ABSTRACT
Lysoform® in the formulation of professional detergent is widely used in several fields, whereas its suicidal ingestion is an unusual occurrence. Therefore, the biological signs of this fatal poisoning remain unclear and elusive, similarly to the histological lesions induced by its main constituent, which is benzalkonium chloride (BZK). Furthermore, since all the deaths that has been reported in the literature occurred immediately, microscopic pictures of BZK lethal toxicity in subjects with prolonged survival have never been reported to date. Specifically, this brief communication reports the unique case of a woman who ingested professional Lysoform® to commit suicide, for which she died two weeks later. The autopsy examination showed either local or systemic signs of caustic ingestion; moreover, the histological analysis showed clear cellular damage of lungs, heart, and kidneys. In our case, toxicological investigations were not authorized as they were no longer considered significant. In this framework, the histological examination has therefore assumed a fundamental role in investigating and demonstrating the lethal effects caused by the systemic dissemination of BZK, which would otherwise no longer be investigable. Therefore, in cases of substance intoxication with prolonged survival where forensic toxicological investigations may be no longer possible or feasible, the histological examination may be the only resource to successfully observe and demonstrate its lethal effects.
ABSTRACT
It has been estimated that approximately one in seven of all global suicides is due to pesticide self-poisoning, mostly in rural areas of developing countries. Organophosphorus (OP) compounds are a group of pesticides exerting their toxicological effects through non-reversible inhibition of the enzyme acetylcholinesterase (AChE). Among these compounds, phorate (thimet) is one of the most dangerous compounds, the use of which is restricted in many countries. A case of intentional suicide after phorate ingestion in a 24-year-old Bengali male is described. This is the second case of suicidal ingestion of phorate reported in the forensic literature, and the first presenting complete toxicological findings.
ABSTRACT
Acute chemical intoxication represents one of the major causes of Emergency Room admittance, and possible errors in diagnosis are extremely frequent, especially when patients present generic and non-specific symptoms. Diquat, a bipyridyl class of herbicides, exerts high intrinsic toxicity as a consequence of free oxygen radicals, leading to cellular death and organ dysfunctions. Following ingestion, with the major source of absorption for suicidal purposes, the chemical induces local irritating effects; systemic symptoms appear later, while specific symptoms can occur in the following 48 h. A smoker and hypertensive 50-year-old man arrives at the E.R., reporting that an episode of herbicide inhalation occurred few hours earlier. Physical examination evidenced alkalosis with hypoxemia, leucocytosis, mild hyperglycaemia and moderate increase in creatine kinase and myoglobin. Despite blood creatine kinase and myoglobin values that were higher than normal, he was prescribed with hydration and anti-pain therapy. During the night, the man left the hospital; he returned the next morning at 8:45 a.m., with cardiorespiratory arrest, medium fixed non-reactive mydriasis, diffused cyanosis of the skin and of the mucous membranes, as well as imperceptible pulse and peripheral pressure. Despite resuscitation attempts, the patient died at 9:30 a.m.; the body was immediately transferred to the morgue. Autopsy and toxicological analyses were carried out nine days later, evidencing paraquat ingestion for suicidal purposes. GC/MS analyses to verify the presence of diquat were performed on body fluids and gastric and colon contents; all specimens resulted positive, thus confirming the cause of death as herbicide ingestion (blood diquat concentration of 1.2 mg/L; more than twice the minimum to observe a systemic poisoning). The procedure followed for patient management resulted to be not in line with the provisions of both guidelines and good clinical practices. Staff did not perform clinical-diagnostical monitoring of the patient's condition or ask for more specific analyses (i.e., serum creatine phosphokinase monitoring). This misconduct led to a decrease in the patient's chances to survive.
ABSTRACT
Aluminum phosphide (ALP) is a highly toxic compound most commonly available as Celphos in Nepal. Suicidal ingestion is common in developing countries like Nepal as it is easily available and has a high mortality rate. Farmers to protect crops from rodents and pests use it. Here we present a case of a 24-year-old female with suicidal ingestion of one and a half-tablet of ALP presented with abdominal pain and vomiting. The patient developed metabolic acidosis, hyperkalemia, acute respiratory distress, and hypotension during the Intensive Care Unit stay. Supportive treatment with gastric lavage (coconut oil), intravenous magnesium sulfate, sodium-bicarbonate infusion, adequate vasopressor and close monitoring of hemodynamic parameters helped in the survival of the patient (AU)
El fosfuro de aluminio (ALP) es un compuesto altamente tóxico más comúnmente disponible como Celphos en Nepal. La ingestión suicida es común en países en desarrollo como Nepal, ya que está fácilmente disponible, teniendo una alta tasa de mortalidad. Los agricultores lo utilizan para proteger los cultivos de roedores y plagas. Aquí presentamos el caso de una mujer de 24 años con ingesta suicida de una tableta y media de ALP que presentó dolor abdominal y vómitos. La paciente desarrolló acidosis metabólica, hiperpotasemia, dificultad respiratoria aguda e hipotensión durante su estancia en la Unidad de Cuidados Intensivos. El tratamiento de soporte con lavado gástrico (aceite de coco), sulfato de magnesio intravenoso, infusión de bicarbonato de sodio, vasopresor adecuado y monitoreo estrecho de los parámetros hemodinámicos ayudaron a la supervivencia del paciente (AU)