Evil Readers! Remember last time I posted a Dr. Dina Supplemental I told you that there would be another involving poisons? Well, here you are. Those of you familiar with this blog know that there has been for the past couple years a random collection of posts called the Ask Dr. Dina Series, focusing on the medical mayhem writers get up to. Regular reader and all-around awesome (evil, of course!) Real Live Animal Doctor Jes Adams of Wayward Creatures Relief Agency has returned, this time with some gospel about using poisons in your work. LISTEN TO HER AND DO AS YOU’RE TOLD.

NOTE: This topic contains some graphic descriptions of Scary Things, so if you’re sensitive to that type of thing, might want to avoid this post.

Without further ado, I give you Dr. Jes. (AKA Dr. Draggon) Preach, sister!

Disclaimers: I am not an author. I know it, and have no illusions that I’d be better at it than any of you. I am, however, actually a doctor (veterinary medicine), an avid reader, and a compulsive proofreader and pedantic. It irks the crap out of me how often easily obtainable medical information is ignored or misrepresented in books, on television, and in movies. So I’m sending our beloved Gothic Goddess some supplementals for her Dr. Dina column. [Gothic Goddess: MUCH APPRECIATION, DOCTOR JES! YOU ROCK!]

Today’s rant topic: Poison!

Scary. Please don’t be scared to research it before you write it though. Realistic effects of toxins make a much more believable story, and help keep people like me from huffing and tossing the book in the “nope” pile. In particular keep in mind the following:

Effects (gastrointestinal vs. neurologic for instance)
Time to onset of signs (it almost certainly is NOT 1-5 minutes),
Duration of effect, and
Treatment options.

Now, the majority of my knowledge is veterinary, so the following summaries will be based on that experience, but frankly, humans are just another animal when most chemicals are concerned. There are some fascinating exceptions, like acetaminophen in cats or xylitol [GG: found in sugar-free gum and other things in place of sugar] in dogs, but those are unlikely to come up in your writing. If they do though, I beg you to get them right!

Now onto the informative bits:

Rat poison – Ah, the good old “rat poison in the coffee” routine. Things you should know about this group of lovelies. That whole “odorless, flavorless, dissolves instantly in liquid” thing? Yeah, I love The Princess Bride too, but if you’re trying for realism, that’s not where you should look. Most rodenticides are, obviously, intended to be eaten by rodents. That means they come in a grain (wheat or corn) -based block or pellet, and are flavored to be attractive, often as something like peanut butter. So if you dump this in somebody’s tea, it will be gritty or chunky, and taste like someone put oatmeal and nuts in it. Don’t expect that to go unnoticed. There are two popular types of rat poison, so pick which one you’re using, and stay consistent:

Group 1: anticoagulants. This is d-CON, and most of the middle-to-older rodenticides of other brands. Anticoagulants will not cause gastrointestinal signs, and they do not have a fast onset. They cause excessive and potentially fatal bleeding 4-7 days after ingestion. That’s horrible, slow, painful internal bleeding from whatever tissue happens to get bumped, so it might be into the stomach (and here you’ll get vomiting of blood), but it is just as/more likely to be into the abdominal cavity, or the joints (OUCH), or the gums, the whites of the eyes, the interior of the eye, the brain, the lungs…the possibilities are myriad. Duration of effect is until you get a transfusion, or 2-3 days, at which point you die. Treatment if you know of ingestion immediately is inducing vomiting. Any time before onset of signs, start massive doses of Vitamin K for 3 -4 weeks. Treatment after onset of bleeding is transfusion + Vitamin K.

Group 2: neurotoxins. Tom Cat brand and a few others are moving away from anticoagulants, because they’re awful and people understandably hate them and don’t want to buy them. That’s great. Unfortunately, there is really no kind way to poison wildlife, and neurotoxins are still decidedly unpleasant, just in a different way. Bromethalin is the culprit here, and it causes “intra-myelin fluid accumulation, leading to long nerve demyelination and intra-myelin cerebral edema.” In layman’s terms, that means it strips the insulating lining off your nerves, and makes your brain swell. You may guess this gets unpleasant, and indeed, somewhere between 4 and 36 hours after ingestion of a large dose, you’re looking at tremors, seizures, depression, and death. If you get a smaller dose, you miss out on the fast and relatively easy death, and instead get slower onset (up to 7 days after ingestion) of paralysis, with eventual respiratory collapse and death when your diaphragm stops working and you suffocate. Ain’t no antidote for this, sorry. If you know you ate it within a couple of hours of doing so, inducing vomiting is your best bet. Failing that, symptomatic treatment and drinking a metric buttload of activated charcoal every 6-8 hours for 2-3 days (because this baby is too stubborn for one try – it cycles between intestine and liver repeatedly before full elimination!) and lots of hoping is your plan. I don’t know about humans, but in cats you sometimes get through all this just to have them suddenly die 2 weeks later anyway, when their liver fails.

Handy tip – want to vomit? Chug hydrogen peroxide. Easily available, cheap, effective, and a lot safer than salt. The more you know, right?

Antifreeze – Ethylene glycol toxicity is a story of metabolic wonders. To start with, it actually tastes pretty freaking sweet. Straight up, it’d be easy to slip into a drink. However, most antifreeze mixes sold for use in cars have a bittering agent to try and prevent animals from drinking it, so pick your brand carefully. Car mixes also usually have a fluorescent dye, to make detecting radiator leaks easier – so you should make a habit of shining your drinks with a UV light if you drink with people who might try to off you like this.

Ethylene glycol in and of itself is not toxic. It hits the kidneys, gets excreted in the urine, and you go on with your life. However, the liver enzyme alcohol dehydrogenase efficiently metabolizes it into two different toxins, and does so before it gets to the kidneys for excretion. Those toxins then reach the kidneys and crystallize with calcium, leading to kidney failure. Signs of toxicity start within an hour of ingestion, sometimes sooner with a high dose. First signs are, well, drunkenness. Just like with alcohol ingestion, degree and duration of drunkenness depends on dose. Just like with alcohol, that goes away, and you get a hangover. Then that goes away, but unlike alcohol, the pain is just starting, because then you get kidney filter function and your pee fills up with crystals. What can you do about this? Well, if you know about it in the initial stages (within a couple hours of ingestion, before or during the drunkenness phase) you try to avoid the liver metabolism by giving alcohol dehydrogenase something else to do – the most straightforward option here is alcohol.

So yes, I am telling you that the treatment for this poison is to pick your poison. Do shots. Get roaring-effing-plastered like your life depends on it. No, I’m not kidding. Doctor Draggon prescribes shot of vodka followed by cup of water, repeat, repeat, repeat, repeat, repeat. Alternately, you can go to a hospital and they will put Everclear in your IV bag, and monitor your kidney values, which is safer but not as macho.

Lead poisoning – super fast and you have to eat lead to be poisoned by it. Metal sitting in your muscles or under the skin does NOT cause lead poisoning; just don’t even go there. You can live for decades with that shrapnel, and have all kinds of fun at the metal detector.

Arsenic (Lace is optional) – Arsenic is a long-time favorite of poisoners, because it’s pretty easy to come by (it’s a natural substance found in soil and groundwater, so keep that in mind the next time someone tells you that “natural” = “healthy”) and quite effective. Acute poisoning (large dose/short time) causes vomiting, diarrhea, bloody urine, and progresses to death, often by way of seizures. Chronic poisoning (repeated small doses/long time) causes all kinds of fun things, including several different cancers, and multi-organ failure. It also causes Aldrich-Mees’ lines, or white bars in the finger and toe nails. These aren’t painful or anything, just interesting and can be an indicator of exposure. Unlike a lot of other toxins, arsenic doesn’t have to be swallowed – you can actually absorb it through the skin, so repeatedly mixing it into your victim’s hand lotion is an option.

“Roofies” – Rohypnol is an increasingly common poison in media lately, and sadly often misrepresented. Flunitrazepam is in the same class of drugs as Valium (diazepam) and is used medically for anxiety and seizure disorders (in non-US countries, anyway). Overdoses cause extreme lethargy, paralysis or loss of consciousness, and often short-term memory loss. Great for kidnapping, but it’s not instant. For crap’s sake people, please don’t fall into that BS of “one sip of roofied beer, and he’s out in under 3 minutes.” The only way you get unconsciousness that fast is by injecting it directly intravenously, and that’s a bit difficult to manage at the bar. It actually takes about half an hour to start getting significantly loopy, and peak effect is 2-3 hours after ingestion. It doesn’t wear off quickly either, so don’t be thinking your protagonist will get useful interrogation an hour after spiking somebody’s punch – they’ll probably be out of it for at least 6-8 hours, maybe longer.

Ether/chloroform – And speaking of knocking someone out for kidnapping, if you’re going to pull out the old “ether soaked rag” tactic, be prepared for a fight! Gas inhalation induction takes 5-10 minutes of breathing a significant percentage of the anestheticn which means you’ve got to hold that rag over the mouth and nose, without letting up, for at minimum five minutes (that’s assuming a small person who increases their respiratory rate by struggling). That old Internet scare thing that freaked Grandma out about people offering “perfume samples” that were actually ether and kidnapping people? Right out malarkey. We do still use ether in veterinary medicine – as an adhesive remover. I have personally stood in a horse stall scrubbing bandage adhesive off surgery sites for 20-30 minutes at a go with ether-soaked rags, and the most pronounced effect was a mild headache, because I was breathing room air, not inhaling through the rag. Besides slow onset, another reason we don’t use either ether or chloroform for medical anesthesia anymore is they’re not very safe – so your poor character who’s been kidnapped a dozen times? They probably should get their liver function checked out. And that old man your villain wants to drag off and threaten for his millions? He might just die instead of waking up to tell where his secret safe is.

One final note – testing!. “Get me a toxin screen, STAT” is not a thing in the real world of actual medicine. Sorry. You need to know what you are testing for, you need to submit proper samples, and you need to give the lab time to work. Specific example – testing for anticoagulants can be done on blood or liver tissue, and takes 5-7 days. Yes, days; not hours, certainly not minutes. Samples have to be sent to a special laboratory and not done in your general practitioner’s office too. You really want to test for all possible toxins? You better be sending about a pint of blood in several different tubes (all those pretty colored tubes have different chemicals in them, which preserve the blood in different ways, or let it clot and separate, and different tests require different samples), chunks of liver and kidney, stomach and bladder wall, stomach contents or vomit, and ideally a brain tissue sample. You should also send a couple thousand dollars along with that, and expect to have results trickling in over the next 2-4 weeks. That’s at a medical lab, by the way – most police/government/forensic labs are so backed up you will probably be looking at months-long turn-around times unless you can pull some serious rank. Sorry, folks, but CSI is full of it.

— Dr. Jes (AKA Dr. Draggon)

And there you have it, folks! I couldn’t have written a better post on the subject myself. Thank you, Dr. Jes, for your time and educating the writing community on another set of Stupid Writer Tricks! You’re welcome on our blog anytime!