- 9 Hidden Heart Toxins and How to Avoid Them
- 8. HIV Medication Risks
- 9. Mercury Poisoning From Fish
- Play It Safe
- Illegal Drugs and Heart Disease
- Limitations of Autopsies Fail to Detect Rare Poisons
- Prescription Drugs
- Pick Your Poison
- Symptoms – Poisoning
- Signs of a medication or drug overdose
9 Hidden Heart Toxins and How to Avoid Them
8. HIV Medication Risks
Treatment with HAART — highly active antiretroviral therapy — in patients with HIV may also cause damage to the heart. Patients with HIV have higher rates of heart failure, atherosclerosis, stroke, and heart attack. Exactly how certain antiviral drugs are toxic to the heart is not yet clear, but is a subject of ongoing research.
9. Mercury Poisoning From Fish
An environmental pollutant, mercury can be profoundly toxic to the heart. Mercury toxicity can raise your blood pressure, cause arrhythmias, and increase your heart attack risk. The most common source of mercury poisoning is fish.
To steer clear of this toxin, don’t eat fish that are known to be high in mercury — which means those containing 100 to 200 micrograms (mcg) of mercury per 4 ounces of cooked fish, according to the U.S. Food and Drug Administration (FDA). Fish highest in mercury include shark, swordfish, king mackerel, and tilefish from the Gulf of Mexico. By comparison, safer choices like salmon and sardines have 100 times less mercury in the same serving size. Tuna has an intermediate level of mercury, between 13 and 50 mcg per 4 oz of fish.
Women and young children should avoid eating any fish high in mercury, advises the FDA. Pregnant women should limit their fish consumption to 12 oz per week overall, including no more than 6 oz of white (albacore) tuna, according to the FDA. The FDA’s advice helps protect the most vulnerable, a developing fetus or growing child. Consumer Reports goes even further, advising pregnant women to avoid tuna altogether.
Check this FDA listing of mercury levels in dozens of types of fish.
Play It Safe
If you’re worried that a medication you’re taking, or a treatment you need, may be toxic to your heart, check with your doctor and get the facts. The benefits may outweigh the risks.
The good news is that the effects of cardiotoxicity are often treatable and reversible, notes cardiologist William T. Abraham, Everyday Health columnist and director of cardiovascular medicine at the Ohio State University in Columbus. “Fortunately, discontinuation of a toxic chemotherapeutic agent or illicit drug, and treatment of the heart muscle damage with medications such as ACE inhibitors and beta-blockers can often reverse the damage and restore heart function,” says Dr. Abraham.
Illegal Drugs and Heart Disease
Most illegal drugs can have adverse cardiovascular effects, ranging from abnormal heart rate to heart attacks. Injecting illegal drugs also can lead to cardiovascular problems, such as collapsed veins and bacterial infections of the blood vessels and heart valves.
Many drugs, such as cocaine, heroin and various forms of amphetamine, affect the central nervous system and can alter a user’s consciousness. In addition to addiction, the side effects and risks associated with use of these drugs include:
- changes in body temperature, heart rate, and blood pressure
- headaches, abdominal pain, and nausea
- impaired judgment and greater risk of some sexually transmitted infections
- the possibility of added substances (such as talc, poisons, herbicides or other particles) which may cause a toxic reaction.
- heart attacks, seizures, and respiratory arrest
More about Cocaine – the “perfect heart-attack drug”
The powdered form of cocaine is either inhaled through the nose (snorted) and absorbed through nasal tissue, or dissolved in water and injected into the bloodstream. Crack is a form of cocaine that has been processed to make a rock crystal that can be smoked.
Even so-called recreational cocaine users may have higher blood pressure, stiffer arteries and thicker heart muscle walls than non-users — all of which can cause a heart attack. An Australian study presented at the American Heart Association’s Scientific Sessions in 2012 was the first to document these cardiovascular abnormalities in seemingly healthy regular cocaine users long after the immediate effects of cocaine have worn off. Researchers – who called cocaine “the perfect heart attack drug” – showed how users had higher rates of multiple factors associated with higher risks of heart attack and stroke:
- 30 percent to 35 percent increase in aortic stiffening;
- 8 mm Hg higher systolic blood pressure; and
- 18 percent greater thickness of the heart’s left ventricle wall.
A United Nations World Drug Report estimated the prevalence of cocaine use in the United States for 2013 to be 1.6 percent of the population aged 12 and older, and it had remained stable in the previous few years.
Cocaine is the illegal drug most often associated with visits to U.S. hospital emergency departments. Cocaine use has been associated with chest pain and myocardial infarction. In 2011, it was involved in an estimated 40.3 percent of illicit drug-related emergency department visits (505,224 visits), versus about 36.4 percent (455,668 visits) for marijuana and about 20.6 percent (258,482 visits) for heroin.
Cocaine, amphetamine and ecstasy can all have adverse effects on the cardiovascular system.
- Amphetamines, a class of drugs which includes methamphetamines, can be habit-forming and prone to abuse. The drugs are prescribed to treat Parkinson’s, obesity, narcolepsy and attention deficit disorder with hyperactivity (ADHD). They stimulate the central nervous system (nerves and brain). This increases heart rate and blood pressure and decreases appetite, among other effects.
- Ecstasy, or MDMA, is illegal. It is known as a synthetic “club drug” with stimulant and hallucinogenic effects.
Drug Abuse is growing among older adults.
According to the National Institutes of Health, the number of illicit drug users age 50 and older is increasing. Illegal drug users aged 50 to 59 more than tripled between 2002 and 2012 – from 900,000 to more than 3 million. Larger numbers of older adults also are seeking treatment for substance abuse and having increased hospitalizations and more visits to emergency departments, up more than 130 percent in 55 to 64-year-olds from 2004 to 2009.
While it is relatively rare for adults over 65 to have ever used illicit drugs, baby boomers, adults currently in their 50s and early 60s, are more likely to have tried them during their youth than previous generations. Greater lifetime exposure could lead to higher rates of abuse as baby boomers age.
For more information and resources, please see:
- The National Institute on Drug Abuse:
- National Institute of Health, about seniors and illicit drugs.
- Alcohol and Heart Disease
- Caffeine and Heart Disease
- Tobacco and Heart Disease
This content was last reviewed September 2015.
Limitations of Autopsies Fail to Detect Rare Poisons
There are 8 million chemical compounds on Earth, yet even the most sophisticated coroner’s lab tests for no more than a few hundred of them. So perhaps it should come as no surprise that when 300-pound Burbank mortician Timothy Waters died three years ago, medical examiners missed the real cause of death–poison.
Waters was thought to have died on April 8, 1985, from a heart attack. But new tests discovered oleander, a potent poison taken from the brightly flowered plant common in California, in his tissue.
Under suspicion of poisoning Waters is David Sconce, a 32-year-old Pasadena funeral home operator already in jail on 67 felony and misdemeanor charges ranging from mutilating corpses to selling body parts. Though the modern forensics laboratory has at its disposal a barrage of testing devices, from gas chromatographs to mass spectrometers, science didn’t focus suspicion on Sconce, who has not been charged in the crime. His bragging about his alleged crime did.
The case is raising questions about how a man could be poisoned, vomit for two days before dying, and be buried without anyone suspecting foul play. The reasons lie in both the limits of the laboratory and the limits on taxpayer dollars that fund medical investigations reaching into the grave.
Medical examiners order autopsies in about a third of the deaths that come to them, said Ventura County Examiner Dr. F. Warren Lovell. In still fewer cases, they request tests to determine the presence of toxins. But even if every test had been done in Waters’ case, experts agree, the cause of death probably still would have gone undetected.
Oleander Not High on List
“Oleander is not high on the list of common poisons,” said Dr. Fredric Rieders, director of National Medical Services in Philadelphia, the laboratory that finally isolated the oleander in Waters’ tissues. “As a matter of fact, it’s probably nowhere on most lists” of chemicals to be tested in a toxicological analysis.
Although each coroner’s office is different, Rieders said, a common practice in a death of uncertain cause is to do a preliminary analysis looking for 100 or so compounds, including alcohol, drugs such as cocaine, amphetamines, barbiturates and Quaaludes, and common poisons, such as arsenic and strychnine. If those tests prove negative, the examiner may order detailed tests on a gas chromatograph for the presence of certain metals and other subtle compounds.
“That is a very, very comprehensive analysis,” Rieders said. Yet it is still incomplete.
“If I were to sit down and go through the lists and find all the different compounds people die of, I would probably generate a list in the thousands,” one California medical examiner said. “But the gas chromatograph picks up less than 50% of those.”
If those tests fail, “then the hunt starts,” Rieders said.
Game of Roulette
The hunt is actually more like a game of roulette, in which researchers, relying on intuition or suspicion, bet everything on a test for a specific compound. Oleander, for instance, mimics the effects of digitalis, a drug designed to make the heart’s contractions stronger. Too much, however, prevents the heart from relaxing again after a contraction.
Testing for the presence of digitalis would have produced a sign that led to oleander. But since Waters was not taking any heart medication, there was little reason to suspect it. “None of the procedures I have mentioned is likely to detect digitalis or oleander,” Rieders said.
When the researcher takes to the chemical trail, he must be willing to trust his instincts and be confident in the backing of superiors, because the investigation can be expensive and time-consuming. “It can bring an entire lab to a halt,” Rieders said.
The analysis for oleander in Waters’ case cost $1,800 and ultimately involved two outside labs.
The best evidence may lie in symptoms before death or in the condition of the body after death. Some poisons leave an odor that is detectable when the body is opened. Waters was ill for two days before he died, which might have raised questions about what the dead man had consumed in his final hours. There was testimony at a court hearing that poison had been dumped into his drink at a restaurant.
Even though he was only 24, Waters’ obesity was compelling evidence of a potential heart problem. Heart attacks can be accompanied by vomiting, Rieders said.
Medical examiners say cases may trouble them for years. From time to time, an idea may pop into their heads and they will run more tests. Tissues from an autopsy are routinely saved so that future tests can be done. Lovell said Ventura County saves blood for five years in all autopsies, including ones such as the Waters case, where foul play was not suspected, a practice common in the profession.
After reports recently reached police that Sconce had been bragging about the killing, Lovell renewed the investigation. Because he suspected that poison was involved, he sent body samples to a laboratory in Foster City with instructions to test for arsenic, which kills slowly. That test was negative.
Casting about for another idea, Lovell had an epiphany. He suggested that oleander might be a possibility.
In contrast to cinematic portrayals, such flashes of insight by a medical examiner are wrong as often as they are right. When they are right, however, it can make for a forensics success story so dramatic that it hits the front pages and the evening news.
Originally, the Waters case did not seem like a very good candidate for medical detective work. The man was greatly overweight, and when the body was opened up by Dr. John Holloway, who performed the autopsy, it was found to have a fatty liver, often associated with excessive drinking.
‘Cardiac Type of Death’
“It looked like a cardiac type of death,” said Holloway, who now works in Bakersfield. Holloway never ordered backup toxicological tests, and Rieders said he can’t blame him.
“It was perfectly reasonable not to do anything more” than an autopsy, he said.
Looking back on it now, Lovell, the current Ventura County medical examiner, said there was non-medical evidence that should have alerted county investigators. Two weeks before his death, Waters had been physically attacked, indicating he had enemies.
“There should have been more suspicion,” Lovell said.
But even if there had been, there is no certainty that the real cause of Waters’ death would have been flushed into the open.
People with heart failure take an average of 6.8 prescription medicines a day. The more drugs you take, the more likely you are to have a drug-drug interaction. This can put your heart at risk.
These drugs can raise your risk of heart failure or related problems:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription NSAIDs include diclofenac, ibuprofen, indomethacin, and ketorolac. More than 70 million prescriptions are written every year for this type of pain reliever. NSAIDs can boost heart failure odds because they make you retain water and salt, make it harder for your blood to flow, and make it tougher for diuretic drugs (often used to treat high blood pressure) to work.
Diabetes medications. Your body gets rid of metformin through your kidneys, so it isn’t a good choice if your kidneys don’t work like they should. Thiazolidinediones (pioglitazone, rosiglitazone) cause fluid retention and weight gain in people with heart failure and make people who don’t have it more likely to get it. Doctors aren’t sure why, but dipeptidyl peptidase-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) seem to send people with heart failure to the hospital. Never stop taking a medication without your doctor’s OK, though.
Blood pressure medicine. Calcium channel blockers can worsen edema or fluid that stays in your body’s tissues. Central agonists (clonidine, moxonidine) cause changes in the way your body releases hormones that affect your heart.
Other types of drugs that can bring on heart failure include:
- Antifungal medications
- Cancer medications
- Tumor necrosis factor (TNF) inhibitors
A diagnosis of stroke by a non-stroke physician can sometimes be a challenge. Studies have shown that nearly a third to half of our patients referred by general practitioners or emergency physicians as having a suspected stroke are actually exhibiting stroke mimics . These are primarily non-vascular disease processes producing some of the clinical pictures akin to stroke (Table (Table11).
Non-vascular disease processes producing some of the clinical picture akin to a stroke
|A. Nervous system|
|Epilepsy||Todd’s palsy presents with postictal confusion, transient focal motor and sensory symptoms, extra-ocular movement deficits; witness and/or history is important and has a resolving course.|
|Hemiplegic migraine||Headache, impaired consciousness, ataxia and hemi paresis; stereotypical attacks can occur.|
|Infection(meningitis/encephalitis/abscess)||Headache, hemiparesis, altered consciousness; systemic disturbances common|
|Intracranial mass lesions||Subdural hematoma, tumors and abscesses can present with headache and abrupt onset focal neurological symptoms. Fever, weight loss, systemic disturbances are common.|
|Encephalopathy||Can present with altered behavior, cognition, coma, aphasia, focal motor and sensory deficits, homonymous hemianopia and hemi hyperreflexia.|
|Multiple sclerosis||Visual and long tract neurological symptoms; recurrences of neurological deficits in space and time are common.|
|Myasthenia gravis (rare)||Ocular myasthenia and weakness mimic stroke; variable and diurnal fluctuation.|
|B. Non-nervous system|
|Syncope||Usually due to hypotension or arrhythmia; Vertebrobasilar insufficiency can cause syncope.|
|Sepsis||Various neurological presentations, systemic disturbances common|
|Hyponatremia, hyperglycemia, hypoglycemia||Can present with fluctuating neurological symptoms, aphasia, cortical blindness and so on; an initial blood sugar check is vital.|
|Functional disorders||Conversion disorders can have hemiparesis, blindness, speech disturbances; psychiatric history|
|Industrial toxins, drug overdose||Conversion disorders can have hemiparesis, blindness, speech disturbances; psychiatric history|
Among the various neurological conditions mimicking strokes, seizures are the most common at 23% . Postictal neurological deficits (also known as Todd’s palsy) may be difficult to interpret specifically if seizures were unwitnessed. Usually, however, these deficits have accompanying lethargy and, in majority of cases, neurological deficits resolve completely. Also, it is rare (< 1%) that seizures occur as a presentation of stroke, which lends it difficult to differentiate from Todd’s palsy.
Both intracranial (encephalitis and meningoencephalitis) and extracranial sepsis, particularly in elderly patients, can present as a stroke mimic. In these cases, prompt identification of intracranial sepsis is important, as any delay in instituting antibiotic or antiviral treatment may produce grave consequences. In most series, the median delay in diagnosing herpes simplex encephalitis from symptoms to presentation was reported as 5.5+/to 2.9 days . This avoidable delay contributes significantly in obtaining a poor outcome in treating patients. Meanwhile, hemiplegic and ocular varieties of migraine can also manifest as a stroke , but migraine usually has a recurrent stereotype presentation.
Among the non-neurological stroke mimics, syncope is the most common at 23% of reported cases . Hypoglycemia may sometimes present with fluctuating neurological symptoms, and cortical blindness and aphasia have been reported in patients with hypoglycemia .
On the other hand, poisoning seldom presents as a stroke mimic. Due to its limited availability, methyl iodide poisoning is rarely seen in clinical practice, and only fewer than 15 case reports have been described in the literature.
Methyl iodide is a monohalomethane, analytic and organic chemistry reagent used by the pharmaceutical industry in microscopy for refraction and also as a fumigant. The population at risk of methyl iodide poisoning via inhalation are workers at the industry, such as occupational groups like tractor drivers, shovelers, soil sealers and tarp removers involved in pre-plant field fumigation. Bystanders (general population) near the area of fumigation are also at risk. The risk through water absorption and to those in the pharmaceutical industry, however, is not significant.
The exact mechanism of neurotoxicity is still debated on, but glutathione (GSH) depletion through methyl halide metabolism is hypothesized. It is also believed that neurotoxicity develops through the high lipid solubility of methyl iodide and due to the effects of proteins and macromolecules on methylation .
In an acute exposure, methyl iodide is a pulmonary and dermal irritant, causing pulmonary edema and alkali burn. Characteristics of the poisoning are: delay in the onset of symptoms after an exposure to the chemical; renal failure, cerebellar and Parkinsonian symptoms, seizures and coma occurring in severe cases; and psychiatric disturbances like personality changes (sleeping problems, excitation, depression, delusions and hallucinations) and cognitive problems (memory, learning, language and cognitive reaction problems) that can last for months or even years .
A review of the documented cases shows that many patients had experienced chronic neurological syndromes characterized primarily by delayed psychiatric, behavioral and cognitive sequelae . Some patients had purely psychiatric symptoms, while others had neurological deficits as well. Some patients had recovered fully in a course of months, while others had persistent symptoms. Our patient had a fairly rapid onset of neuropsychiatric symptoms presenting like a posterior circulation stroke. The acute onset could have been related to a large accidental exposure via inhalation of the chemical, although the quantity of such exposure is usually difficult to determine. An interesting laboratory marker, although non-specific, is a rise in lipid level as was observed in our patient .
Other poisons that may behave like methyl iodide in its neurotoxicity include monohalomethanes like methyl chloride and bromide, solvents like toluene (glue sniffing) and insecticides like organophosphates. The mechanism of toxicity is different for toluene and organophosphates. Cases of poisoning usually involve those who are part of the production and handling of these chemicals.
The accurate diagnosis of stroke depends on how accurate is our patient history obtained using clinical signs suggestive of an anatomical lesion in the part of the brain supplied by a blood vessel. Recent advances in imaging techniques, such as diffusion-weighted MRI, is accurate in supporting the diagnosis in most of the cases reported. However, there is still no substitute for proper history taking and clinical examination.
A recent study analyzing the factors that help in distinguishing mimics from a stroke showed that impairment in cognition and disturbances in other systems are more likely to suggest a mimic. On the other hand, the exact time of onset, which lateralized focal symptoms and signs, suggested a stroke . Another study suggested that an acute onset of disorders of language function is suggestive of cerebrovascular disease, but if associated with changes in behavior may instead suggest a non-stroke physiology . Other studies have shown that reduced levels of consciousness and normal extra-ocular movements favor a mimic, while abnormal extra-ocular movements, visual fields, hypertension, arrhythmias and vascular risk factors reduce the chances of a mimic . Thus, clinical examination provides us with a strong tool to differentiate mimic from a true stroke.
Pick Your Poison
“Pick your poison” may be the old saying, but most poisoning victims don’t get to pick their poison–someone else does it for them. Arsenic, cyanide, and strychnine are the things we think of immediately as poisons. Most pesticides are poisonous to humans, as are the materials sold as rat or rodent poisons. Probably the most famous character in history to die from poison was Socrates, who drank tea made from the hemlock plant. This plant, which resembles parsley, contains a variety of highly toxic chemicals. The most potent of these is coniine, a neurotoxin that destroys the functioning of the central nervous system.
The list of potentially poisonous substance is very large. Many poisons act slowly or require a large dose to be lethal. Poisoning cases can be accidental or suicides, while other poisoning cases are clearly homicides. Many poisons are neurotoxins, affecting the nervous system in a variety of ways but generally leading to impairment of lung function and suffocation of the victim. Homicide poisoning is often intended to mimic some medical situation, a heart attack or diabetic coma. This makes determining the cause of death difficult. However, the forensic toxicologist, like any other forensic investigator, has a broad base of knowledge and a wide array of chemical analytical methods available to dissect even the most complex poison cases.
Murder Most Foul
That’s how the news media portrayed the murder of Nevada Sate Controller Kathy Augustine by her third husband, Chaz Higgs. Police believed that Higgs gave her a lethal dose of the muscle relaxant succinylcholine. Higgs was the nurse who had cared for Charles Augustine, her second husband, after his stroke. Shortly after Charles’s death, Higgs married Kathy Augustine. At the time she died, she was running for State Treasurer. However, Augustine had been impeached by the Nevada Assembly for misuse of state funds. Higgs, who apparently married her because he thought she would have money and power, decided to murder her.
Being a nurse, Higgs had access to a wide array of drugs. The choice of succinylcholine was a good one because it is not normally tested for in toxicology screens. Succinylcholine is a strong muscle relaxant that paralyzes the respiratory muscles. It is normally used in a hospital to allow the insertion of a breathing tube into the throat of a patient who is still conscious. In higher doses it can paralyze the entire breathing apparatus, and the victim slowly suffocates to death. The autopsy showed that Augustine had died of a heart attack. A small needle mark on her buttocks was overlooked in the initial autopsy. However, investigators were not so sure, and when police searched Higgs’ house they found succinylcholine and other drugs in his possession. Higgs was arrested and eventually convicted of her murder.
From Russia with Love
In November 2006, ex-Russian spy Alexander Litvinenko was fatally poisoned with Polonium-210, a highly radioactive material. He survived for several days and suffered greatly during the time. Areas of the hotel where litvinenko stayed and a sushi restaurant that he frequently visited also showed high levels of radioactivity. He would have to ingest a relatively large amount of Polonium-210 to cause fatal poisoning. The material could have been placed in his food on several occasions. However, Scotland Yard officials are not sure how the radioactive material actually entered his body. It is the first time that a radioactive agent has been used as a poison in the UK.
In 1986, an autopsy performed in Japan by Dr. Ono Yokichi led to no clear cause of death, until a toxicology search revealed small amounts of an alkaloid toxin, aconite. Aconite is a plant indigenous to many parts of the world. All parts of this plant are poisonous, but the root is the most highly toxic. A half tablespoon of a tincture of aconite root placed in a bottle of whisky is enough to kill a very large man. A tincture is an alcohol extract of the material. Placed in a drink, the alcohol goes unnoticed. Aconite has been called “the perfect poison to mask a murder.” It can be detected only by sophisticated toxicology analysis using equipment that is not always available to local forensic labs. In some poorer cultures is called the “Queen of Poisons.”
Maryann Neabor of Shamog, NJ, says “she just wanted to make her brother-in-law sick” when she fed him pineapple smoothies laced with antifreeze back in 2004. The jury saw it as aggravated manslaughter. Antifreeze is primarily ethylene glycol, a chemical with a resemblance to sugar which is why it is sweet to the taste. This sweetness allows it to be put into fruit drinks and other foods and go undetected by the person consuming them.
In 1993, Julia Lynn Turner’s husband Maurice, a Georgia police officer, died of sudden and undetermined ailment that was decided to be a heart attack. Soon after she moved in with Randy Thompson, a sheriff’s deputy and firefighter, and things were fine–for a while. They had two children and then the relationship went on the rocks. In 2001, Randy Thompson took ill and died, also from a suspicious ailment. Both men had large life insurance policies which were to be paid out to Julia Lynn. Both had died of kidney and heart failure, so investigators were suspicious. Forensic investigation suggested the men had been poisoned, but with what? Often a poison is no longer present in the victim’s body, because the body metabolizes it. The forensic toxicologist must search for metabolic products of the poison, and in some cases there may be more than one.
When the husband died in 1993, the medical examiner had wondered at the time about the presence of high amounts of calcium oxalate crystals in various tissues from the body. In 2001, the forensic toxicologist found similar results and realized that calcium oxalate forms in the kidneys from oxalic acid. Oxalic acid is a major metabolic product of the metabolism of antifreeze.
But how could this woman get two full grown men, both law enforcement officers, to consume antifreeze? Julia Lynn was a creative poisoner–she laced lemon-lime Gatorade with the antifreeze. The sweet taste and green color were a perfect match. However, Julia Lynn became even more creative, including the antifreeze in lime Jell-O, and even in chicken soup. In May 2004, a jury found Julia Lynn guilty of malice murder in the death of both men.
Ricin is 500 times stronger than cobra venom and 1,500 times more deadly than cyanide. The equivalent of a grain of salt would be enough to kill an adult, and a fatal dose takes around three days to kill the person affected.
The health service is on alert after traces of the poison were discovered in a flat in London and six men were arrested as terrorist suspects at the weekend.
Ricin-related symptoms include fever and nausea, which progresses to severe abdominal pains and fits. Victims die from multiple organ failure and there is no known antidote or vaccine.
The bioxtoxin works by shutting down protein synthesis in the body and takes four to eight hours to incubate after being eaten or inhaled, so a victim would not necessarily realise they were in potential peril at the moment of contact.
The poison inhibits protein synthesis and has widespread toxic effects on the body, which include damage to most organ systems and a combination of pulmonary, liver, renal and immunological failure which may lead to death.
The exact early symptoms depend on the route of exposure. In all cases, fever, gastrointestinal upset, and coughing will be amongst the first effects noted – but of course these are symptoms of any number of benign ailments.
Absorption via inhalation as a result of exposure to the toxin in aerosol form leads to particularly serious lung damage including adult respiratory distress syndrome. Flesh eating lesions develop in the airways and cause respiratory and heart failure.
Swallowing ricin causes gastroenteritis, bloody diarrhoea and vomiting. People poisoned by a large dose could die of shock after massive fluid loss through severe diarrhoea. Effects on the central nervous system have been reported to include seizures.
The symptoms are similar to the first world war gas phosgene, or more modern nerve gases such as sarin, developed in the second world war, and used by the Aum cult on the Tokyo subway system in 1995 in an attack that left 12 people dead.
Yesterday, police urged the public to be vigilant and “alert but not alarmed”, presumably because greater quantities of the deadly biotoxin could still be in circulation. Scotland Yard sources say it is possible that greater quantities of ricin have been moved and that associates of the suspects could still be at large.
However, nobody has yet to be discovered to have recently come into contact with ricin, and the police stress there is no specific intelligence that there have been any attacks or that any are imminent. Anyone with concerns they may have come into contact with ricin is advised to contact their doctor. NHS Direct staff have also been briefed with advice about the poison.
Signs of a medication or drug overdose
Medication overdoses are the most common type of poisoning in the UK.
If someone takes too much of a medicine, they may experience symptoms specific to the medication taken, as well as the more general symptoms listed above.
Some of the most common medicines or drugs involved in cases of poisoning are listed below.
Paracetamol is a widely used over-the-counter painkiller.
Specific signs of paracetamol poisoning include:
- yellowing of the skin and the whites of the eyes (jaundice)
- loss of co-ordination
- low blood sugar (hypoglycaemia), which can cause symptoms including sweating, trembling and irritability
Aspirin is an anti-platelet medicine that thins the blood and reduces the risk of blood clots forming.
Specific signs of aspirin poisoning include:
- rapid breathing
- ringing in the ears (tinnitus)
- temporary hearing loss
Tricyclic antidepressants are used to treat depression, as well as a number of other mental health conditions, such as panic disorder and obsessive compulsive disorder (OCD). Some types of tricyclic antidepressants can also be used to treat nerve pain.
Specific signs of poisoning with tricyclic antidepressants include:
- dry mouth
- large pupils
- irregular or rapid heartbeat
- low blood pressure, which can cause symptoms including lightheadedness and fainting
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a newer type of antidepressant that are also used to treat mental health conditions such as OCD and anxiety disorder.
Specific signs of SSRI poisoning include:
- feeling agitated
- tremor (shaking)
- uncontrolled movement of the eyes (nystagmus)
- severe muscle tension
Beta-blockers are used to treat a number of conditions that affect the heart or blood, such as high blood pressure (hypertension), angina and heart failure.
Specific signs of poisoning with beta-blockers include:
- low blood pressure, which can cause symptoms such as lightheadedness and fainting
- a slow heartbeat (below 60 beats per minute)
Calcium-channel blockers are used for the treatment of high blood pressure and angina.
Specific signs of calcium-channel blocker poisoning include:
- feeling agitated
- low blood pressure, which can cause symptoms such as lightheadedness and fainting
- chest pain
- a slow heartbeat (below 60 beats per minute)
Benzodiazepines are a type of tranquiliser, often used on a short-term basis to treat anxiety and sleeping problems (insomnia).
Specific signs of poisoning with benzodiazepines include:
- co-ordination and speech difficulties
- uncontrolled movement of the eyes (nystagmus)
- shallow breathing
Opioids are a type of stronger painkiller used to treat moderate to severe pain. They include codeine and morphine, as well as the illegal drug heroin.
Specific signs of opioid poisoning include:
- small pupils
- shallow breathing
If you take too much of a stimulant-like drug, such as cocaine, amphetamine, crack or ecstasy, overdose signs can include:
- anxiety and paranoia
- restlessness or agitation
- high temperature
- chest pain
- rapid breathing
- irregular or fast heartbeat
If you smoke (or eat) too much cannabis, you may experience the following symptoms:
- numbness in your arms and legs