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 .
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.
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
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:
- 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 .
- Inactivation / detoxification of the poison, for example complexing heavy metals with chelating agents ,
- 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.
- Blood washing by dialysis (hemoperfusion).
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
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.
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
The legal bases in the field of toxicology are the following laws:
- Law on the trade in medicinal products ( Medicines Act - AMG)
- Law on the traffic in narcotics ( Narcotics Act - BtMG)
- Ordinance on protection against hazardous substances ( Hazardous Substances Ordinance - GefStoffV)
- Regulation on the verification in the disposal of waste ( Ordinance - NachwV)
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
- Socrates died after being sentenced to death by drinking a cup of hemlock .
- Described, but not always provable, are several cases of poisoning (by the "poison of the Borgia") in connection with the pontificate and death of Pope Alexander VI, who was in office from 1492 to 1503 . from the family of the Borgia and the cardinals Orsini , Ferrari and Michiel and Giovanni Borgia .
- Paracelsus used mercury on others and himself for therapeutic purposes and possibly died of mercury poisoning.
- From the end of the 17th century, the poison " Aqua Tofana " achieved similar fame as the "Borgia poison ". It is said that Pope Clement XIV was poisoned with it in 1774 .
- The child powder scandal in France in 1952 killed 103 children.
- The Bulgarian journalist and dissident Georgi Markow fell victim to the umbrella attack in 1978 with a very small ball prepared with 40 µg ricin .
- Former Ukrainian President Viktor Yushchenko was poisoned with dioxin in 2004 .
- The British ex-KGB agent Alexander Litvinenko was poisoned with polonium-210 in November 2006 .
- Helmut Schubothe: Poisoning. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 1195-1217.
- Poisoning and chemical burns . kindergesundheit-info.de - independent information service from the Federal Center for Health Education (BZgA)
- Infographic poisonings - 50 sources of danger for children . (PDF) kindermedizin.info
- Police crime statistics 2004 . Federal Criminal Police Office (Germany) .
- 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.
- Poison in the umbrella . Mirror special
- Speculation about poison attack: Yushchenko's secret medical file . Spiegel Online .
- Secret services: Doctors puzzle over poisoning of ex-KGB agent Litvinenko . Spiegel Online .