Suicide by Inhalation of Carbon Monoxide of Car Exhausts Fumes

Author(s): Murilo Sérgio Valente-Aguiar*, Teresa Magalhães, Ricardo Jorge Dinis-Oliveira*.

Journal Name: Current Drug Research Reviews
Formerly: Current Drug Abuse Reviews

Volume 11 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Carbon monoxide (CO) is a major and ubiquitous component of fire atmospheres produced when organic matter is burned in an inadequate supply of oxygen. Accidental poisoning by CO is common in cold climates where fireplaces, a gas, electric or kerosene heaters or grills are used inside ill-ventilated buildings. In the Brazilian Amazon, with its hot and humid climate, there is no need for the use of heaters and accidents may occur in cases of residential fires or burning of the forests for land use in agriculture.

Objective: We present a case of CO suicide of twenty-six-year-old men.

Methods: A forensic autopsy was performed to evaluate the circumstances, cause and medio-legal death etiology.

Results: Autopsy evidenced the typical but also not commonly published cherry-red color of the hypostasis, lungs and other organs, and the very fluid cherry-red blood. The cause of death was due to a massive CO inhalation.

Conclusion: While these poisonings are well recognized, and a vast number of publications on CO toxicity exist, both in an environmental and industrial context, suicide is infrequently encountered in forensic practice and the typical signs are rarely seen in the literature.

Keywords: Carbon monoxide, suicide, poisoning, forensic autopsy, ill-ventilated, residential fires.

[1]
Alves EA, Brandao P, Magalhaes T, Carvalho F, Dinis-Oliveira RJ. Fatal intoxications in the North of Portugal: 12 Years of retrospective analysis. Curr Drug Saf 2017; 12(1): 39-45.
[http://dx.doi.org/10.2174/1574886311666160724212407] [PMID: 27457768]
[2]
Gozubuyuk AA, Dag H, Kacar A, Karakurt Y, Arica V. Epidemiology, pathophysiology, clinical evaluation, and treatment of carbon monoxide poisoning in child, infant, and fetus. North Clin Istanb 2017; 4(1): 100-7.
[PMID: 28752154]
[3]
Byard RW. Carbon monoxide - The silent killer. Forensic Sci Med Pathol 2019; 15(1): 1-2.
[http://dx.doi.org/10.1007/s12024-018-0040-5] [PMID: 30390280]
[4]
Dinis-Oliveira RJ, Carvalho F, Moreira R, et al. Clinical and forensic signs related to chemical burns, a mechanistic approach. Burns 2015; 41(4): 658-79.
[http://dx.doi.org/10.1016/j.burns.2014.09.002] [PMID: 25280586]
[5]
Dinis-Oliveira RJ, Carvalho F, Magalhães T, Santos A. Postmortem changes in carbon monoxide poisoning. Clin Toxicol (Phila) 2010; 48(7): 762-3.
[http://dx.doi.org/10.3109/15563650.2010.484394] [PMID: 20849333]
[6]
Swain R, Behera C, Kishore S, Krishna K, Gupta SK. Suicidal asphyxiation by carbon monoxide within a polythene bag. Med Leg J 2017; 85(1): 35-7.
[http://dx.doi.org/10.1177/0025817216669286] [PMID: 27620849]
[7]
Blässer K, Tatschner T, Bohnert M. Suicidal carbon monoxide poisoning using a gas-powered generator. Forensic Sci Int 2014; 236: e19-21.
[http://dx.doi.org/10.1016/j.forsciint.2013.12.016] [PMID: 24418208]
[8]
Varlet V, De Croutte EL, Augsburger M, Mangin P. A new approach for the carbon monoxide (CO) exposure diagnosis: Measurement of total CO in human blood versus carboxyhemoglobin (hbco). J Forensic Sci 2013; 58(4): 1041-6.
[http://dx.doi.org/10.1111/1556-4029.12130] [PMID: 23692308]
[9]
França GVD. Medicina Legal. 10th Edition. Brasil: Guanabara Koogan 2015.
[10]
Milroy C, Parai J. Hydrogen sulphide discoloration of the brain. Forensic Sci Med Pathol 2011; 7(2): 225-6.
[http://dx.doi.org/10.1007/s12024-010-9210-9] [PMID: 21161701]
[11]
Sams RN, Carver HW, Catanese C, Gilson T. Suicide with hydrogen sulfide. Am J Forensic Med Pathol 2013; 34(2): 81-2.
[http://dx.doi.org/10.1097/PAF.0b013e3182886d35] [PMID: 23574866]
[12]
Larrey DJ. Memoirs of Military Surgery and Campaigns: Smith and Buisson 1812.
[13]
Myers RA, Snyder SK, Majerus TC. Cutaneous blisters and carbon monoxide poisoning. Ann Emerg Med 1985; 14(6): 603-6.
[http://dx.doi.org/10.1016/S0196-0644(85)80792-7] [PMID: 3994090]
[14]
He H, Gao Y, Li C, et al. Cutaneous blistering secondary to acute carbon-monoxide intoxication. Clin Exp Dermatol 2007; 32(1): 129-31.
[PMID: 16879450]
[15]
Dinis-Oliveira RJ. Drug overdose-induced coma blisters, pathophysiology and clinical and forensic diagnosis. Curr Drug Abuse Rev 2019; 11(1): 21-5.
[http://dx.doi.org/10.2174/18744 73711666180730102343] [PMID: 30058500]
[16]
Saukko P, Knight B. Knight’s forensic pathology. Boca Raton: CRC Press, Taylor & Francis Group 2016.
[17]
Luchini PD, Leyton JF, Strombech Mde L, Ponce JC. Jesus Md, Leyton V. Validation of a spectrophotometric method for quantification of carboxyhemoglobin. J Anal Toxicol 2009; 33(8): 540-4.
[http://dx.doi.org/10.1093/jat/33.8.540] [PMID: 19874665]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 11
ISSUE: 2
Year: 2019
Page: [145 - 147]
Pages: 3
DOI: 10.2174/2589977511666190716165121

Article Metrics

PDF: 20
HTML: 1

Special-new-year-discount