Forensic issues in suicide due to acid ingestion in a case of major depressive disorder.

Although rare, suicide using caustic substances in psychiatric practice is not infrequent. Such circumstances involve important forensic and psychiatric issues. In this case report, death due to sulfuric acid ingestion in a patient with major depressive disorder is reported. The legal issues concerning suicide in a patient with mental illness, autopsy findings, forensic issues, and pathophysiology concerning death by acid ingestion have been discussed.

Death of a toddler due to ingestion of sulfuric acid at a clandestine home methamphetamine laboratory.

Exposure to strong acids such as sulfuric acid to either the skin or the gastrointestinal or respiratory mucosa will result respectively in significant-occasionally fatal-cutaneous chemical burns as well as devastating corrosive damage to the respiratory and gastrointestinal tracts. Most injuries are accidental, but there are reports of using acids as weapons or as a means of suicide. The primary mechanism of acid injury is coagulative necrosis of the tissues. Sulfuric acid is a chemical often used in industrial and chemical laboratories, and it is an ingredient in household products like drain cleaner. Easily accessible, over-the-counter, household drain cleaner is one of several common materials used to manufacture methamphetamine. With increasing clandestine methamphetamine laboratories in the United States, exposure to methamphetamine and the toxic chemicals used for its production is a growing problem. In many instances, children living in these laboratories qua homes are at risk for injury and death. We report the death of an unattended toddler, who ingested sulfuric acid drain cleaner in his home. The gross and histopathological autopsy findings in this case are similar to those of previously described cases of sulfuric acid injury.

Sulfuric acid injury.

Injuries and deaths from exposure to caustic substances are infrequently reported in the forensic pathology literature. Strong acids like sulfuric acid produce a predictable set of injuries with cutaneous exposure and ingestion. Multiple factors influence the resultant pathology, but from the perspective of the autopsy pathologist, the most important is the length of postingestion survival. We report the case of a young man whose desire to 'clean his honor' was manifested through the consumption of a large quantity of sulfuric acid drain cleaner. Although a myriad of physical findings were present at autopsy, the majority of these most likely represented the postmortem action of sulfuric acid on tissues.

[Digestive burns by simultaneous oral and rectal self-administration of ingestion sulphuric acid: an unusual mode of suicide]. / Brûlures digestives d'origine caustique par double voie simultanée haute et basse: un mode inhabituel d'autolyse à Abidjan.

The authors report an unusual mode of suicide in two patients admitted to the Teaching Hospital of Yopougon. One 26-year-old woman swallowed sulphuric acid and then self-administered more of the same product rectally. She presented with abdominal pain, vomiting, bloody diarrhoea, without fever (T=37,9 degrees C). The abdomen did not appear to require surgery. Endoscopy showed erosive cesophagitis on day 5 (D5) and ulcerated bleeding inflammation of the entire colon and rectum on D26. She died on D30, during generalized convulsions. The second patient, a 31-year-old women, ingested sulphuric acid in the same way. She presented initially with diffuse abdominopelvic pains; clinical examination showed neither guarding nor contraction. Her temperature was 37,8 degrees C. Oesogastric endoscopy observed cesophagitis stage II B and III A and gastritis III A and III B. On D9, acute and generalized peritonitis was discovered, leading to surgical exploration. The patient died at the end of the operation. This unusual mode of suicide induces grave clinical presentations despite their apparent calm. The prognosis is worse because of the double localization of the lesions, the toxicity of the product, and the underestimation of its gravity.

Methamphetamine exposure presenting as caustic ingestions in children.

With the growing prevalence of methamphetamine use and production in home laboratories, children are at risk for injuries resulting from living in a drug-endangered environment. Although the ingestion of household cleaners is usually accidental and not a result of illicit drug use or production, medical providers must be aware of the chemicals associated with methamphetamine and illicit drug production to identify patients harmed in this environment. We present the first reported cases of children harmed by ingesting caustic substances used in the production of methamphetamine in the home.

Sulphuric acid marketed in water bottle in India: A cause for fatal accidental poisoning in an adult.

Corrosive acid ingestion is a rare but serious health hazard with fatal complications. Cases of suicidal and accidental acid ingestion have been documented in the scientific literature. Accidental acid poisoning due to a mistaken identity of the bottle containing sulphuric acid is a matter of grave concern especially in a household set-up. We hereby report a fatal case of accidental sulphuric acid ingestion in an adult, who unsuspectingly swallowed about 50 ml of 'toilet-cleaner' at his residence. The bottle containing the acid was recently purchased from a local vendor and placed with water bottles in the kitchen. The autopsy and toxicological findings of this case are discussed in this paper with discussion of medico-legal issues on the sale and use of such corrosive acids in illegal bottles and its subsequent health hazards in India.

Carbon monoxide poisoning and pulmonary injury from the mixture of formic and sulfuric acids.

CONTEXT: The inhalation of carbon monoxide produced by the incomplete combustion of carbon remains a popular method of suicide. A much less common method of producing carbon monoxide for suicide is by mixing formic and sulfuric acids. CASE DETAILS: We describe a patient who attempted suicide by mixing formic and sulfuric acids. He presented with a depressed level of consciousness, chemical burns of his airway and skin, and respiratory distress. He was found to have a metabolic acidosis, a carboxyhemoglobin of 36.8%, hyperkalemia, and rhabdomyolysis. His hospital course was notable for copious pulmonary secretions and hypoxia, but he ultimately recovered with supportive care. DISCUSSION: The case highlights the potential toxicity, particularly from inhaled carbon monoxide and formic acid, with this method of suicide.

Combined exposure to carbon disulfide and sulfuric acid simultaneously increases the risk of hand dermatitis in rayon industry.

OBJECTIVE: To evaluate the association between hand dermatitis (HD) and occupational exposure to CS(2) and to determine whether combined exposure to CS(2) and H(2)SO(4) exhibits a higher risk of HD. METHODS: In all, 110 subjects from a rayon factory were recruited and their exposure was classified into CS(2) exclusively, H(2)SO(4) exclusively, combined exposure, and nonexposure control based on workers' job characteristics. A dermatologist was designated in the diagnosis of HD on palm and dorsal sites for each subject. Other confounding factors including detergent, glove wearing, and participation in wet work were determined using a person-to-person questionnaire interview from 37 randomly selected subjects. RESULTS: Significant elevated odds ratios (ORs) for HD were found in CS(2) exclusively (44.8, P < 0.01) and combined exposure (49.0, P < 0.001) compared with control. Dose-response trends of ORs for HD were found across control, single exposure, and combined exposure for both CS(2) and H(2)SO(4). CONCLUSIONS: HD could occur resulting from occupational exposure to CS(2) alone. This study was unable to affirm that the exposure to H(2)SO(4) alone is associated with HD due to limited H(2)SO(4) exposure subjects. The combined exposure to both CS(2) and H(2)SO(4) simultaneously could increase the risk of HD. The control remedy in preventing dermal contact with either CS(2) or H(2)SO(4) among the rayon workers should be performed immediately.

Corrosive injury to the stomach due to acid ingestion.

Ingestion of acid often causes severe damage to the stomach. Ingestion of alkali, however, usually injures the esophagus and spares the stomach. Early complications of acid ingestion, e.g., massive gastric hemorrhage or perforation, are unusual. The absence of severe symptoms in most patients soon after ingestion of acid is often misleading. Gastric outlet obstruction is a common late result and may develop following an asymptomatic interval. The authors' experience with three patients with severe complications following ingestion of acid is presented. The initial treatment, as well as the surgical management, are discussed.

Mortality study of ethanol and isopropanol production workers at two facilities.

The mortality experience of alcohol process workers (N = 1031) from two chemical plants was followed from the early 1940s to 1983. Reported associations of the production of ethanol and isopropanol by the strong-acid process with upper respiratory tract cancers, heart disease, and lympho- and reticulosarcoma were tested with both external and internal comparisons. Excesses of cancers of the larynx, buccal cavity, and pharynx, based on very small numbers, were observed. There was one death due to sinus cancer. It could not be concluded that there were work-related effects on mortality due to heart disease or lympho- or reticulosarcoma. Workers assigned to the production of isopropanol by the weak-acid method showed no evidence of excess cancer mortality (0 observed, 1.9 expected cancer deaths). The absence of major risks among strong-acid workers can be explained by the initiation of engineering controls and health monitoring that took place after the original medical observations.

Effect of occupational exposure to rayon manufacturing chemicals on skin barrier to evaporative water loss.

To evaluate the effects of the occupational exposure to rayon manufacturing chemicals (RMC, containing predominantly carbon disulfide (CS(2)) and minor sulfuric acid) in a rayon factory on the basal transepidermal water loss (TEWL), barrier integrity (BI), and sequential increasing TEWL profiles. Six Thais and five Chinese workers in the spinning department of a rayon manufacturing plant and five healthy unexposed controls were recruited as the test subjects. An area of 4.5 x 5.5 cm on the mid-side of the volar forearm on the right hand was stripped by means of moderate pressure with commercially available adhesive tape by the same technician throughout the experiment. The skin was progressively stripped until glistening. TEWL was measured at every three and five tape strips on the right hand. The corresponding site on the left hand was measured parallel as the self-control. We found significant differences in basal TEWL and in BI between Chinese workers and Chinese controls, and between Thai workers and Chinese workers, respectively. Two-stage patterns of progressive TEWL profiles were found in such a chronic and repeated occupational exposure to RMC containing CS(2). The occupational exposure to RMC could result in the perturbation of the skin barrier function. Basal TEWL might be more sensitive to chronic skin irritant exposure. The TEWL profile achieved to the glistening stage might be necessary to avoid erroneous pattern estimation. Due to the lack of Thais control in this study, the racial difference in response to the RMC warrants further study.

The effect of steroid treatment on corrosive oesophageal burns in children.

A retrospective study was done on corrosive oesophageal burns to ascertain the preventive effect of corticosteroids on stricture development. Within the last 12 years 351 children were admitted to our medical centre with a history of corrosive agent ingestion. In 235 of these the diagnosis of oesophageal burn was confirmed by means of oesophagoscopy. Children admitted within the first 48 hours received steroid, antibiotic and fluid therapy while fluid and antibiotics were given, if needed, in the rest. Forty-six of the children were lost to follow-up. The type of corrosive agent, the admission period, the degree of the burn and the stricture development were used as parameters. Stricture development was found statistically significant in late admitted patients vs. early admissions. This retrospective study suggests the effectiveness of corticosteroid treatment in preventing the stricture development.

A rare complication due to sulfuric acid ingestion.

The authors present a case of pyloric and duodenal obstruction in an 8-year-old child, resulting from accidental ingestion of sulfuric acid. A marked pyloric and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is seen infrequently, especially in pediatric age. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. This dynamic pathophysiologic event imposes postponement of surgical intervention because of various time length between ingestion of acid and onset of gastric outlet obstruction (17 days to 5 years). Clinical features included postprandial epigastric distress, repeated non-bilious vomiting, and marked weight loss. The authors also discuss the various surgical procedures that were employed to relieve the obstruction. Notwithstanding a potential risk of malignant evolution, a gastro-jejunostomy is the treatment of choice because of the age of the patient, and good postoperative results are confirmed by barium studies.

A survey of effects of gaseous and aerosol pollutants on pulmonary function of normal males.

A total of 231 normal male human subjects were exposed for 4 hr to air, ozone, nitrogen dioxide, or sulfur dioxide; to sulfuric acid, ammonium bisulfate, ammonium sulfate, or ammonium nitrate aerosols; or to mixtures of these gaseous and aerosol pollutants. Only one concentration of each pollutant was used. This study, therefore, represents a preliminary survey, intended to allow direct comparison of studies to plan future research. During exposure each subject had two 15-min exercise sessions on a treadmill at 4 mph and 10% grade. Environmental conditions were mildly stressful, i.e., temperature = 30 degrees C and relative humidity = 60%. A battery of 19 measurements of pulmonary function was performed just prior to exposure (air control); 2 hr into the exposure, following the first exercise session; 4 hr into the exposure, following the second exercise session; and 24 hr after exposure. Significant differences were noted in specific airway resistance (SRAW), forced vital capacity (FVC), and forced expiratory flow at 50% of FVC (FEF50) and in related measurements in those experimental groups exposed to ozone or to ozone plus aerosols. None of the aerosols alone, nitrogen dioxide or sulfur dioxide alone, or mixtures of nitrogen dioxide or sulfur dioxide with aerosols produced significant effects. A distribution analysis of subject responsivity to ozone gave a normal distribution among subjects not exposed to ozone, and a distribution shifted to the right and skewed to the right among those exposed to ozone alone or in mixture, with no evidence of bimodal distribution of ozone sensitivity.

Pyloric obstruction following the ingestion of corrosive acid.

Pyloric obstruction is a well documented end result of ingestion of corrosive acid. Whereas the oesophageal mucosa is resistant to damage, the pyloric spasm and the resultant pooling of acid in the pre-pyloric region, causes injury to this area. The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements, would weigh against the addition of a vagotomy to the drainage procedure. A case of ingestion of concentrated sulphuric acid and the management of its late sequelae, are discussed.

[Effect of sulfuric acid vapors on the respiratory system]. / Wplyw par kwasu siarkowego na uklad oddechowy.

The influence of a mixture of sulphuric acid vapour and SO2 mist upon the respiratory tract of animals was investigated during on exposure lasting 8 and 12 hours. Marked inflammatory changes in the upper respiratory tract, bronchioli and lung parenchyma were found. These changes were manifested by inflammatory infiltrations and abundant production of mucous in the bronchial tree. A significant increase in the number of dust cells in the lumen of bronchioli was also observed. A decrease of mitotic index was found in the epithelium of oral cavity after inhalator intoxication with sulphuric acid. This may lead to disturbances in the repair of epithelium. The authors emphasize the intensity of changes in proportion to H2SO4 dosage.