Fatal inhalation of volcanic gases in three tourists of a geothermal area

A serial analysis of hydrogen sulfide poisoning: three group accidents

Hydrogen sulfide (H2S) is a powerful toxic gas in workplace incidents, and it poses a threat to colleagues or family members involved in rescues, leading to a "domino effect" of multiple deaths. In this report, we describe three incidents in which 10 people died, and we present the results of the analyses performed in different incidents, including paper pulp pit, sewer, and sewage well. We provide the macroscopic and morphological findings of ten victims, which include conjunctival hemorrhage, corneal erosion, pulmonary edema, and pulmonary hemorrhage. Additionally, we observed large amounts of waste paper pulp or black sludge in the upper and lower respiratory tracts or upper and lower gastrointestinal tracts of six victims. Furthermore, we conducted a toxicological examination of the victims' blood sulfide using an alkylation extraction approach combined with gas chromatography/mass spectrometry. The sulfide concentrations in the 10 victims ranged from 0.06 to 6.72 mg/L.

Helium Suicide, a Rapid and Painless Asphyxia: Toxicological Findings

Suicide by helium inhalation has become increasingly common in the last few decades in Europe and the US because it produces a quick and painless death. Inhaled-gas suicides can easily be assessed through death scene investigation and autopsy. However, helium is a colorless and odorless inert gas that unfortunately cannot be detected using standard toxicological analysis. A successful gas analysis was performed following the suicide of a 17-year-old female. For the detection of helium, central/peripheral blood samples and gaseous samples from the esophagus, stomach, and upper and lower respiratory airways (from the trachea and the primary left and right bronchia) were collected with a gastight syringe, ensuring minimal dilution. Qualitative analyses were positive in all gaseous samples. Quantitative analyses were performed using a special gas-inlet system with a vacuum by which the sample can be transferred to a mass spectrometer, reducing the risk of contamination. Helium concentrations were 20.16% from the trachea, 12.33% from the right lung, and 1.5% from the stomach. Based on the high levels of helium, the cause and manner of death were assessed as asphyxia suicide by inhalation of helium. Therefore, toxicological analyses should always be applied in order to gain evidence of inhaled gas in gaseous samples.

Forensic diagnostic approach of peri-volcanic area fatalities: About two cases at piton de la Fournaise

The Piton de la Fournaise, located on the island of Reunion, is a particularly active volcano that gathers many observers during its eruptions. However, this activity, if not supervised, can involve many risks. During the eruption of Piton de la Fournaise in April 2021, two geology students camped in the peri-eruptive zone. They were found dead 48 h later on the surface and were not in the immediate vicinity of a fumarole. The autopsy revealed superficial traumatic injuries, which did not explain the death. Internal examination of both victims showed a nonspecific asphyxia syndrome and hemorrhagic pulmonary edema, with no cause of death identified. Microscopic analysis confirmed the autopsy findings without providing new diagnostic elements. Toxicological analysis revealed abnormally high levels of sulfurous gases (H₂ S and SO₂ ) in the blood and lungs of both victims. The interpretation of all the forensic data allows us to conclude that the death was secondary to volcanic sulfur gas poisoning, despite the atypical context of this event. However, the meteorological conditions of the night of the event may have caused a stagnation of toxic volcanic gases on the ground, with concentrations high enough to cause fatal intoxication in these two persons, although they were not in a confined environment as is usually the case in cases of sulfur poisoning. The dramatic outcome of this event required a rigorous forensic diagnostic approach and reminds us of the need to respect safety conditions in peri-volcanic areas.

Suicide by Pesticide (Phorate) Ingestion: Case Report and Review of Literature

It has been estimated that approximately one in seven of all global suicides is due to pesticide self-poisoning, mostly in rural areas of developing countries. Organophosphorus (OP) compounds are a group of pesticides exerting their toxicological effects through non-reversible inhibition of the enzyme acetylcholinesterase (AChE). Among these compounds, phorate (thimet) is one of the most dangerous compounds, the use of which is restricted in many countries. A case of intentional suicide after phorate ingestion in a 24-year-old Bengali male is described. This is the second case of suicidal ingestion of phorate reported in the forensic literature, and the first presenting complete toxicological findings.

Interpreting sulfhemoglobin and methemoglobin in patients with cyanosis: An overview of patients with M-hemoglobin variants

INTRODUCTION

Methemoglobin (MetHb) and sulfhemoglobin (SHb) measurements are useful in the evaluation of cyanosis. When one or both values are elevated, additional analysis is important to establish the etiology of the disorder. Methemoglobinemia occurs from acquired or hereditary causes with diverse treatment considerations, while true sulfhemoglobinemia is only acquired and treatment is restricted to toxin removal. Some toxic exposures can result in a dual increase in MetHb and SHb. Hereditary conditions, such as M-Hemoglobin variants (M-Hbs), can result in increased MetHb and/or SHb values but are clinically compensated and do not require treatment if they are cyanotic but otherwise clinically well.

METHODS

Herein, we report 53 hemoglobin variant cases that have associated MetHb and SHb levels measured by an adapted Evelyn-Malloy laboratory assay method.

RESULTS

Our data indicate M-Hbs cause variable patterns of MetHb and SHb elevation in a fairly reproducible pattern for the particular variant. In particular, α globin chain M-Hbs can mimic acquired sulfhemoglobinemia due to an isolated increased SHb value.

CONCLUSION

If the patient appears clinically well other than cyanosis, M-Hbs should be considered early in the evaluation process to differentiate from acquired conditions to avoid unnecessary testing and treatment regimens and prompt genetic counseling.

Fatal poisoning of four workers in a farm: Distribution of hydrogen sulfide and thiosulfate in 10 different biological matrices

We evaluate the distribution of sulfide and thiosulfate (TS) in biological samples of four dairy farmers died inside a pit connected to a manure lagoon. Autopsies were performed 4 days later. Toxicological analyses of sulfide and TS were made using an extractive alkylation technique combined with gas chromatography/mass spectrometry (GC/MS). Autopsies revealed: multiorgan congestion; pulmonary edema; manure inside distal airways of three of the four victims. Sulfide concentrations were cardiac blood: 0.5-3.0 μg/mL, femoral blood: 0.5-1.2 μg/mL, bile: <0.1-2.2 μg/mL; liver 2.8-8.3 μg/g, lung: 5.0-9.4 μg/g, brain: 2.7-13.9 μg/g, spleen: 3.3-6.3 μg/g, fat: <0.1-1.5 μg/g, muscle: 2.6-3.5 μg/g. TS concentrations were cardiac blood: 2.1-4.9 μg/mL, femoral blood: 2.1-2.3 μg/mL, bile: 2.5-4.4 μg/mL, urine: <0.5-1.8 μg/mL; liver <0.5-2.6, lung: 2.8-5.4 μg/g, brain: <0.5-1.9 μg/g, spleen: 1.2-2.9 μg/g, muscle: <0.5-5.6 μg/g. The cause of death was assessed to be acute poisoning by hydrogen sulfide (H₂S) for all the victims. Manure inhalation contributed to the death of three subjects. The measurement of sulfide and TS concentrations in biological samples contributed to better understand the sequence of the events. Subjects 3 provided the highest concentration of sulfide in brain, thus, supporting the hypothesis of a rapid loss of consciousness and respiratory depression. One by one, the other farmers entered the pit in attempts to rescue the coworkers but collapsed. Despite the rapid death, subject 3 was the only one with TS detectable in urine. This could be due to differences in metabolism of H₂S.

Metabolism of Sulfur-Containing Amino Acids: How the Body Copes with Excess Methionine, Cysteine, and Sulfide

Metabolism of excess methionine (Met) to homocysteine (Hcy) by transmethylation is facilitated by the expression of methionine adenosyltransferase (MAT) I/III and glycine N-methyltransferase (GNMT) in liver, and a lack of either enzyme results in hypermethioninemia despite normal concentrations of MATII and methyltransferases other than GNMT. The further metabolism of Hcy by the transsulfuration pathway is facilitated by activation of cystathionine β-synthase (CBS) by S-adenosylmethionine (SAM) as well as the relatively high KM of CBS for Hcy. Transmethylation plus transsulfuration effects catabolism of the Met molecule along with transfer of the sulfur atom of Met to serine to synthesize cysteine (Cys). Oxidation and excretion of Met sulfur depend upon Cys catabolism and sulfur oxidation pathways. Excess Cys is oxidized by cysteine dioxygenase 1 (CDO1) and further metabolized to taurine or sulfate. Some Cys is normally metabolized by desulfhydration pathways, and the hydrogen sulfide (H2S) produced is further oxidized to sulfate. If Cys or Hcy concentrations are elevated, Cys or Hcy desulfhydration can result in excess H2S and thiosulfate production. Excess Cys or Met may also promote their limited metabolism by transamination pathways.

Acute myocardial injury following hydrogen sulfide poisoning

BACKGROUND

Hydrogen sulfide poisoning can cause severe myocardial injury, but the damage is subtle and can be easily misdiagnosed. This report presents the dynamic observation of myocardial injury associated with hydrogen sulfide poisoning.

CASE REPORT

Two young men presented with symptoms of "lightning-like" death immediately after entering a tank. They were found and rescued in 20 min at a time when they were already in a coma. Case 1 had no spontaneous breathing and pulse, while case 2 had spontaneous breathing and a pulse. Upon transfer to a local hospital, case 1 received continuous cardiopulmonary resuscitation which led to the recovery of his heart rate 3 min after arriving at the hospital. However, the patient remained in a Glasgow coma scale of 3. He was transferred to our hospital where he, unfortunately, died on the seventh day due to multiple organ failure. Case 2 was also transferred to the intensive care unit in our hospital and on the fourth day of hospitalization, the patient presented ST-segment elevation and dynamic changes in markers of myocardial injury. Changes in electrocardiogram and markers of myocardial injury were monitored and examination improved through conventional echocardiography, coronary artery CT, radionuclide myocardial perfusion imaging, and two-dimensional speckle tracking imaging strain. The treatment gradually improved the patient's myocardial injury and was discharged from the hospital.

CONCLUSION

Hydrogen sulfide poisoning can cause damage to myocardial function and the damage can be more insidious in nature and with a delayed onset. Recovery from myocardial damage can be very slow.