Fatal and nonfatal poisoning by hydrogen sulfide at an industrial waste site

An adult man (A) entered a pit to collect seepage at an industrial waste site in Japan. As he suddenly lost consciousness, three colleagues (B, C, D) entered the pit to rescue him. All of these men lost consciousness in the pit. Two workers (A and B) died soon after the accident, one worker (C) died 22 days after the accident, and one worker (D) survived. Since hydrogen sulfide gas was detected in the atmosphere of the pit, gas poisoning was suspected. Toxicological analyses of sulfide and thiosulfate, a metabolite of sulfide, in blood and urine of the victims were made using the extractive alkylation technique combined with gas chromatography/mass spectrometry (GC/MS). Sulfide was detected in the blood of A and B at levels of 0.13 and 0.11 mg/L, respectively, somewhat higher than in healthy persons. Thiosulfate was detected in whole blood of deceased victims A and B, in the plasma of deceased victim C, at concentrations of 10.53, 4.59, and 4.14 mg/L, respectively. These values were similar to those found in fatal cases of hydrogen sulfide poisoning. Thiosulfate was not detected in the plasma of survivor D. With respect to urine samples, thiosulfate was the highest in the non-acute death victim C (137.20 mg/L), followed by that in the survivor D (29.34 mg/L), and low (0.90 mg/L) and not detected in the acute death victims, A and B, respectively. Based on these results, all four patients were victims of hydrogen sulfide poisoning. The concentrations of thiosulfate in blood and urine were more useful than that for sulfide for determining hydrogen sulfide poisoning. Thiosulfate in urine was the only indicator of hydrogen sulfide poisoning in the non-fatal victim.     

Fatal recreational inhalation of enflurane

We report here a case of fatal enflurane poisoning by recreational inhalation, apparently the first published report of such a case.     

Fatal inhalation of butane-propane gas

Fatal intoxications with butane and/or propane are rare although the inhalation of such liquid gases in order to induce hallucinations is not uncommon amongst youngsters, the number of which is difficult to evaluate. Thus the possibility of gas intoxication should be taken into consideration in all cases of unclear death of youngsters, in which case the macroscopic and histological findings will be unspecific whereas the chemical-toxicological analyses, especially of the native brain, lung and liver tissue, lead to definite conclusions.     

硫化氢中毒者血中硫化氢的检测及特征鉴别

目的探讨硫化氢(H2S)中毒者血中H2S的检测及特征鉴别;方法取新鲜空白血液和5℃下保存1月、1年的血液各2m L,经微波低火加热1min后,吸取顶空气体100μL进行GC/PFPD-S、GC/MS检测;取相同样本进行酸化处理后进行检测;取疑似为H2S中毒者血液直接加热后进行检测。结果新鲜血液和5℃下保存1月、1年的血液均可检出H2S成分,但保存1个月以上的血液可同时检出二硫化碳(CS2)成分;酸化处理后的血液,H2S和CS2成分检出的含量明显比未加酸化的血液高;中毒者血液中除了检出H2S成分外,还检出甲硫醚成分。结论血液样本同时检出H2S和较大量的CS2时,不宜判定为H2S中毒,提示可能为腐败所致,而同时检出H2S和较大量的甲硫醚,则可做出H2S中毒的判断。     

A fatality caused by accidental production of hydrogen sulfide.

A 55-year-old male Caucasian truck driver was dead at the scene after breathing hydrogen sulfide (H(2)S) produced by an accidental transfer of sodium hydrogen sulfide (NaHS) from a tanker truck to a tank containing 4% sulfuric acid (H(2)SO(4)) and iron(II) sulfate (FeSO(4)). Autopsy of the decedent's body revealed pulmonary edema and passive congestion in lungs, spleen, kidneys, and adrenal glands. Postmortem biological samples were analyzed for carbon monoxide, cyanide, ethanol, and drugs. Since a potential exposure to H(2)S was involved, blood was also analyzed for sulfide (S(2-)). The analysis entailed isolating S(2-) from blood as H(2)S using 0.5M H(3)PO(4), trapping the gas in 0.1M NaOH, and determining the electromotive force using a sulfide ion specific electrode. Acetaminophen at a concentration of 14.3 microg/ml was found in blood, and metoprolol was detected in the blood, liver, and kidney samples. The blood S(2-) level was determined to be 1.68 microg/ml. It is concluded that the cause of death was H(2)S poisoning associated with a hazardous material accident in an industrial situation.     

顶空GC／MS法检验血液中的硫化氢

目的建立血液中硫化氢的气相色谱质谱联用分析方法。方法取心血3mL-5mL,置于20mL顶空瓶中,加入1g氯化钠,加3mL-5mL蒸馏水,加入2mol／L盐酸1mL,加盖密封,混匀后于80℃水浴中加热20min。取液上气体0．5mL进样分析。结果在中毒死亡者的心血中检出硫化氢,保留时间参考值为3．6min。结论该方法可用于刑事案件中硫化氢的快速分析。     

Fatal occupational accidents--the five-year Metro Dade County experience, 1979-1983

A study of fatal occupational accidents in Metropolitan Dade County between the years 1979 and 1983 was performed from the case files of the office of the medical examiner. A total of 147 cases were collected and were subdivided into 25 traffic-related and 122 nontraffic-related cases. Cases were then analyzed as to age, race, sex, cause of death, alcohol, toxicology, scene circumstances, and who was at fault in the accidental fatality. Traffic-related fatalities, comprising 17% of the cases, were young white males, commonly less than 45 years of age, who died of multiple injuries in the majority of instances while working as drivers on tractor trailers, migrant farms, or fruit produce trucks. The most common seenario was a vehicle-vehicle collision in which seat belts were not used and the decedent or the decedent's driver was at fault. Nontraffic-related fatalities, comprising 83% of the cases, were likewise white males, commonly less than 45 years of age, who died of multiple injuries in the majority of instances as construction workers or as loading/forklift operators. The most common seenario was one in which alcohol or drugs were not involved. While the "fault" was unassignable in the majority of cases, in those in which it could be, the deceased was at fault approximately half the time with the company or others at fault the other half.     

Fatal assumption

This article questions the assumption that mentally disabled individuals are regularly afforded competent counsel. It finds that such counsel is frequently not available and that our failure to challenge this assumption threatens to make illusory reform efforts by lawyers and mental health professionals alike. The presence of vigorous, independent counsel is critical, especially since legal rights are not self-executing. Such counsel serves an educative function in the entire process, seeks to assure the implementation of collateral legal rights, and avoids the “underidentification” of mental disability cases. These functions have become more important as the political and social climate has changed and as the subject matter has become more complex. A series of reform recommendations is offered to litigators, policy makers, judges, and legislators.     

Fatal verapamil poisoning

A case of fatal verapamil poisoning is reported. The pathologic and toxicologic findings are discussed.     

Fatal bromethalin poisoning

Bromethalin is a neurotoxin found in some rodenticides. A delusional 21-year-old male presented to a hospital with altered mental status the day after ingesting a bromethalin-based rodenticide. He died 7 days after his self-reported exposure to c. 17 mg bromethalin (equivalent to 0.33 mg bromethalin/kg). His clinicopathologic course was characterized by altered mental status, obtundation, increased cerebrospinal fluid pressure, cerebral edema, death, and diffuse histologic vacuolization of the white matter in the central nervous system seen on microscopic examination at autopsy. The presence of a demethylated form of bromethalin in the patient's liver and brain was confirmed by gas chromatography with mass spectrometry. Clinical signs and lesions observed in this patient are similar to those seen in animals poisoned with bromethalin. This case illustrates the potential for bromethalin ingestion to result in fatal human poisoning.     

Fatal cocaine poisoning

A case of lethal cocaine poisoning after parenteral application is described. The results of the quantitative gas chromatographic determination in blood, liver, urine, stomach contents and muscle are reported.     

Fatal arrow wounds

Two instances of fatal arrow wounds are described, one by a field-tip (target arrowhead), the other by a broadhead (large-game hunting arrowhead). The essential characteristics of the two types of wounds are discussed. In particular, the field-tip can closely simulate a bullet wound by causing a circular entrance hole with abraded margins, whereas the broadhead can create unusual radiating incised wounds.     

Fatal thyrotoxic crisis

Graves' disease is a form of hyperthyroidism. A rare complication of Graves' disease is thyrotoxic crisis. Although the crisis is frequently fatal, it is a distinctly unusual cause of sudden death. We investigated the case of a young woman with Graves' disease who died suddenly. Radioimmunoassay tests of thyroid function were used to establish the diagnosis.     

Fatal pedestrian-bicycle collisions

Although, fatal collisions between pedestrians and bicycles are relatively rare, they are still of forensic relevance because of the need to explore the circumstances of the accident. Based on three reconstructed cases, situation and injury patterns are presented that might prove useful in future cases: usually the person causing the accident is the cyclist while the pedestrian generally suffers more severe injuries; the situation at the site of accident is important for its reconstruction: end location of the persons involved in the accident, injuries and traces on pedestrians and cyclists, traces at the site of accident and on the bicycle; because of the lack of pre-crash traces and any eyewitness accounts, the pedestrian's injuries are the best starting point for the reconstruction of the accident; a characteristic wound on the lower leg of the pedestrian that reveals the initial impact between the front wheel and the leg is crucial not because of its seriousness, but because of its external morphology; the injuries that can be expected by the following impact between body and handlebar are unspecific and only minor; the most severe injuries to the pedestrian as a result of the accident are caused secondarily by falling and hitting the head on the road; the fall of the cyclist, however, corresponds to a throw-off followed by a sliding phase with less impact load when the head hits the ground [maximum abbreviated injury scale 1 (MAIS 1)]; the cyclists involved are mainly younger persons on fashionable bicycles (here: mountain bikes); in the great majority of cases, the injured pedestrians are frail, elderly people with a lower tolerance of trauma.     

Fatal mephenesin intoxication

This report describes a death related to the abuse of and intoxication by mephenesin. To the best of our knowledge, this is the first report case of lethal intoxication involving solely mephenesin and reporting mephenesin blood concentrations. The victim was a 48-year-old woman found unconscious at home. Resuscitation was unsuccessful. Toxicological analysis was performed on a blood sample collected during resuscitation. The results being negative, the body was exhumed for an autopsy, which revealed bronchial inhalation syndrome. Analysis in a second laboratory has revealed the presence of mephenesin in samples collected during autopsy. No other drug/toxin was found, and alcohol was negative. Reanalysis of the peripheral blood collected during resuscitation found a mephenesin concentration of 15.81 microg/mL (15-fold greater that the maximum concentration that would result from a single intake of a 500 mg formulation). The pathologist has concluded on a bronchial inhalation syndrome consecutive to a mephenesin overdose as the cause of death. The manner of this death is discussed in the light of the toxicological hair analysis and the medical past of the victim.     

Fatal propane-butane poisoning

Two lethal poisonings by butane and propane are described, and the corresponding concentrations in the body fluids and organ tissues are evaluated. One case appeared to be an accident after deliberate inhalation for butane, one was a suicide. The mechanism of the inhalation could be reconstructed in both cases. The concentrations in the biological material agreed well with observations in similar cases.     

Fatal meprobamate self-poisoning

A case involving a suicidal overdose resulting from the ingestion of 90 tablets (400 mg) of meprobamate is presented. The drug was quantified using a gas chromatograph equipped with a flame ionization detector (FID). While the blood level was 204.6 micrograms/ml, the maximum concentration was found in the heart (708 micrograms/g), confirming the cardiac toxicity of meprobamate. Other drugs were not detected.     

Fatal diltiazem poisoning

The diagnosis at postmortem examination and the results of the chemical analysis in a case of a diltiazem intoxication are presented. Two metabolites were identified as desacetyldiltiazem and N-desmethyldiltiazem.     

Fatal colchicine poisoning

In two cases, after i.v. injections of colchicine serum concentrations of 170 ng/ml and 240 ng/ml were found before death. Colchicine was extracted from serum with the aid of Extrelut extraction columns and analysed using HPLC. Urine was also analysed and the findings were confirmed by drawing a UV-curve for colchicine using the stop-flow method. In one case, colchicine was still detectable in urine 10 days after injection.