Poisoning deaths in China: Type and prevalence detected at the Tongji Forensic Medical Center in Hubei

106 Cases of homicide poisoning in China-A retrospective study

Homicidal poisoning has received limited scholarly attention, despite having recently increased in frequency in China, especially in rural areas, where it causes numerous deaths and disabilities. In this study, the author collected data on 106 cases of homicidal poisoning from 1995 to 2000. Of these cases 105 were found through website established by the Supreme Court of China, and one case was as an exception identified from the internet. There were 46 male perpetrators and 59 female perpetrators. The most common reason male perpetrators poisoned someone was conflict among neighbours (include residents in the same village) (ten cases), and the most common reason female perpetrators did so was an affair (13 cases). Compared with the perpetrators of general homicide, those who poisoned people included a high proportion of female, elderly, and well-educated individuals. This is related to the nonviolent nature of the poisoning, which requires no physical strength. Residents living in rural and urban areas chose poisoning based on convenience. People living in rural areas used pesticides most often, and people in urban areas have greater access to drugs or medications obtained at work or online. In this study, a total of 9.4% of the perpetrators were diagnosed with psychiatric disorders or psychosis. In all, the 106 cases resulted in 58 human deaths. Tetramine and paraquat caused many of the deaths, and this suggests a need for the government to manage and monitor these highly toxic pesticides. These cases are representative of issues in contemporary Chinese society, for example, population mobility, fierce competition.

Spontaneous Bilateral Basal Ganglia Haemorrhage Secondary to Methanol Poisoning

Methanol toxicity remains as major problem in the medical field.[1],[2],[3] With its active metabolite, formic acid often leads to severe metabolic acidosis and to some extend brain damaged.[4],[5],[6] We are reporting a case of brain hemorrhage at the right external capsule and left basal ganglia with mass effect and obstructive hydrocephalus in a methanol poisoning patient. A confused 29-year-old gentleman was brought into hospital. Initial investigation showed severe metabolic acidosis with raised anion gap. Initial brain CT scan was normal. Subsequently, serum methanol was reported to be high (112 mg/dL). Intravenous (IV) ethanol 10% was given without any delayed. As there was no improvement in his consciousness level, a repeat brain CT was performed and it showed multiple cerebral hemorrhage with obstructive hydrocephalus. Hence, clinicians should have high index of suspicion for cerebral hemorrhage in a patient with methanol toxicity, who presented with altered mental status and severe metabolic acidosis.

Retrospective analysis of 217 fatal intoxication autopsy cases from 2009 to 2021: temporal trends in fatal intoxication at Tongji center for medicolegal expertise, Hubei, China

This retrospective analysis of fatal intoxication case autopsies was performed at Tongji Center for Medicolegal Expertise in Hubei (TCMEH) from 2009 to 2021 to obtain up-to-date information on intoxication cases. The objective was to describe important data about evolving patterns in intoxication occurrences, enhance public safety policies, and assist forensic examiners and police in more efficient handling of such cases. Analyses based on sex, age, topical exposure routes, toxic agents, and mode of death were performed using 217 records of intoxication cases collected from TCMEH as a sample, and the results were compared with reports previously published (from 1999 to 2008) from this institution. Deaths from intoxications occurred at a higher rate in males than in females and were most common among individuals aged 30-39 years. The most frequent method of exposure was oral ingestion. The causative agents of deadly intoxications have changed when compared to the data from the previous 10 years. For instance, deaths from amphetamine overdoses are becoming more prevalent gradually, whereas deaths due to carbon monoxide and rodenticide intoxication have declined dramatically. In 72 cases, pesticides continued to be the most frequent intoxication cause. A total of 60.4% of the deaths were accidental exposure. Men died from accidents at a higher rate than women, although women were more likely to commit suicide. Particular focus is needed on the use of succinylcholine, cyanide, and paraquat in homicides.

Case Report: Venoarterial Extracorporeal Membrane Oxygenation Support for Caowu-Induced Cardiac Arrest

Introduction: Caowu, the main root of the Aconitum plant, is widely used in China. Aconitine is the main toxic component of Aconitum, which can cause a variety of malignant arrhythmias and lead to death. Four patients who developed malignant arrhythmia after drinking medicinal wine containing Caowu were reported in this study. Cardiac arrest occurred soon after symptom onset. All patients received venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after conservative medical treatment had failed. Patients who were directly transferred to our hospital received VA-ECMO support earlier than patients who were first treated at a local hospital. One patient received hemoperfusion in the emergency room before VA-ECMO support; the other three patients began hemoperfusion after VA-ECMO treatment. Surviving patients who received VA-ECMO earlier after symptom onset showed no obvious neurological complications. The patient who received a longer cardiopulmonary resuscitation time but received hemoperfusion before VA-ECMO had mild neurological complications. The mortality rate was 25% (1 of 4 patients). Two patients had thrombotic complications in venous vessels.

Conclusions: Cardiogenic shock due to refractory ventricular tachycardia caused by aconitine is lethal. Conservative supportive treatment did not provide a short-term antiarrhythmic effect and the cardiogenic shock was not well controlled. VA-ECMO treatment combined with hemoperfusion is promising temporary support to successfully treat aconitine-induced cardiogenic shock caused by refractory ventricular tachycardia.

Epidemiological Characteristics of Sedative-Hypnotics and Opioid Painkillers at High-Frequency Exposure

Drug poisoning has a high incidence and serious consequences in medical institutions; its epidemiological characteristics also directly affect the changes in national laws and policies and the implementation of local management policies. Chinese statistics on drug-related abnormal death cases generally come from judicial appraisal centers and medical units. However, due to differences in work content and professional restrictions, there are differences in information management forms, which makes it difficult for appraisers to conduct a professional and systematic analysis of drug-related cases. This article focuses on the analysis of epidemiological characteristics of sedative-hypnotics and opioid painkillers and their exposure patterns in cases of poisoning death by analyzing the annual report of the American Association of Poison Control Center, combined with the characteristics of drug exposure in China.

Pesticide poisoning deaths: a 19-year retrospective study of medicolegal autopsies in center Tunisia

Background

Pesticide poisoning is recognized as an important public health problem worldwide, especially in the developing countries, such as Tunisia, where these products are massively used in agriculture. The objective of our study was to document the forensic deaths caused by pesticides reported from a forensic center located in the coastal region of Tunisia.

Methods

This is a 19-year retrospective descriptive study of lethal pesticide poisoning victims autopsied in the Department of Forensic Medicine at Farhat Hached University Hospital in Sousse, Tunisia, from 1991 to 2009.

Results

One hundred thirty deaths were collected. The majority of the victims were female (62% vs 38%). The mean age was 27.46 years with the highest frequency of poisoning deaths occurring in the 21-30 years age group (34%). Eleven percent of the victims were found in a state of coma and 4.6% suffered from respiratory distress. Signs observed during the external examination of the bodies were as follows: bluish discoloration of the lips and the limbs (n = 130, 100%), leakage of urine (n = 13, 10%), foaming at the mouth or the nose (n = 66, 50.8%). The most frequent signs found during autopsies were pulmonary edema in 88.4% of the cases and multiorgan congestion in 86.9%. Toxicological screening of the stomach content was positive for pesticides in 126 cases. Intoxication was mainly caused by cholinesterase inhibitor insecticides: carbamates (50%) and organophosphorus compounds (31.5%). In 92% of cases, death was in a context of suicide.

Conclusions

This study shows that a large proportion of pesticide poisoning deaths are preventable. Prevention is, on the one side, by restricting the availability of pesticides and on the other side by promulgating more vigorous legislation concerning the manufacturing, the marketing, and the use of these products.

Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015

OBJECTIVES

Comprehensive and up-to-date data on fatal injury trends are critical to identify challenges and plan priority setting. This study provides a comprehensive assessment of poisoning mortality trends across Iran.

STUDY DESIGN

The data were gathered from various resources, including death registration systems, cemetery databases of Tehran and Esfahan, the Demographic and Health Survey of 2000, and three rounds of national population and housing censuses.

METHODS

After addressing incompleteness for child and adult death data separately and using a spatio-temporal model and Gaussian process regression, the level and trend of child and adult mortality were estimated. For estimating cause-specific mortality, the cause fraction was calculated and applied to the level and trend of death.

RESULTS

From 1990 to 2015, 40,586 deaths due to poisoning were estimated across the country. The poisoning-related age-standardized death rate per 100,000 was estimated to have changed from 3.08 (95% uncertainty interval [UI]: 2.32-4.11) in 1990 to 0.96 (95% UI: 0.73-1.25) in 2015, and the male/female ratio was 1.35 during 25 years of study with an annual percentage change of -5.4% and -4.0% for women and men, respectively. The annual mortality rate was higher among children younger than 5 years and the elderly population (≥70 years) in the study period.

CONCLUSIONS

This study showed that mortality from poisoning declined in Iran over the period from 1990 to 2015 and varied by province. Understanding the reasons for the differences of poisoning mortality by province will help in developing and implementing measures to reduce this burden in Iran.

Epidemiologic profile of deaths due to drug and chemical poisoning in patients referred to Baharloo Hospital of Tehran, 2011 to 2014

BACKGROUND

In developing countries with high mortality rates, poisoning is one of the most common causes of admission to emergency rooms. To minimize future deaths related to poisoning, the epidemiological profile of deceased individuals is essential.

METHODS

The medical records of all dead patients due to poisoning during 2011-2014 in Baharloo Hospital, Tehran, were evaluated. Exclusion criteria include: incomplete records, unknown causes of death, and persons less than 6 years of age. Data analysis was done by means of SPSS at the significance level of P < 0.05.

RESULTS

The study included 184 males and 65 females. The mean age range was 37.65 ± 16.78 years. The highest mortality rate was seen in the age range of 21-30 years (30.5%). The most common cause of poisoning was aluminum phosphide (101 cases). The average time of hospitalization was 3.61 days. Most deaths occurred during the first 10 days of admission with intentional poisoning being the most common type (81.5%).

CONCLUSION

The outcome of this study indicates that the main cause of death among young people is intentional poisoning with AIP. This study proves that a greater focus when diagnosing mental health patients, as well as an increase in restrictions when accessing lethal drugs and toxins, is crucial.

Poisoning deaths in China, 2006-2016

Objective

To provide a comprehensive overview of poisoning mortality patterns in China.

Methods

Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately.

Results

In 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6–6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25–64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25–44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females.

Conclusion

Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.

[The morphofunctional features of the heart associated with acute morphine poisoning during the period of chronic drug intoxication]

The objective of the present study was to improve forensic medical diagnostics of the cases of death associated with morphine poisoning based on the investigation into the biochemical changes in blood and pericardial fluid as well as morphological changes in the myocardial structures. The studies were carried out with the use of thin-layer chromatography, colorimetric and morphological methods including hematoxylin and eosin, Lee's methylene blue, and van Gieson's picrofuscin staining. These techniques were supplemented by light and polarization microscopy. The study has demonstrated the presence of morphine in 99.16% of the blood and pericardial samples obtained in the cases of poisoning. The comparison of the results of biochemical and pathomorphological studies of the myocardium made it possible to evaluate the functional and morphological conditions of the heart in the case of acute morphine poisoning during the period of chronic drug intoxication.

Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis

Objective:

To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period.

Materials and Methods:

The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates), socio-demographic pattern, and the nature of the poison were noted.

Results:

A total of 1860 poisoning cases (80 deaths) were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62%) were males. The majority of cases were seen in the 21-30 age group (41.24%). The poisonings were largely deliberate self-harm (n = 1,755; 94.35%), followed by accidental (n = 85; 4.57%). Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause.

Conclusion:

The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.

Human fatality due to thallium poisoning: autopsy, microscopy, and mass spectrometry assays

Thallium has been responsible for many intoxications since its discovery; however, toxicological profiles for thallium in human fatalities have not been updated recently. Autopsy, microscopic investigations, and toxicological analyses were performed on a married couple who died from thallium sulfate intended homicidal poisoning. The distribution of thallium was established by inductively coupled plasma mass spectrometry with hair samples showing the highest thallium concentration. Electron microscopy revealed a dystrophic condition of hair with disorganized cuticle and atrophy of the hair bulb. Thallium interacts with cells at different levels, with prominent ultrastructural injuries in the mitochondria and endoplasmic reticulum, and high concentration of electron dense granules observed in the cytoplasm and mitochondria of several organs. Alopecia, toxic encephalopathy, and peripheral neuropathy were diagnosed in the victims and suggested to be crucial implications for thallium poisoning. The analytical procedures used in this case are of considerable forensic importance in the diagnosis of thallium poisoning.

A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol

BACKGROUND AND AIMS

Unrecorded alcohol constitutes about 30% of all alcohol consumed globally. The aims of this systematic review were to determine the epidemiology (occurrence, types, prevalence) of unrecorded alcohol consumption in different countries/regions, analyse the chemical composition of unrecorded alcohol and examine health outcomes caused by the consumption of unrecorded alcohol, based on either epidemiology or toxicology.

METHODS

A systematic search for, and qualitative analysis of, papers with empirical results on the different categories of unrecorded alcohol, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Unrecorded alcohol was widespread in all regions of the world. Artisanal fermented beverages and spirits were the most common categories of unrecorded alcohol globally, and were available on all continents. In India, industrially produced spirits (country spirits) were most prevalent. In Russia and countries of the former Soviet Union, surrogate alcohols complemented artisanal spirits. Cross-border shopping was the most prevalent method of obtaining unrecorded alcohol in parts of Europe. Ethanol was the most harmful ingredient of unrecorded alcohol, and health consequences due to other ingredients found in unrecorded alcohol were scarce. However, as unrecorded alcohol is usually the least expensive form of alcohol available in many countries, it may contribute to higher rates of chronic and irregular heavy drinking.

CONCLUSIONS

Very large amounts of alcohol are produced globally that go unrecorded. The primary harm from this kind of alcohol arises from the fact that it is typically much cheaper than licit alcohol.

Evaluation of poisoning deaths in the Cukurova Region, Turkey, 2007-2011

Complications of substances detected in poisoning deaths are important in order to observe changes in poisoning patterns and to monitor effects of preventive work. The aim of the present study was to describe the characteristics of substances investigated and detected in poisoning deaths by Adana Group Authority of the Council of Forensic Medicine, Department of Forensic Chemistry, Cukurova, Turkey, between 2007 and 2011 retrospectively. A total of 7681 examinations were performed, of which, 7% (n = 564) determined positive for at least one compound investigated. Ages of the cases ranged from 1 to 97 years (mean ± SD: 36.10 ±19.16). Carbon monoxide (CO) poisonings were found most frequently with an incidence of 27.0%, followed by prescription medications with 25.0%. Illegal drug poisonings were present in 20.0% of blood and urine samples analyzed. Pesticides, mostly endosulfan, were found in 13.0% of the 564 cases investigated. In the blood samples analyzed, methyl and ethyl alcohol were detected in 14.0% and volatile substances in 1.0%. Overall, this study has managed to contribute substantial additional information regarding the epidemiology of poisoning in Cukurova region, Southern Turkey. The results confirm other epidemiological data that indicate CO as the major cause of poisoning deaths in Turkey.

Prevalence of Non-drug Poisoning in Patients Admitted to Hospitals of Mazandaran University of Medical Sciences, 2010-2011

Introduction:

Every year million people have poisoning. Most of them will duo to severity of complications. Identifying the pattern of poisoning will help to prevent of them. Because of the non-medicine substance have a wide variety range and easily is used among people, so the aim of this study was to determine frequency of non-medicinal poisoning according to 10th revision of International Classification of Diseases (ICD-10) in hospitalized patient.

Method:

This is a descriptive cross section study. The medical records of inpatient hospitalized in hospitals of Mazandaran University of Medical Sciences during 2010-2011 were reviewed. The ICD-10 codes for retrieval patient records were T51-T65 which was included alcohol, organic solvent, halogen derivatives, corrosive substance, detergent, metals, inorganic substance, carbon monoxide, gases, fumes and vapors, pesticide, noxious substance has eaten as seafood, noxious substance has eaten as food, unspecified substances. The data were analyzed with SPSS and descriptive and X2 statistics.

Results:

Of the 1546 in patient with diagnosed poisoning, the 581(37.5%) were non medicine poisoning. Median of age 29±17 years, 231(51.6%) female, 300(51.6%) are intentional, and the most material were insecticide276 (47.5%), sting 96(16.3%) and alcohol 76(13%) and organic solvent 40 cases and the 38(95%) of them was children.

Conclusion:

According the result of this study the most cause of poisoning was insecticides. Preventive program for all the groups are suggested and for intentional self-harms and suicide attempted the program of consultation is necessary.

Carbon monoxide-related deaths in Ankara between 2001 and 2011

OBJECTIVE

The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey.

METHODS

Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10,720 medico-legal autopsy reports were obtained and reviewed by the authors.

RESULTS

Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100,000), followed by Karabuk (8.3/100,000), Cankiri (7.8/100,000) and Kirsehir (5.0/100,000).

DISCUSSION AND CONCLUSION

These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Risk and prognostic factors of inpatient mortality associated with unintentional insecticide and herbicide poisonings: a retrospective cohort study

Introduction

Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings.

Methods

We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).

Results

There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42).

Conclusions

We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.

Trends in poisoning hospitalization and mortality in Taiwan, 1999-2008: a retrospective analysis

Background

Subjects with non-fatal poisoning may be left with permanent, disabling sequelae, and the resultant long-term use of medical services smay be a burden on the public health care system. The objective of this study was to describe the epidemiology of poisoning in Taiwan from 1999 to 2008.

Methods

We analyzed poisoning-related data of mortality rates sourced from official Taiwanese vital statistics and of hospitalization from the National Health Insurance (NHI) Research Database. The data were age-adjusted to the year 2000 Standard Population to determine 10-year hospitalization and mortality rate trends, which we stratified according to gender, age, and poisoning agent. Poisson regression was used to investigate the trends.

Results

There were 20,260 deaths and 210,021 hospitalizations related to poisoning, with mortality and hospitalization rates of 8.21 per 100,000 and 86.30 per 100,000 population, respectively. Males exhibited higher rates of mortality and hospitalization as a result of poisoning, with the highest risk in those aged 65 years or older. Medicinal drugs followed by pesticides were the two most common agents of poisoning. There was an increasing trend of both poisoning-related mortality and hospitalization rates during the study period, with a greater increase occurring in the hospitalization rate than in the mortality rate.

Conclusions

We found the males aged 65 years or older were at highest risk of poisoning, with medicinal drugs being the leading cause. Hospitalization rates increased more than mortality rates over the 10-year period. Appropriate poisoning prevention programs need to be developed. We should strengthen case management and improve access to health services to increase survival in cases of poisoning.

Seven cases of fatal aconite poisoning: forensic experience in China

This paper presents seven fatal cases of aconite poisoning encountered in the Tongji Center for Medicolegal Expertise in Hubei (TCMEH), China, from 1999 to 2008 retrospectively. In six of the cases, deaths occurred after drinking homemade medicated liquor containing aconite, and in one case death was due to ingestion of traditional Chinese medication containing aconite. Forensic autopsy and pathological examinations ruled out the presence of physical trauma or life-threatening diseases. Diagnosis of aconite poisoning was made after postmortem toxicological analysis. Animal experiment was performed in one case demonstrating that the medicated liquor could cause death rapidly. We present the autopsy and histopathological findings, toxicological analysis, and results of animal experiment done on samples from those seven cases. As an important herbal Chinese medicine, Aconitum species deserve special attention, especially because it contains poisonous alkaloids.

Prevalence of anticoagulant rodenticide poisoning in humans and animals in France and substances involved

INTRODUCTION

Anticoagulant rodenticides have been used for over 50 years to control rodent populations. Since their first introduction, resistance developed in rodents, and second-generation products, more active but also more toxic, have been marketed. These compounds are currently being reviewed under European Regulations.

METHODS

The purpose of this work is to describe anticoagulant poisoning based on retrospective data from French human and animal poison control centers. Cases from 2004 to 2007 were collected.

RESULTS

Overall, the proportion of anticoagulant exposure reported to the Lyon poison control center appeared very limited and mostly occurred in young children, with no or very limited clinical severity. Some cases also occurred after intentional use of anticoagulants in adults. Circumstances of exposure are predominantly accidental in man (77%). In animals, both domestic and wild species, anticoagulant exposure seems more common, and often more accompanied by clinical signs. Among domestic species, dogs represent over 60% of the cases: in wildlife hares and rabbits account for almost 50% of the submitted cases, followed by predators and scavengers.

CONCLUSION

Rodenticides involved are representative of the market share of anticoagulants, for human and domestic animal exposures. In wildlife, bromadiolone and chlorophacinone are by far the most important products, being the only ones registered for field use. There is no report of mortality in the human data, and less than 1% of all exposure cases in domestic animals were fatal.

Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug-alcohol interactions and poly-drug use

Over a 10-year period (1998-2007) all deaths in Sweden classified by forensic pathologists as fatal drug poisonings (N = 6894) were retrieved from a toxicology database (TOXBASE) belonging to the National Board of Forensic Medicine. The deaths were further classified as suicides N = 2288 (33%), undetermined N = 2260 (33%) and accidental N = 2346 (34%). The average age (± SD) of all victims was 49.1 ± 15.9 years and men 47.4 ± 15.6 years were 5-year younger than women 52.2 ± 15.8 years (p < 0.01). Most of the deceased (78%) were poly-drug users although a single drug (mono-intoxications) was found in 22% of all poisoning deaths (p < 0.001). The number of drugs in blood samples varied from 1 to 12 with a median of 3-4 per case. Mono-intoxication deaths were mostly ethanol-related (N = 976) and the mean and median blood-alcohol concentration (BAC) was 3.06 g/L and 3.10 g/L, respectively. The BAC decreased as the number of additional drugs in blood increased from 2.15 g/L with one drug to 1.25 g/L with 6 or more drugs. The mean (median) concentrations of non-alcohol drugs in mono-intoxication deaths were morphine (N = 93) 0.5mg/L (0.2mg/L), amphetamine (N = 39) 2.0mg/L (1.2mg/L), dextropropoxyphene (N = 33) 3.9 mg/L (2.9 mg/L), dihydro-propiomazine (N = 32) 1.6 mg/L (1.0mg/L) and 7-amino-flunitrazepam (N = 28), 0.4 mg/L (0.3mg/L). Elevated blood morphine in these poisoning deaths mostly reflected abuse of heroin as verified by finding 6-monoacetyl morphine (6-MAM) in the blood samples. When investigating drug poisoning deaths a comprehensive toxicological analysis is essential although the results do not reveal the extent of prior exposure to drugs or the development of pharmacological tolerance. The concentrations of drugs determined in post-mortem blood are one element in the case. The autopsy report, the police investigation, the findings at the scene and eye-witness statements should all be carefully considered when the cause and manner of death are determined.