毒物分析
Clinical Toxicology
授課教師：賴滄海教授
03-30-2009
The categories with the largest number of deaths are as follows:
Salicylate

Aspirin (Acetylsalicylic acid)
has analgesic, antipyretic and antiinflammatory
properties.
Therapeutic concentration:
analgesic-antipyretic (lower than 60 mg/L)
anti-inflammatory (150 to 300 mg/L)
Aspirin interferes with platelet aggregation
and thus prolongs bleeding times.
Pharmacologic effect of salicylates




Stimulate central respiratory center
Uncoupling of oxidative phosphorylation
Enhance anaerobic glycolysis, Inhibite
Kreb’s cycle and transaminase enzyme.
Respiratory alkalosis predominates in
children over age 4 and in adults.
Fig.25-13. Nomogram for estimating the severity of acute salicylate
intoxication.(From Done, A.K.:salicylate intoxication: Significance of
measurements of salicylate in blood in cases of acute ingestion. Pediatrics,
26:800, 1960. Reproduced by permission of Pediatrics.)
Symptoms of salicylate intoxication







Tinnitus （耳鳴）
Diaphoresis （出汗）
Hyperthermia
Hyperventilation
Nausea, vomiting
Acid-base disturbances
CNS effects
lethargy, disorientation, coma and seizures.
Respiratory alkalosis (19％)
 Metabolic acidemia (15％)
 Combined (61％)

Treatment
Ipecac to induce vomiting
 Correction of acid-base and
electrolyte imbalance, activated
charcoal to prevent absorption
 Hemodialysis

Screening Assay for
Acetaminophen and Salicylate

Acetaminophen
After acid hydrolysis, the sample was reacted with ocresol in basic solution to show blue color.

Salicylate
Salicylates reacted with Ferric chloride solution to
produce a violet color reaction.
(Interferant: Diflunisal, labetalol, keto acids)
Methemoglobin

Less than 1.5％of total hemoglobin in normal
blood

Caused by methhemoglobin reductase
deficiency or ingestion of nitrites, nitrates,
phenacetin, phenazopyridine, sulfonamides,
sulfones, aniline dyes.

Determined spectrophotometrically at 630mm
Alcohols
Ethanol
 Methanol
 Ethyleneglycol
 Isopropylalcohol

Ethyleneglycol
資料來源： 2007年5月7日自由時報
Effects of Ethanol

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Cardiovascular system—Increase high-density
lipoprotein
Central nervous system-CNS depression
(Respiratory center, coma, death)
Gastrointestinal tract-Stimulate the production
of gastric juices
Kidney-Diuretics ( Inhibit the secretion of
ADH)
Liver-Fatty liver,Cirrhosis
Fetal alcohol syndrome
Determination of Ethanols
1.
2.
3.
Enzymatic
Headspace-GC
Breath-testing device (amount of ethanol in
1mL of blood equals to 2100mL of breath air)
Henry’s law
Carbon Monoxide

Lithium
Use to treat manic-depressive illness.
It enhances reuptake of neurotransmitters, thus
produces sedating effect on the CNS

Toxicity
apathy, sluggishness, drowsiness, lethargy, speech
difficulties, irregular tremors, muscle weakness,
ataxia, epileptic seizures.
Determined with ISE or Atomic Absorption
Spectrometry, Flame emission photometry
Lead

Toxicity
Inhibits amino levulinic acid dehydratase (causes
accumulation of protoporphyrin in RBC)
Forms covalent bonds with the-SH group of cysteine
in proteins (Nerve cells are particular susceptible)

Determination
whole blood was analyzed with atomic absorption
spectrometry
•Fig.25-27. Effects of inorganic lead on children and adults (lowest observable
adverse effect levels). (From Royce, S.E., Needleman, H. L., Eds.: Case Studies in
Environmental Medicine: Lead Toxicity. U.S. Public Health Service, ATSDR, 1990.)
Iron

Toxicity
Severe irritation of the epithelial lining of the GI tract
and results in hemosiderosis, which may develop into
hepatic cirrhosis.

Hemosiderosis
A term used to imply iron overload without associated
tissue injury
Determined spectrophotometrically after reaction
with Bathophenanthroline or Ferrozine