Poisoning by medicines

In countries with sophisticated medical services, poisoning with medicinal

compounds is very common and exceeds death from any other types of toxic
agents especially in suicidal and accidental poisoning. This is explained by the
ease of access of such substances whether from a doctor on prescription or on
demand across the counter.

Post-mortem examination

In order for intoxication or a fatality to occur, a large amount of medicinal

preparation will have to be ingested (low toxicity rating) and during autopsy there
may still be a mass of solid or liquid drug in the stomach. In clinical investigations
the stomach should be washed out to remove any remnants clinging to the walls
before it can cause any further damage or systemic effects.

The majority of modern medicinal preparations are by design, bland and non
irritant to the tissues and the GI tract. Most of them are taken orally and though
the active ingredient may be portent in their pharmacological effect on target
organs and tissues, they will cause no erosion or damage to the alimentary
canal.

They leave no characteristic or significant morphological lesions and unless there

is an indicative or suggestive history as to which drug was taken then an autopsy
has to be performed ‘blind’. There will thus be need for a full toxicological screen
to be undertaken.

Analgesics May cause some Spot test using ferric chloride soln
Aspirin; most abnormalities (erosion (10%) on tablet or urine sample
widely used of the gastric mucosa) (purple colour)
analgesic,
antipyretic, and
anti-inflammatory
Antidepressant Toxicities may occur IA for quick screen followed by the
s include tri- & from concurrent confirmatory tests
tetra- cyclics ingestion with other
drugs or food

Post mortem investigations of a fatality from a therapeutic preparation can be

difficult for a number of reasons.

1. Post-mortem changes may make interfere with analysis (difficult,

inaccurate or impossible)
2. detection/identification of the substance may be difficult
3. there may be more than one substance
4. there may be a sufficient delay between ingestion and death to allow
blood, urine and tissues concentrations to decline below fatal, toxic or
therapeutic levels
5. information about toxic levels may be unavailable or unobtainable
6. where death is delayed after administration there may be none
recoverable from the GI tract
7. the original substance may be rapidly metabolised into one or more
breakdown products adding to the difficulties of identification and
interpretation