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%.     

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.     

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.     

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…     

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.     

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.     

Hyperuricemia in rats during acute carbon monoxide poisoning

The effect of carbon monoxide (CO) inhalation on plasma levels of uric acid and hypoxanthine in rats was investigated. Exposure to 3% CO caused respiratory arrest within about 2 minutes. The plasma uric acid level of CO-treated rats increased to 157% above that of ether-treated rats. When rats were exposed to 1% or 0.8% CO, the exposure periods until the onset of respiratory arrest were prolonged, and plasma uric acid levels at respiratory arrest were further elevated. Plasma uric acid levels at respiratory arrest increased with prolongation of the exposure periods. Under our experimental conditions, hypoxanthine or xanthine was not detected in plasma of CO-treated rats. These results are discussed in relation to the hyperuricemia in hemorrhagic shock or hypoxemia: CO-induced hyperuricemia can be attributed to the stimulated degradation of adenine nucleotides under tissue anoxia, and thus could be an excellent parameter of tissue anoxia.     

Fetal death due to nonlethal maternal carbon monoxide poisoning

Fetal death due to acute carbon monoxide poisoning is rarely reported in the medical literature. Of the eight cases found in literature review, only one documented the fetal carboxyhemoglobin concentration. This paper reports a fetal death due to accidental nonlethal maternal carbon monoxide intoxication in which both maternal and fetal carboxyhemoglobin concentrations were obtained. The corrected carboxyhemoglobin concentration was 61% at the time of death in utero, while the maternal carboxyhemoglobin was measured at 7% after one hour of supplemental oxygen. The authors review the mechanisms of fetal death and emphasize the different carbon monoxide kinetics in the fetal circulation.     

Liver damage in rats during acute carbon monoxide poisoning

Plasma leucine aminopeptidase (LAP) levels and respiration rates of isolated liver mitochondria were studied in carbon monoxide (CO)-poisoned rats sampled at respiratory arrest. An increase in LAP levels paralleled a decrease in the respiratory control ratio and the $\text{ADP}\text{O}$ ratio. The results suggest that the damage to mitochondria closely correlates with the liver damage in rats during acute CO poisoning.     

Suicidal asphyxiation by inhalation of automobile emission without carbon monoxide poisoning

Reported herein is the suicidal asphyxiation of a young man due to exhaustion of oxygen in the interior of a sealed automobile into which the exhaust emissions were diverted. His blood carboxyhemaglobin concentration was less than 5% saturation. The car was equipped with a catalytic converter and when tested, the exhaust carbon monoxide concentration was 0.01%.     

Carbon monoxide poisoning

This paper illustrates the remarkable fall of carbon monoxide poisoning due to the abolition of coal gas in the 1970 era and a corresponding decrease in suicide deaths. It enfolds the varying forms of suicide and accident according to age, sex and circumstance.     

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.     

Apoptotic and necrotic brain lesions in a fatal case of carbon monoxide poisoning

A 41-year-old man was accidentally exposed to carbon monoxide (CO) gas and found in a state of cardiopulmonary arrest while he took bath. After admission, he was resuscitated and underwent artificial ventilation in a comatose state and died about 19h later. Computed tomography (CT) examination disclosed bilateral low density area in the basal ganglia and the thalamus, a well-known finding in the CO intoxication. Necropsy, histological examination, DNA ladder assay gave the first line of evidence for the presence of apoptosis as well as necrosis in the human case of CO intoxication. TdT-mediated dUTP-biotin nick-end labeling (TUNEL) positive apoptotic cells were more predominant in the CA2 area than in CA1 area. There is general co-relation between the ratio of TUNEL-positive cells and the DNA laddering on the agarose gel. Basal ganglia and thalamus, which showed bilateral low density area in CT, were revealed to be severe edema. The two types of cell death occurred in the cortex, basal ganglia, hippocampus, thalamus, and cerebellum. Hypoxia caused by CO-hemoglobin formation alone cannot explain the phenomena.     

不同来源一氧化碳中毒死亡者血液中COHb含量分析

目的探索一氧化碳中毒存在的个体差异性,分析女性可能存在的抵御一氧化碳中毒的机制。方法收集207例不同来源的一氧化碳中毒死亡者血液,测量COHb含量,将案例按照不同的因素分类进行统计学分析。结果不同一氧化碳的来源对于死者的COHb浓度影响显著,而性别对于COHb浓度影响不显著,少年儿童和老年人有可能对COHb的抵御能力差于成年人。     

Suicidal carbon monoxide poisoning in an automobile with the engine switched off

Report is made on a suicidal carbon monoxide poisoning through entrance of exhaust fumes into the interior of the vehicle. The situation of discovery (switched-off engine) occasioned experimental examinations. The result showed that fatal carbon monoxide concentrations can obviously remain in the interior of a vehicle over a long period of time.     

New findings concerning the pathogenesis of acute carbon monoxide (CO) poisoning

The pathomechanism of carbon monoxide (CO) poisoning was studied by means of cardiopathological and neuropathological investigations in experimental CO intoxication. It has been shown that besides CO-hemoglobin association, the binding of CO to cytochromes is a significant factor. The latter is thought to be responsible for the cytotoxic phenomena. Combined ultrastructural and cytochemical studies have enabled differentiation between toxic, hypoxic, and mixed alternations.     

Deaths caused by carbon monoxide poisoning in an open environment (outdoors)

Three deaths as a result of inhalation of carbon monoxide from the exhaust fumes of automobiles are reported. All deaths occurred outside and not in a structure. The individuals were white males, ages 24 to 26 years. Blood carboxyhemoglobin concentrations ranged from 58 (in a decomposing body) to 81%. The three cases illustrate the fact that even in the outdoors death from carbon monoxide inhalation can occur if an individual is in close proximity to a rich source of carbon monoxide.