一起毒鼠强食物中毒的调查分析及其实验室筛查探索

目的 探讨原因不明性食物中毒的检查策略。方法 结合一起发生的原因不明性食物中毒案例，应用流行病学和简易急性动物试验等方法，对导致中毒的致病因素进行分析与判定。结果 中毒案例的暴露时间为早餐时，平均潜伏期为47．84分。中毒反应以神经症状和消化道症状为主。依病例的客观特征分层对其食谱分析，筛选出水煮豆腐是本次中毒的可凝食物。7种剩余食物进行的急性动物试验中发现，水煮豆腐的小白鼠灌注量与中毒反应呈剂量反应关系，半数致死剂量为LD50＝1．68mg/g。气相色谱－质谱仪分析确定水煮豆腐中的毒性性质为四次甲基二砚四胺。结论 本案通过采用症状分析、急性动物实验和毒物分析测定方法确定了一起原因不明性食物中毒的中毒原因。这种检查策略有助于原因不明性食物中毒及其它突发中毒事件的性质判定。     

毒鼠强中毒误诊为癫痫大发作1例

毒鼠强中毒临床表现与疾病性癫痫大发作症状极为相似。若不结合案情综合分析,易混淆,以致影响案件定性,贻误破案战机。现报告一起案例如下:     

尸体火化后鉴定秋水仙碱中毒一例

<正> 随着犯罪手段的现代化,某些药物中毒表现与疾病的相似之处,可被用来掩盖犯罪,必须引起重视。临床医师在遇到诊断不清,治疗无效时,应警惕药物中毒的可能。对鉴定临床死亡原因不明而又没有尸体的中毒案例,法医工作者可通过相应的动物实验和对死者生前一系列症状、体征及实验室检查结果的综合分析,仍可得出具有科学根据的结论。现报告一例。     

毒鼠强中毒误诊为有机磷中毒1例

毒鼠强中毒的临床表现有的明显 ,有的不明显 ,易出现误诊现象 ,给医务人员及法医工作者带来诊断治疗和鉴定的困难 ,特别是临床上一些经验不足的医务人员由于对毒鼠强中毒的症状与体征认识不是很深刻 ,容易与其它毒物中毒如氟乙酰胺、有机磷中毒或某些疾病相混淆 ,从而导致了误诊误治 ,耽误了有效的抢救时机 ,造成不可弥补的不良后果。本文报道一例毒鼠强致两人中毒后 ,由于医院误诊为甲胺磷中毒 ,大剂量使用阿托品 ,最后导致二患者死亡的医疗纠纷案例进行法医学分析。1　案例简介某日 ,A、B两人因食用了被他人投放有毒鼠强的食物 10min后出…     

9例铊中毒的法医学鉴定分析

铊是一种稍带蓝色的银白色稀有金属,金属铊单体基本上无毒,但是铊盐却有较大毒性,一般所指的铊中毒均指铊盐中毒,而其中又以硫酸铊中毒最为常见。由于铊盐溶液无色无味,且毒性剧烈,所以近年来利用铊盐投毒的案例时有发生[1-3]。利用铊盐投毒隐匿性强,往往给案件的侦破工作带来很大困难,同时也常因诊断不明而耽误患者的治疗。本文通过对一起2年内,系列铊投毒案的案情及9例中毒者的病史资料进行研究,拟阐明铊中毒症状的特点、毒物分析及损伤程度评定的要点,以期对法医学鉴定有所帮助。1案例资料湖北省某县2000年9月~2003年4月发生的一起铊投毒…     

铊中毒致轻伤法医学鉴定1例

1案例资料 1.1简要案情 张某,男,29岁。2011年12月20日与女友喝茶后出现恶心、呕吐、腹痛、腹泻等症状,怀疑食物中毒,随即到医院就诊。经对症治疗,消化道症状减轻。2012年1月19日,感觉视力下降、四肢乏力、疼痛,并出现脱发等症状,再次到医院就诊。尿化验铊为1483.1μg/L,怀疑急性铊中毒。张某遂报案,经查其女友为某化工厂主管,因双方感情纠纷报复对方。     

中毒致人体损伤程度鉴定2例

在法医鉴定中，对中毒未死者进行损伤程度鉴定常常会有不同的意见，现报道2个实例。1案例案例1：某男，53岁，某化工厂职工。98年9月8日误服被他人故意投放有重金属盐氯化镉的茶水后中毒。服下茶水后约20min，出现呕吐6～7次，大汗淋漓，面色苍白，继之出现头昏、发热、胃痛、四肢胀痛等症状。经医院检查：血GPT、r-GT、AKP、LDH-L、GOT等升高，血镉、尿镉含量升高。医院诊断：急性氯化镉中毒，中毒性肝病，中毒性支气管炎。经住院治疗，至98年11月12日出院，出院时查血镉、尿镉转为正常，但肝功能仍有部分指标偏高。99年1月25日，来…     

20例中毒合并损伤尸检资料分析

在法医学尸体检验中,中毒死亡或损伤致死的案例经常遇到,但中毒合并损伤死亡的案例文献报道较少.本文对20例中毒合并损伤死亡的尸检资料加以分析,从判断死亡原因、确定案件性质等方面进行归纳,力图找出其中的规律和特点.1 资料分析1.1一般资料中毒合并损伤死亡的案例中,男14例,女6例,男女比为7:3.年龄最大者为67岁,最小的19岁,20～60岁16例.其中农民18例,教师和售货员各1例.1.2中毒、损伤与死亡原因的关系本组案例全部经过系统解剖、毒物检验,除3例检见致命性损伤外,其余17例损伤均匀非致命伤.3例有致命伤的案例中,2例检出非剧毒毒物,为损伤致死,1例检出剧毒毒物,为中毒致死;17例非致命伤的案例均检出剧毒物质,均为中毒致死.     

81例不明原因猝死法医学鉴定分析

目的总结不明原因猝死案例的流行病学及法医病理检验特点,为探明其死因提供依据和线索。方法回顾分析发生于云南省的81例不明原因猝死案例的年龄、性别、死亡时状态等流行病学特征以及解剖检验和组织学检验结果。结果 81例不明原因猝死中7例为聚集性不明原因猝死,74例为散发性不明原因猝死。聚集性不明原因猝死发生具有时间、空间和家庭聚集性,死亡时清醒状态较多。散发性不明原因猝死以男性较多见,死亡时以睡眠状态居多。聚集性不明原因猝死病理改变以心肌炎为主,同一家庭内死亡案例间病变可互不相同。散发性不明原因猝死常见的心脏病变依次为心肌脂肪浸润、心肌间质水肿、心肌纤维断裂等非特异性病变和心肌间质局灶性炎性细胞浸润。结论聚集性不明原因猝死符合云南不明原因猝死的特征,其病因可能与季节、环境、遗传等多种因素有关。散发性不明原因猝死大多数具有青壮年猝死综合征的特征。     

急性异烟肼中毒四例尸检报告

<正> 异烟肼(INH)是一种有效的抗结核病药物。因服用过量引起中毒死亡的病例时有发生,但尸检资料国内仅见5例报告,其中一例为治疗剂量的 INH 局部注射而致死亡。本文报告四例 INH 中毒尸检资料,其中一例为急性迁延性中毒。     

氯硝安定在急性中毒家兔体内的分布

从生物检材中提取、分离氯硝安定，采用薄层色谱扫描法能准确地定性、定量，对急性中毒家兔体内氧硝安定测定结果表明，当血浓度达峰时，尿和胆汁中的含量显著高于其它脏器中的含量，说明肾、胆是氯硝安定的主要排泄途径。在疑为氯硝安定中毒时，采集尿、胆汁行毒物分析是必要的。     

Homicidal Poisoning in China Using Several Anesthetic Drugs

The authors describe a case of a well‐designed homicidal poisoning in China. A male was treated with starvation, intravenous fluids and antibiotics while in the hospital for acute diarrhea. He suddenly suffered from shortness of breath and subsequently died. A forensic autopsy was carried out, and several specimens were collected for toxicological screening. Propofol was tentatively identified in the blood by GC‐MS. Based on the presence of propofol in the blood, a suspect confessed that two other drugs, namely midazolam and vecuronium, were involved in this murder. Analytical drug quantification was then performed by GC‐MS and LC‐MS/MS. Blood analysis revealed the following: propofol at 0.5 μg/mL, midazolam at 0.098 μg/mL, and vecuronium at 0.10 μg/mL. These results suggest that the cause of death was respiratory depression due to the acute combined effect of several anesthetic drugs administered by the victim's companion.     

舒乐安定在急性中毒家兔体内的分布

从生物检材中提取分离舒乐安定，采用薄层邑谱扫描法能准确定性、定量，适合于做微量毒物分析。对急性中毒家兔体内舒乐安定测定结果表明，血药浓度达峰值时，肾中含量显著高于其它脏器。因此，在疑为该药中毒时，采集尿进行分析是重要的。     

毒物分析在侦查破案中的应用

毒物分析主要研究涉及法律问题的生物检材或其他检材中毒物的分离与鉴定,能查明中毒原因,澄清案件性质,在死因鉴定中是不可或缺的关键环节。近年来,随着毒物检验鉴定技术的不断发展,毒物分析技术手段已在侦查破案中发挥着越来越重要的作用。本文报道了两起中毒死亡的案例,通过运用气相色谱-质谱联用技术,在关键检材中分别检出特丁硫磷和一氧化碳目标物质,后结合现场勘查等材料成功侦破,还原了案件真实面目,突显了毒物分析技术在服务和支撑实战中发挥的决定性作用。     

Fatal brodifacoum rodenticide poisoning: autopsy and toxicologic findings.

This report details the pathologic and toxicologic findings in the case of a 15-year-old girl who deliberately and fatally ingested brodifacoum, a commonly used rodenticide. The mechanism of death, massive pulmonary hemorrhage, has not been previously reported. Brodifacoum was quantitated in liver, spleen, lung, brain, bile, vitreous humor, heart blood, and femoral blood using HPLC with fluorescence detection. The highest brodifacoum concentrations were detected in bile (4276 ng/mL) and femoral blood (3919 ng/mL). No brodifacoum was detected in brain or vitreous humor. A brodifacoum concentration of 50 ng/g was observed in frozen liver while formalin fixed liver exhibited a concentration of 820 ng/g. A very high blood:liver brodifacoum concentration ratio suggested acute poisoning but the historical and pathologic findings suggested a longer period of anticoagulation. Though most cases of brodifacoum poisoning in humans are non-fatal, this compound can be deadly because of its very long half-life. Forensic pathologists and toxicologists should suspect superwarfarin rodenticides when confronted with cases of unexplained bleeding. Anticoagulant poisoning can mimic fatal leukemia or infectious diseases such as bacterial sepsis, rickettsioses, plague, and leptospirosis. A thorough death scene investigation may provide clues that a person has ingested these substances.     

Fatal alcohol poisoning: medico-legal practices and mortality statistics

Compilation of mortality statistics from death certificate data is based on international and national conventions which in certain situations result in the underlying cause-of-death other than that established and reported by the physician. The present study compares all fatal alcohol poisonings in 1997 as registered on forensic toxicological grounds at the accredited central laboratory and as presented in the national cause-of-death statistics, according to the underlying cause-of-death, by applying international statistical rules and principles in ICD-10. Four groups were formed, and case frequencies in each group were obtained from forensic toxicological data, group "T51" for acute poisonings due to alcohol alone, and group "Comb" for acute alcohol poisonings combined with some drug, medicament or other biological substance, and from cause-of-death statistics data, group "X45", for deaths from alcohol poisoning, and group "F102" for those medico-legal fatal alcohol poisoning deaths which at the statistics office were inferred to be due to alcoholism. The study shows that in Finland the officially compiled statistics on fatal alcohol poisonings, when compared with medico-legal statements based on forensic toxicological examinations, were underrepresented by 31.4% in 1997. About two-thirds of this underrepresentation is explained by preferring, as the underlying cause-of-death, alcoholism to acute alcohol poisoning, and about one-third by preferring, in cases of acute combined poisonings, the drug component to the alcohol. From 1998 onwards, more emphasis has been put on the alcohol component when coding medico-legally proven accidental deaths from simultaneous poisoning with alcohol and a medicinal agent. This change in coding practices presumably explains the subsequent decline in the annual underrepresentation rate of alcohol poisoning in mortality statistics to the level of 15-16%. It is concluded that the present ICD rules inevitably lead to underrepresentation of alcohol poisonings in the mortality statistics, and conceptual and practical proposals for future procedures are made.     

Seven cases of fatal aconite poisoning: forensic experience in China

This paper presents seven fatal cases of aconite poisoning encountered in the Tongji Center for Medicolegal Expertise in Hubei (TCMEH), China, from 1999 to 2008 retrospectively. In six of the cases, deaths occurred after drinking homemade medicated liquor containing aconite, and in one case death was due to ingestion of traditional Chinese medication containing aconite. Forensic autopsy and pathological examinations ruled out the presence of physical trauma or life-threatening diseases. Diagnosis of aconite poisoning was made after postmortem toxicological analysis. Animal experiment was performed in one case demonstrating that the medicated liquor could cause death rapidly. We present the autopsy and histopathological findings, toxicological analysis, and results of animal experiment done on samples from those seven cases. As an important herbal Chinese medicine, Aconitum species deserve special attention, especially because it contains poisonous alkaloids.     

54例氯化琥珀胆碱中毒案件的法医学分析

目的观察分析氯化琥珀胆碱中毒案件的法医学表现,以期提高氯化琥珀胆碱中毒的检验鉴定。方法收集54例氯化琥珀胆碱中毒案例,通过病理学、毒理学变化及案件特点进行回顾性分析,观察氯化琥珀胆碱中毒的检验鉴定规律。结果氯化琥珀胆碱中毒的病理学表现以急性肺淤血、肺水肿等一般猝死改变为主,部分死者心肌排列紊乱及断裂。死者心血中均检见琥珀胆碱成分,皮肤组织部分检见琥珀胆碱成分。结论氯化琥珀胆碱中毒具有死亡快、手段隐蔽、难以抢救、易漏检等特点。对于猝死案件、死因可疑案件应将氯化琥珀胆碱作为常规检验指标,防止此类案件的未检或漏检。     

采用纯CO气体杀人案件的分析

一氧化碳(CO)气体中毒致人死亡多见于自杀和意外事件,采用纯CO气体杀人的案例国内罕有报道。本文报道了一起采用瓶装纯CO气体致人中毒死亡的案例,作案方式隐蔽,作案手段鲜见,且伪造了作案现场,给侦查带来一定困难。经刑事技术人员认真细致地现场勘查、尸体检验和物证提取检验,结合调查访问,最终明确了案件性质,认定了犯罪嫌疑人,全面还原了其作案过程。笔者总结分析了该案刑事技术工作中的要点和难点,希望能对同行们有所帮助。