poisoning

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Classification according to ICD-10
T36 Poisoning by systemically acting antibiotics
T37 Poisoning by other systemically acting anti-infectives and anti-parasitics
T38 Poisoning by hormones and their synthetic substitutes and antagonists, not elsewhere classified
T39 Poisoning from non-opioid analgesics, antipyretics, and anti-inflammatory drugs
T40 Poisoning by narcotics and psychodysleptics [hallucinogens]
T41 Poisoning from anesthetics and therapeutic gases
T42 Poisoning from anti-epileptic drugs, sedatives, hypnotics and anti-Parkinson drugs
T43 Poisoning by psychotropic substances, not elsewhere classified
T44 Poisoning from drugs that primarily affect the autonomic nervous system
T45 Poisoning by primarily systemic and blood-acting agents, not elsewhere classified
T46 Poisoning from agents primarily affecting the cardiovascular system
T47 Poisoning from agents primarily affecting the gastrointestinal tract
T48 Poisoning from agents acting primarily on the smooth muscles, skeletal muscles and the respiratory system
T49 Poisoning by means of topical application that act primarily on the skin and mucous membranes and are used in the eyes, ear, nose and throat and dentistry
T50 Poisoning by diuretics and other and unspecified drugs, drugs and biologically active substances
T51 Toxic effects of alcohol
T52 Toxic effect of organic solvents
T53 Toxic effects of halogenated aliphatic and aromatic hydrocarbons
T54 Toxic effect of corrosive substances
T55 Toxic effects of soaps and detergents
T56 Toxic effect of metals
T57 Toxic effects of other inorganic substances
T58 Toxic effects of carbon monoxide
T59 Toxic effect of other gases, vapors or other smoke
T60 Toxic effects of pesticides (pesticides)
T61 Toxic effect of harmful substances ingested with edible marine animals
T62 Toxic effect of other harmful substances ingested with food
T63 Toxic effect through contact with poisonous animals
T64 Toxic effects of aflatoxins and other mycotoxins in contaminated food
T65 Toxic effects of other and unspecified substances
ICD-10 online (WHO version 2019)

When poisoning (from " poison ") or intoxication are in living organisms that damage referred to by taking a respective minimum quantity of various substances (u. A. Toxins , but also drugs or psychotropic substances , such as ethanol and nicotine , as well as so-called hazardous substances caused).

The clinical picture is called toxicosis ( Greek τοξίκωση toxíkosi , German 'poisoning' ). Poisoning with several substances is called poly or mixed poisoning .

diagnosis

The possibility of poisoning should be considered

  • unexpected deaths in young, previously healthy people
  • in the case of sudden illnesses in children without known previous illnesses
  • if several people or living beings are ill at the same time
  • in drug addicts
  • when administering medication
  • in people with easier access to poisons

The proof of poison is mostly done by laboratory tests.

Causes of poisoning

The causes of poisoning are strongly dependent on the age group and the places of poisoning. The most common cases of poisoning happen e.g. B. in children aged 1 to 4 years from medicines, chemicals and plants and in infants more often than in people over 70 years old.

Mostly they are due to mix-ups under the influence of improper storage (e.g. in beverage bottles). Other common causes of poisoning are cosmetics, pesticides, mushrooms, and food and beverages . Most poisoning occurs in the home, followed by the workplace, kindergartens and hospitals.

The causes of poisoning are to be discovered as early as possible on the basis of the symptoms and treated with the appropriate therapy.

Chronic poisoning

Of a chronic poisoning is called (in the case of prolonged exposure exposure ) of a poison. This is an important problem in occupational medicine . Long-term use of medication can also lead to chronic symptoms of intoxication. Famous examples are the lead children and the Gressenich disease , but also alcoholism and smoking .

Forensic medical aspects

An important forensic task in poisoning cases is the preservation of evidence and documentation. It should venom samples, urine -, blood - or tissue samples secured are.

In some cases of poisoning, external signs allow a diagnosis of the toxin. For example, commercially available preparations of the plant protection agent E 605 are colored in an intense light blue. This means that poisoning can sometimes be recognized by the blue color on the patient's mouth .

Measures and detection of poisoning

Measures in the event of acute poisoning

Acute poisoning must be treated by a doctor as soon as possible. General measures ( elementary aid ) or goals that are usually undertaken or should be achieved in the event of acute poisoning are:

  1. Removal of the poison from the body (detoxification). Measures aimed at primary poison elimination are the administration of adsorbents such as activated charcoal , forced diarrhea with sodium sulfate and gastric lavage . The induction of vomiting by Ipecacuanha syrup is not without problems, since there is a risk of aspiration due to possibly weakened or extinguished protective reflexes . In the case of locally damaging noxae such as B. Acids , the esophagus can be additionally damaged by the new passage. Typical example: poisoning of a toddler with dishwashing detergent . One measure of secondary poison elimination is forced diuresis through increased fluid intake, for example through Ringer's solution or through a loop diuretic such as furosemide .
  2. Inactivation / detoxification of the poison, for example complexing heavy metals with chelating agents ,
  3. Use of an antidote: the administration of an antidote against the poisonous effect is only possible after a strict indication for the respective measure. Above all, the type and quantity of the poison must be known. The timing of the poisoning and the patient's clinical condition also play a role. Some antidotes in turn have serious side effects.
  4. Blood washing by dialysis (hemoperfusion).

Recognizing poisoning

Poisoning can be recognized by the first letters of the word sepsis with the clinical pictures. These always occur collectively.

S chüttelfrost, fever or severe muscle pain
E Xtreme, unprecedented malaise
P eriphere reduce circulation, discolored skin
S chläfrigkeit, confusion
I ch felt like I was dying
S chnelle, heavy breathing, shortness of breath

Poison information

Such information is provided by poisoning advice centers (for example in Germany, Switzerland, Austria). They provide quick help in cases of suspected poisoning for the population and for medical professionals. For the normal consumer, the poison control centers for questions about domestic cases and the Tropical Institute for long-distance trips.

Effect of poisoning

Poisons affect the organism in various ways. Poisons can have a corrosive effect on organs and paralyze the nervous system and / or consciousness . In addition, cell respiration can be completely blocked or disturbed, which in turn can lead to organ disorders or destruction. All of these factors can appear alone or together as a symptom of intoxication and cause the most varied, but mostly inconspicuous symptoms . All of these can make poisoning difficult to detect and treat quickly.

Epidemiology

In 1995 (in Germany) 2,944 deaths from acute intoxication were counted. The most common substances in these intoxications are carbon monoxide (CO), opioids ( heroin , morphine , etc.) followed by sleeping pills ( barbiturates and others) and sedatives (hypnotics). This is followed by alcohol poisoning ( ethanol , methanol and ethylene glycol ).

According to the 2004 crime statistics of the Federal Criminal Police Office (BKA), ethanol comes first. In 1995 too, according to the BKA, the proportion of drugs and poisons that were not marketable in fatal poisoning was around a third. Alcohol and legal tobacco would, according to the Federal Criminal Police, however, a 2 / 3 valency of intoxication.

Legal situation in Germany

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

The legal bases in the field of toxicology are the following laws:

In the Criminal Code , poisoning was regulated as an independent offense of a crime in Section 229 of the old version of the Criminal Code until 1998 . The 6th Criminal Law Reform Act transferred it to Section 224 ( dangerous bodily harm ). This downgraded the offense to an offense , the qualifications of which are now based on the rules of bodily harm. A conviction for the crime of serious bodily harm or murder through the use of poison is still possible. The legal regulation also includes external poisoning by contact poisons .

Selection of historical poisoning cases

See also

literature

  • Helmut Schubothe: Poisoning. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 1195-1217.

Web links

Wiktionary: Poisoning  - explanations of meanings, word origins, synonyms, translations
Wikibooks: Poisoning First Aid  - Learning and Teaching Materials

Individual evidence

  1. ↑ Police crime statistics 2004 . Federal Criminal Police Office (Germany) .
  2. ^ Oskar Panizza : German theses against the Pope and his dark men. With a foreword by MG Conrad. New edition (selection from the “666 theses and quotations”). Nordland-Verlag, Berlin 1940, p. 172 f.
  3. ↑ Poison in the umbrella . Mirror special
  4. ↑ Speculation about poison attack: Yushchenko's secret medical file . Spiegel Online .
  5. ^ Secret services: Doctors puzzle over poisoning of ex-KGB agent Litvinenko . Spiegel Online .