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Re: disease & poisons

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  • robj3.geo
    ... the old ... of ... First error on a quick scan:- Heroin is only twice as potent as morphine (it s two morphine molecules joined together). Hence its other
    Message 1 of 12 , Oct 1, 2002
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      > Chris Tutty wrote:
      > > A while ago I typed up some of my notes onto the web. When I
      > > get the time :-) I'd like to add extracts from this group and
      the old
      > > world-design archives. Anyway, there's a document with all of
      > > my poison notes at
      > >
      > > http://pages.quicksilver.net.nz/chris.tutty/poison.htm
      > >
      > > It's just a long list of effects and sources of drug and poisons
      of
      > > different kinds.

      First error on a quick scan:-
      Heroin is only twice as potent as morphine (it's
      two morphine molecules joined together). Hence its other name,
      diamorphine! Clinically, it's a very useful drug (used more often
      than morphine in Britain with acute pain, for ex).

      Some thoughts on poisons and diseases:-
      Useful parameters for modelling either are as follows.

      i. Route of administration/vector of transmission
      ii. Potency (dose required to get an effect)/infectivity (ease of
      transmission)
      iii. Onset time/incubation period
      iv. Systems attacked (?attribute penalties)
      v. Lethality/virulence (LD50 doesn't necessarily correlate with
      potency!)


      I'll post some notes I scribbled up for Traveller a long time
      ago to the file list when I get a chance.


      Robert O'Connor
      medico, gamer
    • Frank Sronce
      Thanks for the help, folks! Okay, so I have kind of a revised system. The disease or toxin gets: a potency rating (how difficult the resistance check is) a
      Message 2 of 12 , Oct 1, 2002
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        Thanks for the help, folks! Okay, so I have kind of a revised system.

        The disease or toxin gets:

        a potency rating (how difficult the resistance check is)

        a time interval (how long between checks)

        an onset time (how long of a delay before you start making resistance
        checks, usually the same as the time interval)

        a description of how lethal it is (non-lethal, normal or deadly)

        a description of any special side effects (generally triggered as soon
        as you fail the first resistance check)

        Diseases may also have a contagion rating, which you have to resist to
        avoid catching it if you're exposed to it. Sometimes this is a lot
        harder or easier to beat that the actual potency. An illness might not
        be very transmittable, but very, very difficult to get rid of if you do
        catch it. Poisons generally don't have a contagion rating- you've either
        been poisoned or you haven't.

        Poisons may also have a maximum duration, after which the poison breaks
        down even if you haven't resisted it.

        To make a resistance check, the victim rolls Guts (my equivalent of
        Constitution/Endurance) vs the potency (a few illnesses may change this
        to Muscles & Guts or even Guts & Will, but it'll mostly be a flat Guts
        check).

        Results
        -------
        Critical success (win by 5+) or better: you're cured. Any side effects
        suffered vanish as you heal the accumulated damage.
        Success: it gets weaker. You get +1 to all future resistance checks.
        Tie: no effect.
        Failure: You take 1 Wound from it.
        Critical failure (fail by 5+): You take 2 Wounds. If it's a disease, it
        gets stronger (-1 to all future resistance checks).
        Extraordinary failure (fail by 10+): You take 3 Wounds. If it's a
        disease, it gets much worse (-2 to all future resistance checks). If the
        resistance penalty is already -4 or worse, only increase the penalty by
        -1, but the deadliness goes up a step.

        That's for deadly diseases/poisons. For a normal disease/poison,
        whenever you take wounds from it, convert the first wound to a point of
        Fatigue instead. For a non-lethal one, convert the first 2 to Fatigue
        (so a non-lethal illness does 2 fatigue and 1 wound on an extraordinary
        failure).



        So the flu might be a non-lethal disease with Potency d6, Contagion d10
        and a daily timer interval. You'd have to resist d10 to avoid catching
        it if exposed to it (by hanging around someone who's sick already, since
        it can be transmitted by air). Once you do, you make checks daily to see
        how it progresses. It's not likely to ever kill you unless you really
        fail a lot to the point where you start getting Extraordinary Failures
        all the time. Then it would change from a non-lethal illness to a normal
        one... then to a deadly one... and shortly after that you probably
        croak. It has the side effects of sniffling and sneezing and generally
        feeling miserable.

        A tranquilizer dart would be a potency 2d12+2 non-lethal poison with a
        once per minute check (if you take 3+ points of fatigue, you have to
        start making consciousness checks to stay awake so it knocks you out
        pretty quickly). It lasts at most 3 minutes, so if you aren't knocked
        out by 3 resistance checks, it'll stop hitting you. Really it should be
        X divided by your Size in duration... Hm.

        Okay, the duration for a poison is generally either a flat value or some
        number X divided by your character's Size. Since a Size of 8 is typical,
        the above tranq dart (intended for human-sized targets) has a duration
        of 32 / Size in minutes. Someone with Size 4 might die, while someone
        with Size 12 would only be hit for 3 minutes (2 2/3 rounded up). Someone
        with Size 16 (probably a monster rather than a PC) would only get a
        duration of 2 minutes. Does that sound reasonable?



        There are several ways to boost your chances of survival:
        A doctor can make Brains & Doctor rolls vs the potency to try and treat
        the symptoms. This is treated like an "extra" resistance roll, but it
        can only makes things worse on a botch. The doctor can only try once per
        time interval. Successful use of the Herbalism skill can give the doctor
        a small bonus by letting them find herbs that will help.
        Anti-venoms, anti-toxins, anti-bacterials or anti-virals (they were
        invented before the Last War wiped everyone out) can give you big
        bonuses to your checks (like +5 or +10) if the doctor correctly
        identifies what you have and has access to the correct cure.
        A vaccine can give similar bonuses, which apply to resisting both the
        contagion check and the potency if you do catch it.
        Cure-Paks (containing medical nanites in a suspension fluid) are the
        fastest fix (automatically curing almost anything except a nanite-based
        military plague), but since the characters are all mutant animals you
        really want veterinary cure-paks, not the ones intended for humans. The
        human-only ones are unreliable when used on other creatures.


        Any comments or suggestions?

        Kiz
        --
        http://home1.gte.net/res08kg0
      • robj3.geo
        ... breaks ... Yes. Most poisons lack specific antidotes, so supportive treatment consists of limiting absorption and waiting for the body to eliminate it. ...
        Message 3 of 12 , Oct 1, 2002
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          --- In rpg-create@y..., Frank Sronce <frank.sronce@v...> wrote:
          > Poisons may also have a maximum duration, after which the poison
          breaks
          > down even if you haven't resisted it.
          Yes. Most poisons lack specific antidotes, so supportive treatment
          consists of limiting absorption and waiting for the body to
          eliminate it.

          >
          > Results
          > -------
          <snip>
          I'm not familiar with the base mechanic of your rules.
          What sort of probabilities are we looking at here?

          >
          > So the flu might be a non-lethal disease with Potency d6,
          Contagion d10
          > and a daily timer interval.
          <snip>
          Reasonable.

          > Okay, the duration for a poison is generally either a flat value
          or some
          > number X divided by your character's Size. Since a Size of 8 is
          typical,
          > the above tranq dart (intended for human-sized targets) has a
          duration
          > of 32 / Size in minutes. Someone with Size 4 might die, while
          someone
          > with Size 12 would only be hit for 3 minutes (2 2/3 rounded up).
          Someone
          > with Size 16 (probably a monster rather than a PC) would only get
          a
          > duration of 2 minutes. Does that sound reasonable?
          Yes, but you'd alter the dose of drug in your darts to match likely
          targets, right?
          <g>

          > Successful use of the Herbalism skill can give the doctor
          > a small bonus by letting them find herbs that will help.
          It's going to be a very small bonus, unless they're very special
          herbs (pharm plants??).


          Robert O'Connor
          medico, gamer
        • Frank Sronce
          ... It s a heavily modified form of the Ironclaw system. Basically, everything is rated in sets of dice (usually a single die from d4 to d12). When you test
          Message 4 of 12 , Oct 1, 2002
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            robj3.geo wrote:
            > --- In rpg-create@y..., Frank Sronce <frank.sronce@v...> wrote:
            >
            >>Poisons may also have a maximum duration, after which the poison
            >
            > breaks
            >
            >>down even if you haven't resisted it.
            >
            > Yes. Most poisons lack specific antidotes, so supportive treatment
            > consists of limiting absorption and waiting for the body to
            > eliminate it.
            >
            >
            >>Results
            >>-------
            >
            > <snip>
            > I'm not familiar with the base mechanic of your rules.
            > What sort of probabilities are we looking at here?
            >


            It's a heavily modified form of the Ironclaw system. Basically,
            everything is rated in sets of dice (usually a single die from d4 to
            d12). When you test it, you roll all of the dice and take the highest
            number as your result. A typical person's stats in the system are rated
            at d8.
            So if you have a Guts of d8 and you're rolling against a difficulty of
            d10, then you're at a disadvantage. If the difficulty is 12, you're
            probably going to fail.
            A difficulty of 2d12+2 means to roll 2 twelve-sided dice, take the higher
            result and add two to it, giving you a result from 3 to 14. Naturally,
            it's really hard to beat a difficulty of 2d12+2 unless you're really,
            really good or have major bonuses.


            >
            >>So the flu might be a non-lethal disease with Potency d6,
            >
            > Contagion d10
            >
            >>and a daily timer interval.
            >
            > <snip>
            > Reasonable.
            >
            >
            >>Okay, the duration for a poison is generally either a flat value
            >
            > or some
            >
            >>number X divided by your character's Size. Since a Size of 8 is
            >
            > typical,
            >
            >>the above tranq dart (intended for human-sized targets) has a
            >
            > duration
            >
            >>of 32 / Size in minutes. Someone with Size 4 might die, while
            >
            > someone
            >
            >>with Size 12 would only be hit for 3 minutes (2 2/3 rounded up).
            >
            > Someone
            >
            >>with Size 16 (probably a monster rather than a PC) would only get
            >
            > a
            >
            >>duration of 2 minutes. Does that sound reasonable?
            >
            > Yes, but you'd alter the dose of drug in your darts to match likely
            > targets, right?
            > <g>
            >


            If you knew how, yes. :-)

            Of course, we're talking about PCs here, so if they find any tranquilizer
            darts they'll probably TRY to overdose the target. :-)


            >>Successful use of the Herbalism skill can give the doctor
            >>a small bonus by letting them find herbs that will help.
            >
            > It's going to be a very small bonus, unless they're very special
            > herbs (pharm plants??).
            >

            Yeah, a +1 or +2 bonus at best, compared to the +5 or +10 for high-tech
            drugs. Since it's a post-Apoc setting, no one sells aspirin anymore. You
            have to make your own. :-)
            This may actually be unrealistically generous towards the PCs in some
            ways (without modern technology, a LOT of basic illnesses can turn
            fatal), but I don't want it to be _too_ harsh. One reason why I put the
            nano-tech healing materials in the setting was to make it more survivable.

            Kiz

            >
            > Robert O'Connor
            > medico, gamer
            >


            --
            http://home1.gte.net/res08kg0
          • Chris Tutty
            From: robj3.geo ... Or, in the case of some farm chemical poisonings, replacing your blood once a month until it s been flushed. I
            Message 5 of 12 , Oct 1, 2002
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              From: "robj3.geo" <robocon@...>
              > --- In rpg-create@y..., Frank Sronce <frank.sronce@v...> wrote:
              > > Poisons may also have a maximum duration, after which the poison
              > breaks
              > > down even if you haven't resisted it.
              > Yes. Most poisons lack specific antidotes, so supportive treatment
              > consists of limiting absorption and waiting for the body to
              > eliminate it.
              >
              Or, in the case of some farm chemical poisonings, replacing
              your blood once a month until it's been flushed. I think it's a
              bit flasher than an oil change (take the bung out and let everything
              drain into a basin) but still a bit bizarre. Had that happen to
              a work-mate - Paraquat?

              Chris Tutty
            • Chris Tutty
              From: robj3.geo ... Many thanks. Text updated. Chris Tutty
              Message 6 of 12 , Oct 1, 2002
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                From: "robj3.geo" <robocon@...>
                > > Chris Tutty wrote:
                > > > world-design archives. Anyway, there's a document with all of
                > > > my poison notes at
                > > >
                > > > http://pages.quicksilver.net.nz/chris.tutty/poison.htm
                > > >
                > First error on a quick scan:-
                > Heroin is only twice as potent as morphine (it's
                > two morphine molecules joined together). Hence its other name,
                > diamorphine! Clinically, it's a very useful drug (used more often
                > than morphine in Britain with acute pain, for ex).
                >
                Many thanks. Text updated.

                Chris Tutty
              • Robert O'Connor
                Chris Tutty wrote:- ... Blood replacement ? This suggests transfusion. More likely options:- Dialysis - removing low molecular weight substances from the
                Message 7 of 12 , Oct 2, 2002
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                  Chris Tutty wrote:-
                  > Or, in the case of some farm chemical poisonings, replacing
                  > your blood once a month until it's been flushed.
                  'Blood replacement'? This suggests transfusion.
                  More likely options:-
                  Dialysis - removing low molecular weight substances from the blood.
                  Plasmapheresis - removing larger MW substances (e.g. proteins) from the
                  blood. Sometimes immunoglobulin or albumin is put in during a pheresis
                  run.

                  Neither treatment is an evidence-based one for organophosphate
                  poisoning, which is the most likely farm chemical to cause problems.

                  Herbicides aren't going to be removed by dialysis/pheresis either ; they
                  tend to accumulate in tissue, so the plasma concentration is very low.
                  So skimming the blood isn't going to materially effect elimination.

                  Dialysis is likely if kidney failure occurred during the early
                  post-ingestion period (for whatever reason - more likely to be
                  associated with being so sick rather than the toxic agent per se), and
                  would continue for some months following discharge from hospital.

                  >Had that happen to a work-mate - Paraquat?
                  No. Paraquat kills by generating oxygen free radicals.
                  If absorption is not limited by fuller's earth (a diatomaceous clay),
                  serum levels are measured.

                  Beyond a certain value, death is inevitable.
                  As one of the toxicologists I used to work with said "Send them home
                  with a bottle of morphine ; there's nothing we can do."

                  This is a slow, agonizing process (a couple of weeks) as you fall
                  apart from the inside.

                  Again, beyond limiting absorption, treatment is supportive.


                  Robert O'Connor
                  Medico, gamer
                • Robert O'Connor
                  Chris, herewith some further comments on your poison notes. i. Narcotics and Withdrawal - Time of onset and duration for narcotic withdrawal is usually 4
                  Message 8 of 12 , Oct 2, 2002
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                    Chris, herewith some further comments on your poison notes.

                    i. Narcotics and Withdrawal
                    - Time of onset and duration for narcotic withdrawal is usually 4
                    half-lives from last dose, so 12-16 hours for morphine, pethidine,
                    heroin ; 4-6 days for methadone.
                    The time span you have there fits alcohol withdrawal very well.
                    - Pupils are usually dilated via increased sympathetic activity rather
                    than constricted (constriction usually occurs _with_ doses of narcotic).

                    > In the case of barbituates, minor tranquillisers and alcohol
                    withdrawal
                    > may be more dangerous and severe.

                    Minor tranquillisers include the benzodiazepines, the imidazoline
                    congeners zolpidem and zopiclone, and old-fashioned stuff like chloral
                    hydrate, paraldehyde, urethane, and meprobamate ('Miltown').

                    The newer drugs are relatively benign (you can take 10s of grams of
                    benzos without ill effects - a similar barbiturate overdose is likely to
                    be lethal). Seizures are the big problem with hypnosedatives, generally,
                    in withdrawal.

                    ii. LSD and other hallucinogens
                    LSD was synthesized in the laboratories of Hoffman-La Roche.
                    Mescaline is a distinct compound. Source appears in the section
                    'Plants'.
                    Morning glory is an alkaloid found in the seeds of that plant.

                    www.drugscope.org.uk looks like a useful initial point of reference.

                    iii. Barbiturates, Stimulants, Tranquillisers
                    I'd probably split stimulants and sedatives...

                    > Barbituate withdrawal similar to chronic alcoholism; blackouts,
                    > irrationality, slurred speech, poor co-ordination, emotional
                    deterioration
                    > psychosis. Little tolerance build up.
                    Tolerance does occur. It's limited by the toxicity of barbiturates (see
                    above).

                    Cocaine:-
                    > Large doses. excitement, mental confusion, convulsions, euphoria,
                    > hyperexcitability, hallucinations. Habit forming, maybe physically
                    > addictive. Little tolerance. Paranoia.
                    Add accelerated onset of heart disease, increased likelihood of heart
                    attack, stroke, high blood pressure and malignant heart rhythms.

                    Essentially, people under 30 with clinically significant coronary artery
                    disease are either very unlucky or coke/amphetamine/steroid abusers.

                    iv. Plants
                    Nutmeg:-
                    > Excessive consumption of nutmeg can lead to a high (with
                    hospitalisation).
                    The active ingredients are central nervous system poisons.
                    Gram doses (~2-3) are required for adults.

                    > Datura incapacitates victims
                    These sort of plants contain anticholinergic (atropine-like) compounds.
                    Belladonna / Deadly Nightshade are the classical examples.
                    There are many substances which have anticholinergic effects, and they
                    are managed similarly.

                    > Stramonium
                    A Datura species.


                    > Wolfsbane / Monkshood / Aconite
                    The description fits with an anticholinesterase (e.g. organophosphate
                    pesticides, war gases). You could lump these all together.

                    > Wild Black Cherry
                    >
                    > Contains cyanide.
                    All stone fruit seeds contain compounds which can be metabolized to
                    release cyanide. You just need to eat enough, as some people found out
                    during the laetrile fad of the late 1960s - early 1970s.

                    [Laetrile is - somehow - one of the B group vitamins, found in largish
                    amounts in apricot seeds. Someone thought it was a cure for cancer. Some
                    of the more fringe alternative health mob still do.]

                    More on cyanide:-
                    > Inhalation of fumes can cause instant death.
                    Prompt collapse and cardiac standstill within 30 seconds, using the KGB
                    gas-gun murders as an example.
                    The assassin fired a custom weapon which broke an ampoule of hydrogen
                    cyanide releasing compound near a target. This was fired at point blank
                    range. The assassin took amyl nitrate and sodium nitrite prior to use
                    (which must have been very unpleasant) to avoid dying in the attack.

                    > Oleander
                    Contains glycosides similar to digoxin (foxglove).
                    Symptoms are as described. Death is usually due to direct toxic effects
                    on the heart leading to lethal rhythms (ventricular fibrillation).

                    > Hemlock
                    Both types have a very similar alkaloid (coniine/cicutine).

                    v. Animals
                    Tetrodotoxin (most famously the puffer fish), saxitoxin
                    (dinoflagellates) and the poisons of the blue-ring octopus and box jelly
                    all block cell membrane sodium channels.

                    This either leads to paralysis via nerve block or cardiac arrest via
                    ventricular fibrillation (even if breathing hasn't stopped).

                    Some of the elements of cone shell toxins work similarly (as do local
                    anaesthetics).

                    Snake venoms generally have three modes of action:-
                    i. Neurotoxic - paralysis, convulsions, etc.
                    ii. Myotoxic - paralysis, tissue breakdown
                    iii. Haemotoxic - anti-coagulant ; often cause disseminated
                    intravascular coagulation (not good!)


                    > Irish potent against snakes. A variety of bluestone found on irish
                    beaches
                    > can cure snakebite.
                    Ah, the legend of Saint Patrick.

                    vi. Miscellany
                    > Curare
                    As described - pure muscle blockade, ineffective by oral route (not
                    absorbed).

                    Many synthetic compounds used in anaesthesia with this effect (succinyl
                    choline, vecuronium, rocuronium, atracurium, etc. etc.)

                    > Nicotine
                    > Pure nicotine paralyses the nerves and may be quickly fatal.
                    More specifically, it interferes with the transmission of nerve impulses
                    from the spine to the peripheries (a ganglion blocker). In many other
                    ways, it acts like an anticholinesterase...


                    Robert O'Connor
                    Medico, gamer
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