An unusual case of suicidal carbon monoxide poisoning

A 35 years old student with prior suicidal tendencies was found dead laying enclosed in a plastic-bag together with four plastic-bags of minor capacity. Three bags were opened by cuts and empty, one bag contained 73 1 of 83.2 Vol.% carbon monoxide. Postmortem carboxyhemoglobin concentrations in blood of five different regions of the corpse ranged from 80.3% to 93.4%. From the circumstances--chemicals and apparatus--it could be reconstructed that carbon monoxide was produced by the reactions of formic acid and sulfuric acid.     

Four deaths due to carbon monoxide poisoning in car washes.

In a period of 13 months, three separate incidents of lethal carbon monoxide (CO) poisoning in closed car wash bays resulted in the deaths of 4 white men aged 20 to 36 years. Each man appears to have been intoxicated with mind-altering substances, which may impair judgment, perception of outside conditions, and self-awareness. All four died in winter months. For three men, the deaths were ruled accidental, and for the remaining man, the previous deaths appear to have provided a model for suicide. Warning signs may not be effective to prevent future CO deaths in car washes because of the possible role of intoxication. Mechanical or electronic methods to prevent a bay door from closing completely may be preferable.     

Three deaths involving triazolam--analytical aspects

This case report describes three case histories and the analytical procedures used for the identification and quantification of triazolam. The levels of triazolam detected in the blood are interpreted with reference to those previously reported in the literature.     

Asphyxial deaths caused by automobile exhaust inhalation not attributable to carbon monoxide toxicity: study of 2 cases

The authors report two suicides that resulted from the intentional inhalation of automobile exhaust gases in which death occurred without the formation of physiologically significant amounts of carboxyhemoglobin. These circumstances are correlated with measurements of the involved vehicles' exhaust gases, which showed reduced concentrations of carbon monoxide present, reflecting improvements in automobile engine technology. In the absence of carbon monoxide toxicity, the authors attribute death in these cases to asphyxia caused by carbon dioxide intoxication and diminished atmospheric oxygen concentrations.     

Unusual carbon monoxide poisoning

Despite of indicative death scenes or characteristic findings of the external examination, about 40% of the accidental fatal intoxications due to carbon monoxide are not recognized before the performance of the autopsy. Six cases are reported which illustrate possible reasons for the delayed establishment of the diagnosis: unusual circumstances of the intoxication or sources of carbon monoxide, only subtle degree or lack of external signs of the intoxication or a competing cause of death at autopsy.--Cases 1 and 2: 53, respectively 54-year-old couple, found dead in a caravan, extreme putrefaction of the bodies, spectrophotometric detection of the fatal carboxyhaemoglobin level in oedema fluid of the scalp.--Case 3: 23-year-old lorry driver, found dead in the tightly closed cab of his lorry, operation of a source of electricity with "environmentally friendly" fuel, carboxyhaemoglobin level 83%.--Case 4: 19-year-old man, found dead in the flat of friends, removal of the CO-source before alerting the police forces, lack of the bright pink coloration of livor mortis, haemopericardium due to atrial rupture at postmortem examination, carboxyhaemoglobin level 65%.--Case 5: 27-year-old man, found dead in his flat, advanced decomposition of the body, residues of a charcoal fire in a metal bucket in the sink, carboxyhaemoglobin level 80%.--Case 6: 42-year-old woman, lying dead in the garage beside her car, engine switched-off, ignition key next to the body on the floor under the car, carboxyhaemoglobin level 46%.     

Postmortem formation of carbon monoxide

Since carbon monoxide (CO) production after death was suggested in a drowned body, CO and carboxyhemoglobin (HbCO) levels in blood and body cavity fluids of cadavers which were not exposed to fire and CO have been analyzed. CO released from the tissues was determined by gas chromatography and gas chromatography-mass spectrometry, and the total concentration of hemoglobin (Hb) was measured as cyanmethemoglobin (CNmHb). The HbCO level was calculated by the ratio of CO content and CO-binding capacity. CO levels (ml/100 g at STP) of the seven cases in which blood and body cavity fluids could be collected ranged from 0.13 to 0.87 in blood and 0.02 to 0.80 in body cavity fluids. HbCO levels in blood and body cavity fluids were from 0.3 to 6.0% and from 2.3 to 44.1%, respectively. In a typical case showing postmortem formation of CO, the CO levels in body cavity fluids were higher than that in blood. It is suggested that CO in a putrefied body is due to CO in blood prior to death and the CO formed by the decomposition of Hb, myoglobin and other substances during putrefaction. The significance of HbCO levels in body cavity fluids of cases with marked postmortem decomposition seems difficult to interpret without the value of HbCO in blood.     

Production of carbon monoxide in cadavers

Carbon monoxide (CO), total hemoglobin (Hb) and carboxyhemoglobin (HbCO) in the blood and reddish discolored body cavity fluids of cadavers which had not been exposed to fire and CO were analyzed. In 13 cadavers found on land, the maximum saturation of HbCO in the blood was 3.6%, and was 10.1% in the body cavity fluids. There was only one case in which the HbCO saturations in the body cavity fluids were more than 10%. In seven drowned bodies found in fresh water, the highest HbCO saturation in the blood was 6.1%, and was 44.1% in the body cavity fluids. There were three cases in which the HbCO saturations in the body cavity fluids were more than 10%. In 12 drowned bodies found in sea water, the HbCO saturations in the blood were not more than 6.2%, and the maximum saturation of HbCO in the body cavity fluids was 83.7%. There were eight cases in which the HbCO saturations in the body cavity fluids were more than 10%. The results seem to indicate that the interpretation of HbCO saturation in the blood would not be affected significantly by the postmortem formation of CO, and that body cavity fluids should not be used for CO determination.     

一氧化碳（CO）中毒检测方法

作者查阅近20年国内外相关文献的基础上,对一氧化碳(CO)中毒的检验方法进行了全面的阐述,同时对每种方法的优缺点和适用条件作了比较,并对适用于我国国情的顶空气质联用法进行了改良.     

The application of NIST's Fire Dynamics Simulator to the investigation of carbon monoxide exposure in the deaths of three Pittsburgh fire fighters

A case is reported in which computer fire modeling was used to reevaluate a fire that killed three fire fighters. NIST's Fire Dynamics Simulator (FDS) was employed to model the fire in order to estimate the concentration of carbon monoxide present in the dwelling, which was the immediate cause of death of two of the fire fighters, who appear to have removed their face pieces in order to share available air. This estimate, along with an assumed respiration volume and known blood carboxyhemoglobin, was plugged into a standard equation to estimate the time of exposure. The model indicated that 27 min into the fire, the carbon monoxide concentration had already reached approximately 3600 ppm. At this concentration, and a respiration of 70 L/min, an estimated 3 to 8 min of exposure would have been required to accumulate the concentrations of carboxyhemoglobin (49, 44, and 10%) measured on the fire fighters at autopsy.     

Toxicologic aspects of deaths due to falls from height

A prospective study of 161 victims of falls from height is reported. The aim was to determine the interest of systematic qualitative and quantitative toxicological analysis in such fatalities. The primary cause of death was suicide (84.5%), followed by accidents (7%) and homicide (1%). In the remaining 7.5%, cause of death was undetermined. In the suicides, there was evidence of psychotropic medicines in 57% of the observations, with a much higher proportion of benzodiazepines and antidepressants in women than in men. Quantitative toxicologic analysis showed overdosing on medication in 16 suicide victims, with toxic levels in 11 of these. Systematic qualitative and quantitative toxicologic analysis made a significant contribution to the diagnosis of suicide by revealing either an unknown psychiatric treatment or a toxic level.     

Measuring carbon monoxide content in muscles

A method ist described to determine the CO-content in the tissue of muscles. The prepared tissue is pulverized in a swinging mill at the temperature of liquid nitrogen. Parts of the powder are weighed into headspace vessels. Carbon monoxide ist ejected by a formerly described method and measured gaschromatographically. The Fe-content is determined after an acid disintegration by AAS. Acute intoxications lead to higher CO-contents in heart than in periphere muscles. Chronic exposure to carbon monoxide does not produce these differences.     

Narcolepsy mimicking suicidal carbon monoxide poisoning

We present a case of narcolepsy mimicking suicidal carbon monoxide poisoning. The signs and symptoms of narcolepsy in this previously undiagnosed man were initially missed, which emphasizes the importance of extracting a detailed history of a decedent's behavior prior to his or her death. Narcoleptics are often involved in motor vehicle accidents. This report again demonstrates that narcolepsy and driving don't mix, even when the vehicle is stationary. We also briefly review the various sleep disorders.     

Non-intentional motor vehicle-related carbon monoxide deaths-revisited

A study of non-intentional, motor vehicle-related, carbon monoxide-related deaths was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade Country in Miami, FL (USA) during the years 1980-1984. A total of 15 cases were collected during that time period. These are presented in some detail. A discussion ensues that compares the similar circumstances of these cases, notably running the engine of an automobile in an enclosed space, with older reports in the literature which emphasized defective vehicle exhaust systems as the leading etiology for these deaths.     

Macroscopic, histological and toxicological aspects of early Gammarus pulex scavenging

Two cases of scavenging postmortem freshwater shrimps (Gammarus pulex) are presented. We report the two first illustrated observations of cutaneous postmortem injuries inflicted by a G. pulex population, a small freshwater crustacean, on two non putrefied drowning victims, and we describe their particular histological features and their potential in forensic investigations.     

Forensic aspects of 40 accidental autoerotic deaths in Northern Germany

Between 1983 and 2003, 40 accidental autoerotic fatalities have been investigated. in the Institute of Legal Medicine in Hamburg. Only 50% (n = 20) were autopsied (13 legal autopsies, 6 for scientific purposes and 1 for an insurance company). All the victims were males, aged between 13 and 79 years (among them five children and adolescents, the deceased mainly between 20 and 40 years). The paraphiliacs utilized a great range of devices and props as fetishism, sexual aids or pain-stimulating agents, like intimate feminine garments, ropes, chains, bondages, locks, pornographic magazines, condoms, rubber items, and chemical anaesthetics. The cause of death was strangulation in 20 cases (17× hanging, 3× ligature strangulation), 11× suffocation (8× under plastic bags, 3× with face-masks, 2× thoracic compression, 1× positional asphyxia, and 1× cocaine intoxication). Five cases without autopsy remained unclear because of missing morphological and toxicological findings; it could not be differentiated between asphyxiation/intoxication/natural disease, although the scene characteristics seemed to be typical for autoerotic deaths. It is emphasized that the findings at the scene, the morphological and toxicological examination of the dead body (full autopsy as prerequisite) by experienced investigators and the personal history of the deceased have to be evaluated very carefully and intensely to reconstruct the accidental fatal autoerotic course accurately and undoubtedly (to exclude the possibility of sexual homicide, neglected killing, or suicide).     

36例一氧化碳中毒分析

本文对36例59人因管道煤气引起一氧化碳中毒案例进行了分析. 资料分析 资料来源:本文收集1993年10月至1997年12月经东风汽车公司公安处检验鉴定的东风汽车公司范围内管道煤气用户中毒案共36例59人,其中死亡58人,仅1人经抢救存活.     

36例一氧化碳中毒分析

本文对36例59人因管道煤气引起一氧化碳中毒案例进行了分析。资料分析资料来源:本文收集1993年10月至1997年12月经东风汽车公司公安处检验鉴定的东风汽车公司范围内管道煤气用户中毒案共36例59人,其中死亡58人,仅1人经抢救存活。资料统计:季节分布:春季12例26人;夏季8例12人;秋季6例7人;冬季10例14人。一次中毒涉及人数:1人:19例;2人:11例;3人:3例;4人:1例;5人:1例。其中有3例中毒中有2人有逃生行为,1人经抢救存活。发现情况:36例均由邻居、家人、同事嗅到煤气味或尸臭味或因没去上班而发现。死后24ｈ内发现27例40人,24～48ｈ6例11人,48ｈ以…     

Lethal poisoning with carbon monoxide in children

Expert evaluations of 39 cases with lethal poisoning of children with carbon monoxide are analyzed. Epidemiological data are presented. Mechanism of toxic effect of carbon monoxide is discussed. Pathomorphological data and forensic chemical findings are analyzed.     

Experimental study on postmortem formation of carbon monoxide

Rats were drowned and kept immersed for 1 month in either boiled city water, or boiled or unboiled fresh water collected from a river. A small amount of carbon monoxide (CO) formed after death and a low carboxyhemoglobin (HbCO) saturation was found in blood and thoracic cavity fluid of the animals immersed in boiled city water and in boiled fresh water. A considerable amount of CO and a high HbCO saturation was observed in blood and thoracic cavity fluid in two out of three rats immersed in unboiled fresh water at 4-6 degrees C, and in one out of three at 6-16 degrees C. It is suggested that microorganisms in the water, in which the rats were drowned and kept immersed, and low temperatures of around 5 degrees C during storage, played an important role in the postmortem formation of carbon monoxide.