Mr Kim Jong Nam could barely breathe, had abnormally small pupils and was sweating excessively when he turned up at a clinic in the Kuala Lumpur International Airport (KLIA) one morning in February, a court heard yesterday.
Mr Kim, the estranged half-brother of North Korean leader Kim Jong Un, later started to have seizures and became unconscious, medical staff who attended to him at the clinic told the Shah Alam High Court.
He laboured to breathe and, after his epileptic fit, his mouth had a mix of his own blood, vomit and saliva, the witnesses said.
Mr Kim, 45, died at 11.20am on Feb 13 - two hours after he was attacked by two women at Terminal 2 of KLIA.
A doctor at the airport's clinic said that the victim had "constricted pinpoint pupils".
"Pinpoint pupils are usually seen if the person is exposed to poison," added Dr Nik Mohd Adzrul Ariff Raja Azlan.
The doctor was the fourth witness called to the stand in the closely watched murder trial.
Chemical pathologist Nur Asyikin Osman from Hospital Kuala Lumpur (HKL) said that after Mr Kim's body was sent to HKL from the clinic, she conducted an enzyme test that would indicate the presence of muscle contraction. The results showed Mr Kim could have been poisoned with insecticide or a nerve agent, she told the court.
Two women charged with his murder - Siti Aisyah, 25, from Indonesia, and Doan Thi Huong, 29, from Vietnam - pleaded not guilty at the start of the trial on Monday. The prosecution has charged that the duo smeared Mr Kim's face with VX, a chemical poison banned by the United Nations.
Four others, who have not been named, have been accused of committing murder along with Siti Aisyah and Huong. Malaysian police had named four North Koreans as suspects in the case and said they flew out of Kuala Lumpur for Pyongyang on the day of the killing.
Mr Kim was at the airport intending to take a flight to Macau.
After the attack, he turned up at Menara Medical Clinic escorted by airport security workers. One employee, Ms Juliana Idris, told the court on Monday that Mr Kim told her two women had attacked him by smearing something on his face.
Menara clinic medical assistant Rabiatul Adawiyah Mohd Sofi also told the court on Monday that Mr Kim appeared to be in pain and was not responsive to questions when he arrived at the clinic. She said that his eyes were bloodshot and that he was sweating profusely.
Dr Nik said Mr Kim had very low blood pressure and very low oxygen levels when he attended to him. The doctor was also unable to detect a pulse on him.
The court was told that a small dosage of atropine, described in the court as an antidote for VX poisoning, was given to Mr Kim.
He was also given adrenaline to increase the heart rate, the court heard.
When the non-invasive procedures did not work, the doctor tried to carry out intubation.
Dr Nik recalled that when he tried to insert the tube into Mr Kim's trachea, the smell from the victim's mouth was "difficult".
The doctor had to perform suction first.
Chemical pathologist Nur Asyikin Osman from Hospital Kuala Lumpur (HKL) was also called to the stand yesterday.
She said that after Mr Kim's body was sent to HKL from the clinic, she conducted an enzyme test that would indicate the presence of muscle contraction. The results showed Mr Kim could have been poisoned with insecticide or a nerve agent, she told the court.
The VX nerve agent can affect the lung and heart muscles, disrupt the functions of saliva secretion and sweat glands, and cause the constriction of the pupils, she told the court.