SLE312 Toxicology – Report assignment Marks – 40% Length – 2,000 words for the report Due – 5.00pm Friday 26th May 2016 (via Dropbox) This assessment task requires you to work individually to apply your understanding of toxicology, to analyse a toxicological event/scenario and produce a technical report. This assignment is meant to assist you to consolidate your knowledge of toxicology in the context of a case study. It will require you to find toxicological information and to interpret according to principles that you have learned in this unit. You are required to:  choose one scenario (from those attached), and analyse the data/information provided;  nominate the audience that the report is directed to;  research current literature;  create a professional written technical report, meeting industry standards for a professional audience; and The elective topics and the core topics are to be used as sources of information and important toxicological principles. It is important that you do not just state information – you must analyse/discuss/comment on data information you use and relate back to the specific scenario question or task – you are providing expert advice so need to analyse the information to provide advice to the stakeholder. General Instructions The final topics in this unit are designed to provide background information on a number of applied areas of toxicology. You need not study all of these but should use them to help you understand these professional areas and to consolidate your knowledge of toxicology. For your final assignment, there are four case studies to choose from. You should select just one of these to complete. Whichever you chose, it will provide the same opportunity to bring together the basic principles of toxicology introduced throughout this unit and to learn how to apply this knowledge to a real world problem in a professional context. Report The assignment must be submitted as a report (2,000 words not including references) written for a specified audience and purpose (see the details in the relevant cases studies). Please read the specific instructions for each case study. The report should have the following section headings and relevant content.  Your name and student number  Case Study Title  Abstract Write a very short summary of your report  Suspected toxic substance Give the chemical and common name (if any) of the substance and CAS number (CAS Registry Numbers are unique numerical identifiers assigned by the Chemical Abstracts Service to every chemical described in the open scientific literature).  ADME List the possible routes of uptake of this substance, the relevant metabolites if any, and the routes of excretion. Indicate the half-life (or lives) of the substance and relevant toxic metabolites in the body, and indicate if it can accumulate in the body.  Toxicology of the suspected substance Summarise the toxic effects of the substance, the target organs and the toxic mechanism. Give the acute and toxic doses (eg LD50, LC50, SHD, chronic toxic doses as relevant). Indicate the time course of the effects – for example are they delayed and by how long.  Conclusion Does the information support the details in the case study or not  Other Information Provide specific information suitable for the specialist toxicologists relevant to the case study you chose (see the specific instructions for each case study).  References All information included in the report must be properly referenced. Any quotations must be identified in italics or quotation marks and the source included in the references. Note that Case Studies 3 and 4 have special instructions in regards to the target audience. Marking Marks will be assigned according the following general scheme: Component of the assignment Maximum Marks Abstract 10% Obtaining relevant information relating to the headings above 20% Correct referencing of all information obtained (this is essential) 10% Analysing/commenting/interpreting the information obtained in the context of the case study 35% Correctly applying the concepts that you have learned in this unit 10% Writing concise notes that correctly summarise the information 10% Conclusion as to your advice 5% Submission The assignment must be submitted into the unit Dropbox by 5.00pm Friday 26th May 2017. Case Study 1 FORENSIC TOXICOLOGY Specific Instructions: Write a report using the format described in the general instructions with the purpose of briefing Forensic Scientists of the features of Paraquat poisoning that they might encounter in their professional work. For this professional group, other important information relates to how they would identify a suspected case of poisoning by this substance. Metropolitan News-Enterprise - Tuesday, July 17, 2001 High Court Upholds Death Sentence in ‘Poisoned by Love’ Murders By KENNETH OFGANG, Staff Writer/Appellate Courts The state Supreme Court yesterday unanimously upheld the death sentence given a Fresno man convicted of killing his mother and two wives by poisoning. Steven David Catlin was sentenced to death by Kern Superior Court Judge Lewis E. King in 1990 for the 1984 murder of his mother, Martha Catlin, after being convicted of her murder and that of his fourth wife, Joyce Catlin, which occurred in 1976. The case was the subject of the 1993 television movie “Poisoned by Love: The Kern County Murders.” Steven Catlin was portrayed by Harry Hamlin, better known as one of the stars of the television series “L.A. Law.” The two crimes were tried together under an information filed in 1985, but the death penalty did not apply to the murder of Joyce Catlin because it occurred before California reinstated the death penalty. Catlin was tried separately in the 1984 death of his fifth wife, Glenna Kaye Catlin, and convicted in 1988. Catlin’s court-appointed appellate attorney, Horace Freedman of Culver City, argued that it was unfair to prosecute his client in Joyce Catlin’s death because two possible witnesses had died in the interim. Had he not been tried simultaneously for Joyce Catlin’s murder, Freedman further argued, he might not have received the death penalty for killing Martha Catlin. In any event, Freedman contended, the two murders shouldn’t have been tried together. Unknown Microorganisms Joyce Catlin died in a Bakersfield hospital three weeks after being admitted with flu-like symptoms. The death certificate listed the cause of death as acute respiratory failure to due unknown microorganisms, although paraquat poisoning was suspected. Paraquat is a herbicide used to control weeds. Experts testified that tests capable of disclosing the presence of the substance more than 72 hours after administration didn’t exist in 1976. After Martha Catlin died in 1984, doctors concluded she died of paraquat poisoning. After police interviewed doctors who treated and autopsied Joyce Catlin, Steven Catlin was charged with both murders. He was also convicted in Monterey Superior Court of the murder of Glenna Kaye Catlin, who also died of paraquat poisoning, and sentenced to life imprisonment without parole, prior to the Kern County trial. Prosecutors at the Kern County trial presented evidence of all three murders, although jurors were not told until the penalty phase that Catlin had been convicted in the Monterey case. They were then told to consider the prior-murder-conviction special circumstance along with the financial- gain, murder-by-poison, and multiple-murder special circumstances they had already found true. Financial Motives Prosecutors presented evidence that Catlin had financial motives for killing the women—he was the beneficiary of life insurance policies on his wives and the sole beneficiary of his mother’s estate. There was also testimony that he had expressed fear his mother might disinherit him and leave her estate to charity instead, and that she had disapproved of his multiple marriages and divorces. There was also evidence that Catlin—who worked in agriculture in the 1970s—had access to paraquat and had told people that it could be used to poison someone. Police obtained a bottle of paraquat, with a 1977 date marked on it, from a garage that Catlin shared with Glenna Kaye’s father. Prosecutors also presented testimony from a jailhouse informant that Catlin asked for assistance in intimidating his third wife—who had persistently told authorities that Catlin murdered the three women—and that Catlin had admitted the killings. In the penalty phase, there was evidence that Catlin had assaulted his first wife in the 1960s. Catlin testified that he never killed anyone, didn’t have access to paraquat, and never told anyone about the substance’s deadly properties. Chief Justice Ronald M. George, writing for the high court, said there was no error in trying Catlin for the murder of his fourth wife, or in joining that charge with that of murdering his mother. Catlin didn’t show that the deceased potential witnesses—employees of the Kern County Coroner’s Office at the time of Joyce Catlin’s death—would have given favorable testimony, the chief justice said. Nor was Catlin prejudiced by his own loss of memory over the intervening nine years, the chief justice said, since there were no significant details that he might have forgotten. “Moreover, the delay in prosecution was justified,” the chief justice went on to say. “Because of limitations in forensic science and because of the manner in which Joyce’s tissue had been preserved, it would have been extremely difficult or impossible to make out a case against defendant at or near the time of the murder.” A joint trial was appropriate, George said, because of the similarity between the two murders. And the other- crimes evidence concerning Glenna Kaye Catlin’s murder was admissible for similar reasons, the chief justice said. “Paraquat poisoning is rare, and its occurrence with respect to two close relatives of one person is unlikely to be a matter of chance or to be the result of a spontaneous impulse,” George wrote. “When evidence of a third instance of the same type of poisoning is introduced, as it properly was in the present case, the inference regarding a common design or plan becomes very strong.” The case is People v. Catlin, 01 S.O.S. 3394. Case Study 2 ENVIRONMENTAL TOXICOLOGY Specific Instructions: Write a report using the format described in the general instructions with the purpose of briefing Environmental Scientists and Local Government Environmental Health Officers of the possible effects of environmental lead exposure. For these professional groups, other important information relates to how environmental lead exposure can occur and its possible impact on the health of populations. Report proves lead poisoning legal cases: Lawyer Courtney Trenwith, September 17, 2010 Scientific evidence showing lead poisoning caused the permanent retardation of three Mt Isa children would boost their legal cases, a lawyer says. An international expert found the children were suffering irreversible brain damage and lead poisoning was the only neuro-developmental risk factor in their background. Slater and Gordon lawyer Damian Scattini, who represents the children, says the reports prove a crucial element of the legal case against mining giant Xstrata, its subsidiary Mount Isa Mines Ltd, Mt Isa City Council and the state government. Xstrata has maintained the lead was naturally occurring in the ground and not a result of its mining. Bethany Sanders, 4, and Sidney Body, 5, recorded blood lead levels well in excess of the international safety limit. Sidney, who recorded the worst lead poisoning of all affected children, had a blood lead level of 31.5 micrograms per decilitre. Bethany’s level was 27.4 micrograms per decilitre. The National Health and Medical Research Council states Australians should have a blood lead level below 10 micrograms per decilitre. Mr Scattini said the results of a third child, who has not been named, were similar. US neuroscience expert Theodore Lidsky, of City University in New York, found lead poisoning was the only explanation for the children’s brain damage. “The reports confirm the parents’ worst fears: that their children are mentally retarded with a history indicative of brain injury,” Mr Scattini said. “Professor Lidsky concludes that lead poisoning is the only neuro-developmental risk factor in their background. “Their brain injury is permanent, and functional recovery will not occur as they grow older. Their educational prognosis is grim.” About 150 children aged one to four years were tested for lead poisoning in 2008 following concerns the mine was emitting damaging levels of the metal. Eleven per cent of children had dangerously high levels of lead in their blood stream. A report to be released later this year is expected to say that figure has dropped to five per cent. Queensland Health led an education campaign urging parents to wipe down benchtops, clean regularly and maintain a healthy diet. Mr Scattini said authorities could no longer ‘‘pretend’’ that wiping down dusty surfaces with a damp cloth would protect children in the town. “Lead has had a devastating effect on the children we represent – and many, many others,” Mr Scattini said. “It is time that Xstrata, Queensland Health and some locals in Mt Isa faced up to reality – the lead in Mt Isa is harming the town’s children. “The parents who have stood up on this issue should be applauded for their courage, rather than being ostracised for their supposed disloyalty to the town.” Mr Scattini is representing eight children suing over lead poisoning. Five claims so far have been delivered. Reports for the other two children are still in progress. Mr Scattini said the scientific evidence was the last step in forming the cases and they would now go to a compulsory conference. He expects the conference to be held by the end of the year. "We wither resolve it at that conference or we move on to court," Mr Scattini said. Case Study 3 NATURAL PRODUCTS Specific Instructions: Write a report using the format described in the general instructions with the purpose of briefing Scientists in the Department of Primary Industries of the possible toxic effects of hemlock (which does in occur in Australia). For this professional group, other important information relates to the occurrence and identification of Oenanthe crocata1 and its dangers. A case of multiple poisoning: Case report - Emergency Medicine J2002;19:472-473 doi:10.1136/emj.19.5.472 C Downs, J Phillips, A Ranger, L Farrell A group of eight young adults who were on holiday in Argyll collected what they thought were water parsnips from a small stream. The roots were cleaned, chopped, and added to a curry. All consumed the curry, but the majority of the group only had a small amount of the root, which was easily identifiable in the curry, partly because there was some doubt regarding its nature and partly because of its bitter taste. Early the next morning, 10 hours after ingestion one of the group had a witnessed grand mal seizure lasting about five minutes. He was taken to the community hospital and was in a post-ictal state. No connection at this point was made with the ingestion of the plant root the night before. Gradually over the course of the next four hours a number of the group became unwell and nauseated. During this time four of the group consumed the left overs for lunch. One of these individuals, subsequently become increasingly unwell, nauseated, and began to vomit. He had a witnessed grand mal seizures lasting about three minutes. On arrival at the emergency department this person was conscious but vomiting and experiencing visual hallucinations. The patient was agitated, tachycardic, but blood pressure and oxygen saturation were within normal limits. He was hyper-reflexive with dilated pupils, but there were no focal neurological signs. He had one further subsequent grand mal seizure controlled with intravenous diazemuls. The other patients all had varying degrees of nausea, vomiting, lethargy, sweating, and low grade fever. Initially it was uncertain from the description as to the identity of the poisonous plant. The community hospital that they were admitted to serves a rural area of Argyll. The police were able to take an asymptomatic member of the group to the stream to recover a further plant. The police knew of a local botanist in the area who was able to positively identify the specimen. The main toxic constituent of hemlock water dropwort is oenanthotoxin. The concentration of this poison in the plant roots is highest in winter and spring and ingestion of very small amounts may prove fatal. 1 Note that some literature may refer to Conium Maculatum – if this is what you find, then you use it and mention it in your report. Case Study 4 CLINICAL TOXICOLOGY Specific Instructions: Write a report using the format described in the general instructions with the purpose of briefing Clinical Toxicologists working in emergency medicine of the possible toxic effects of Aspirin (acetyl salicylate). For this professional group, other important information relates to the identification of aspirin toxicity and its treatment. Management of salicylate toxicity Author: Robert E. Sallis Family Physician, Date: Jan, 1989 A 44-year-old woman came to the emergency department in moderate respiratory distress. For two days, she had experienced mild respiratory difficulty and shortness of breath. Intermittent vertigo and tinnitus had been present for three days, and her children had complained to her that "she was getting deaf." Her past medical history included sciatica and bipolar disorder, which was treated with lithium. For her sciatica, the patient had been taking up to 16 aspirin tablets (325 mg each) per day, along with ibuprofen, 400 mg three times daily, and indomethacin (Indocin), 25 mg three times daily. On admission, the patient was awake and alert. She was in moderate respiratory distress and appeared restless and diaphoretic. Her temperature was 37oC (98.6oF); blood pressure, 110/60 mm Hg; pulse, 80, and respirations, 30. Diffuse rales were heard bilaterally. Heart rhythm was regular; there were no murmurs or gallops. Abdominal and neurologic findings were normal. There is debate regarding the maximum time interval after ingestion in which gastric emptying should be performed. Because salicylates delay gastric emptying, emesis or lavage may be of value up to 12 hours after ingestion. Emesis is induced with syrup of ipecac (15 mL in children and 30 mL in adults, taken with water or soft drinks). Gastric lavage is performed through a large-bore orogastric tube using normal saline. Lavage is continued until the returning contents are clear. It may be necessary to perform lavage with warm water to dissolve concretions of salicylate in the stomach. Activated charcoal acts by adsorbing to particles of salicylate in the gastrointestinal tract, thus preventing their absorption.(9) The efficacy of charcoal depends on how soon after ingestion it is given. Charcoal is of questionable value when it is given later than one to two hours after ingestion. Alkaline diuresis, using fluids containing sodium bicarbonate, is the key component in the treatment of salicylate toxicity. It should be considered for all patients whose salicylate levels exceed 35 mg per dL (2.50 mmol per L). In general, hemodialysis (peritoneal dialysis or hemoperfusion) is indicated for severe toxicity that is not responsive to alkaline diuresis. The Done nomogram is a widely used tool for estimating the severity of salicylate toxicity.(12) It is of value only in acute intoxication and when the time of ingestion is known.(1) In addition to the initial salicylate level, the level should be determined at least six hours after ingestion. Final Comment Salicylate toxicity is a serious and complicated problem. Because of its frequency, family physicians and other primary care physicians must be knowledgeable about its management. Poison control hotlines should be utilized as a source of up-to-date information and clarification. Most important, physicians need to think of the diagnosis; it can be confirmed quickly using urine salicylate screening tests. Next, physicians of extensive interstitial fluid consistent with adult respiratory distress syndrome. The patient was given intravenous fluid therapy and bicarbonate. While still in the emergency department, she became progressively more dyspneic and ultimately required intubation prior to her transfer to the intensive care unit. Vigorous diuresis was maintained, and the salicylate level dropped in four hours to 61.7 mg per dL (4.45 mmol per L). Because the patient's condition appeared to have stabilized, dialysis was not performed. Although the salicylate level continued to decline over the next few days, the patient's respiratory status gradually worsened. Three days after admission, the patient was started on antibiotic therapy for fever and increasing yellow secretions from the endotracheal tube. Her pulmonary status continued to worsen and on the fourth day of hospitalization, she was noted to have a creatine kinase level of 547 U per L (9.12 ukat per L) with 7.8 percent (0.8) MB fraction. There were no significant electrocardiographic changes. On the fifth day, the patient suffered a cardiac arrest and died.