket fuel Picrotoxin Poisoning
 Forensic staining Mode of Toxic Action
 Electric batteries  blocks presynaptic inhibition and strychnine-resistant postsynaptic inhibition in the
 Etching copper central nervous system.
 Leather, textile mordant  Picrotoxin selectively antagonizes the effects of the predominant inhibitory
 Colored glass transmitter, gamma-aminobutyric (GABA), at all levels of the central nervous
 Reagent for the preparation of organic derivatives system.
 Was used in the past as an antimicrobial and in a 1% solution for the treatment of Fatal Dose
burns  20- 25mg
Identification Test Signs and Symptoms
 Grelot Test – formation of dark red crystals  Tonic- clonic seizures
 Picramic Acid Test – formation of dark red crystals  Salivation
 Ammoniacal Copper Test – formation of dark red crystals  Vasomotor stimulation leading to an elevation of blood pressure
Picric Acid Poisoning  Emesis
Mode of Toxic Action  Change in temperature of patient
 Unconfirmed by studies, but has been shown to be an inhibitor of electron  Cardiac dysrhythmias
transport  Hemolysis
Antidote  white, odorless, acicular crystal or crystalline powder which gradually discolors
 Activated charcoal when exposed to sunlight. Has a first bitter taste that gradually becomes sweet.
 Symptomatic treatment of seizures with diazepam  It is soluble in alcohol, ether, chloroform and carbon disulfide.
 A carboxylic acid that is excreted in the urine mostly conjugated through the amino
CAFFEINE acid glycine.
Synonyms Uses
 1,3,7- trimethylxanthine  Analgesic, antipyretic, anti-inflammatory, antiplatelet
 Methyltheobromine  Keratolytic, fungicidal, bacteriostatic
 Theine, mateine, guaranine Identification Test
Characteristics  Pellerin Test – violet color that may vary from violet- red, violet-green or violet-
 The active alkaloid found in coffee beans, cola nuts, and cocoa beans. blue depending on the type of phenol
 White crystalline powder with a bitter taste  Millon’s Test – pink to dark red color
Uses  Halogenation/ Bromination Test – disappearance of bromine’s brown color upon
 used to restore mental alertness or wakefulness during fatigue or drowsiness. addition to solution
 Caffeine is also found in some headache and migraine medications  Methyl Ester Test – Oil of Wintergreen odor
 in certain dietary supplements used for weight loss, Salicylic Acid Poisoning
 and in many popular energy drinks. Mode of Toxic Action
 Used in the treatment of apnea in newborns and in postlumbar puncture headache  Salicylates inhibit cyclooxygenase, thereby reducing the formation of
in the form of caffeine citrate injection prostaglandins, and cause platelet dysfunction.
Identification Test  Salicylates stimulate the respiratory center in the brainstem, interfere with the
 Oxidation Test – Formation of dimethyl alloxan, which is white rhombic crystals vs Krebs cycle (limiting ATP production), uncouple oxidative phosphorylation (causing
caffeine’s needle- like or crystalline crystals accumulation of pyruvic and lactic acid and heat production), and increase fatty
 Tannic Acid Test – whitish to yellow ppt acid metabolism (generating ketone bodies). The net result is a mixed respiratory
Caffeine Poisoning alkalosis and metabolic acidosis.
Mode of Toxic Action Fatal Dose
 produces mild psychostimulant and sometimes anxiogenic effects by antagonizing  15g for a 70kg person
adenosine at A(1) and A(2A) receptors  LD50 Mouse oral 480 mg/kg
 Phosphodiesterase inhibition activity Signs and Symptoms
 Beta 1 and 2 adrenergic stimulation secondary to catecholamine release  Mild: Tinnitus, GI upset, tachypnea, respiratory alkalosis
Fatal Dose  Severe: Lethargy, Convulsions, Coma, Metabolic Acidosis
 In one 5-year-old patient, death occurred following oral ingestion of approximately Antidote
3 g of caffeine.  Concentrations greater than 30 mg/dL warrant therapy with
 In adults, iv doses of 57 mg/kg and oral doses of 18-50 g have been fatal  Sodium bicarbonate for urine alkalinization
Signs and Symptoms Hemodialysis indicated if the patient is experiencing renal failure, congestive heart failure,
 GI pain altered mental status, seizures, evidence of cerebral edema, worsening acidosis despite
 Fever adequate resuscitation, persistently rising salicylate concentrations despite adequate
 Mild delirium and insomnia treatment (greater than 50 to 60 mg/dL in a chronic poisoning or levels greater than 90 to
 Seizures, cardiac dysrhythmias 100 mg/dL in an acute overdose).
 Wine or red brown diuresis, dehydration  Patients with an altered mental status may have cerebral edema, a head CT should
Antidote be should be obtained, in this case, mannitol can be given
 Fluid repletion and electrolyte replacement
 Esmolol IV infusion, or other available beta- blockers IODINE
Characteristics
SALICYLIC ACID  nonmetallic element of the halogen group
Synonyms  is a bluish-black, lustrous solid. It volatilises at ambient temperatures into a pretty
 2- hydroxybenzoic acid blue-violet gas with an irritating odour.
 Oil of Wintergreen  forms compounds with most elements, but is less reactive than the other halogens,
Characteristics which displace it from iodides.
  exhibits some metallic-like properties.
Uses
 Antiseptic and disinfectant in the form of a tincture due to poor water- solubility
(solubilizes when combined with potassium iodide)
 Reduction of size of thyroid in preparation for thyroidectomy
 Treatment of thyroid storm
 Used in the purification of water
Identification Test
 Silver Nitrate Test – Yellow coloration that may develop specks of gray/ silver upon
exposure to light
 Lead Acetate Test – Brownish- yellow precipitate that will settle at the bottom due
to lead’s density
 Starch test – formation of blue- violet complex
 Mercuric Chloride test – formation of red color
Iodine Poisoning
Mode of Toxic Action
 Small amounts of iodine are necessary for normal thyroid function.
 It is believed that iodine precipitates the proteins of the microorganisms by
forming salts via direct halogenation.
Fatal Dose
 2 and 4 g of free iodine or 1 to 2 oz of the strong tincture
Signs and Symptoms
 Brown black skin discoloration
 Blue bowel
 Hemolysis
 Hypotension
 Pharyngeal and glottal edema may also occur if Iodine is ingested.
 Iodides can penetrate the placenta and may cause neonatal hypothyroidism and
death from respiratory distress secondary to goiter.
 Inhalation of iodine vapors may cause irritation of the respiratory tract.
Antidote
 Vasopressors for hypotension, plasma transfusion for hemolysis
 Starch solution to convert iodine to iodide