Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning

Severe necrosis of oesophageal and gastric mucosa in fatal methanol poisoning

Methanol is a potent neurotoxic substance that causes severe metabolic acidosis and serious neurological disorders. Most of the cases are accidental exposures to drinking beverages contaminated with methanol. There are few articles reporting pure methanol intoxication; however, it is well known that small quantities of pure methanol causes blindness and death, the minimum lethal dose being 50-100 ml.A case report is presented of a 67-year-old woman, who committed suicide by ingestion of 500 ml of absolute methanol. Despite symptomatic and supportive intensive care, the woman died 23 h after hospital admission due to metabolic acidosis and multiple organ dysfunction syndrome. A complete medico-legal autopsy was performed. Grossly, there was complete detachment of the oesophagus mucosa and brownish discolouration of the gastric mucosa. Histological findings showed diffuse haemorrhagic necrosis of the stomach mucosa and intense acute inflammatory infiltration of the lamina propria. To our knowledge, this is the first autopsy report of such severe digestive injuries. A discussion and review of the recent literature on the subject are given.

Agrochemical Poisoning

A general increase in the use of chemicals in agriculture has brought about a concomitant increase in the incidence of agrochemical poisoning. Organophosphates are the most common agrochemical poisons followed closely by herbicides. Many agricultural poisons, such as parathion and paraquat are now mixed with a coloring agent such as indigocarmine to prevent their use criminally. In addition, paraquat is fortified with a “stenching” agent. Organo-chlorines have an entirely different mechanism of action. Whereas organophosphates have an anticholinesterase activity, organochlorines act on nerve cells interfering with the transmission of impulses through them. A kerosene-like smell also emanates from death due to organochlorines. The diagnosis lies in the chemical identification of organochlorines in the stomach contents or viscera. Organochlorines also resist putrefaction and can be detected long after death. Paraquat has been involved in suicidal, accidental, and homicidal poisonings. It is mildly corrosive and ulceration around lips and mouth is common in this poisoning. However, the hallmark of paraquat poisoning, especially when the victim has survived a few days, are the profound changes in lungs. Other agrochemicals such as algicides, aphicides, herbicide safeneres, fertilizers, and so on, are less commonly encountered. Governments in most countries have passed legislations to prevent accidental poisonings with these agents. The US government passed the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) in 1962 and the Indian government passed The Insecticides Act in 1968. Among other things, these acts require manufacturers to use signal words on the labels of insecticides, so the public is warned of their toxicity and accompanying danger.

Mercury in the environment: effect on health and reproduction

Mercury is a heavy metal that is found naturally in the environment in various forms. Human activity can release mercury into the air, water, and soil. Mercury is also released into the environment after its conversion to methylmercury by bacteria. Mercury was once used in medicine, but the medicinal aspect changed because of its devastating poisoning effect on humans and animals. Today, mercury is one of the most potent neurotoxins known, having a number of adverse health effects in animals and humans. As the sources of mercury are many, the general population is exposed to mercury in day-to-day life, in occupational settings, and in cases of accidental exposure. In addition, ignorance about the use of mercury in cosmetics and religious materials has opened an additional source of exposure. Therefore, making people aware of mercury's effects on health, its sources of entry into the environment, and its chelating remedies becomes a necessity so that strategies can be adopted to minimize use and exposure.

Coma blisters in a case of fatal theophylline intoxication

A case of fatal poisoning caused by theophylline toxicity (serum level 127 micro g/ml) is presented. At external examination, skin blisters on regions exposed to pressure were distinctive. Histologic examination demonstrated subepidermal bullae with eosinophilic necrosis of the eccrine sweat gland coil but no epidermal necrosis, vascular changes, or inflammatory infiltrate. To the authors' knowledge, this is the first description of coma blisters in a case of theophylline intoxication.