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Nakamura A, Ninomiya K, Fukasawa M, Ikematsu N, Kawakami Y. Accidental carbon dioxide poisoning due to dry ice during a funeral wake: An autopsy case. Leg Med (Tokyo) 2023; 64:102298. [PMID: 37506607 DOI: 10.1016/j.legalmed.2023.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
We report the autopsy case of a male in his 60 s diagnosed with carbon dioxide (CO2) poisoning caused by dry ice for cooling in a coffin during a funeral wake. He was last seen alive, clinging to his family member's body with his head inside the coffin. The autopsy and histological findings did not indicate a specific cause of death. To confirm the concentrations of CO2 and oxygen (O2) in the coffin, an experiment was conducted to reconstruct the scene. Based on the experimental results, 9 h after placing dry ice, the CO2 concentration at the estimated closest point to his head was 24%, a lethal level for CO2 poisoning. Contrastingly, although the concentration of O2 had fallen, it never reached a lethal concentration at any of the determination points during the experiment, thereby ruling out asphyxia as a cause of death. Based on our findings, we concluded that the cause of his death was CO2 poisoning. Forensic pathologists tend to overlook CO2 poisoning unless suspected, as it does not exhibit specific autopsy findings. For the diagnosis of CO2 poisoning, it is essential to collect detailed information about the deceased and the scene of death. The toxicity of CO2 itself is not well known, although dry ice is widely available to the public. In order to make its risk well known, it is necessary to inform people about the dangers of using dry ice.
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Affiliation(s)
- Ayano Nakamura
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Kenji Ninomiya
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
| | - Maki Fukasawa
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Natsuki Ikematsu
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Yuka Kawakami
- Department of Radiology, University of the Ryukyus Hospital, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
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2
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Righi FA, Brown P, Hagen C, Quinton RA. Suicide by Gaseous Displacement of Atmospheric Oxygen With Carbon Dioxide From Dry Ice Sublimation. Am J Forensic Med Pathol 2022; 43:369-371. [PMID: 35642774 DOI: 10.1097/paf.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Deaths from gaseous substances can occur from exposure to toxic gases or from accumulation of nontoxic gases that displace oxygen. We present a 38-year-old man with no known medical history, who was found deceased in a small bathroom with blankets and towels shoved under the door from the inside.At autopsy, the decedent was found to be in a moderate state of decomposition. There was mild pulmonary congestion, with no other significant findings. Standard postmortem toxicology on femoral blood was noncontributory.A search of the decedent's cell phone revealed statements and internet searches regarding carbon dioxide (CO 2 ) and asphyxia using dry ice. A journal entry also outlined a suicide plan using large amounts of dry ice, which was enacted by placing a laundry basket of dry ice into a bathtub containing water. Based on the investigation, the cause of death was determined to be asphyxia from displacement of oxygen with CO 2 .Dry ice sublimates into gaseous CO 2 , which quickly accumulates, with concentrations of 10% or more, rapidly becoming life-threatening. There are no pathognomonic autopsy findings seen in CO 2 -related asphyxia. In these circumstances, scene investigation is the most important factor in determining cause of death.
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Affiliation(s)
- Fabiola A Righi
- From the Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Day BA, Wilmer CE. Genetic Algorithm Design of MOF-based Gas Sensor Arrays for CO 2-in-Air Sensing. SENSORS (BASEL, SWITZERLAND) 2020; 20:E924. [PMID: 32050552 PMCID: PMC7039381 DOI: 10.3390/s20030924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 01/17/2023]
Abstract
Gas sensor arrays, also known as electronic noses, leverage a diverse set of materials to identify the components of complex gas mixtures. Metal-organic frameworks (MOFs) have emerged as promising materials for electronic noses due to their high-surface areas and chemical as well as structural tunability. Using our recently reported genetic algorithm design approach, we examined a set of 50 MOFs and searched through over 1.125 × 1015 unique array combinations to identify optimal arrays for the detection of CO2 in air. We found that despite individual MOFs having lower selectivity for O2 or N2 relative to CO2, intelligently selecting the right combinations of MOFs enables accurate prediction of the concentrations of all components in the mixture (i.e., CO2, O2, N2). We also analyzed the physical properties of the elements in the arrays to develop an intuition for improving array design. Notably, we found that an array whose MOFs have diversity in their volumetric surface areas has improved sensing. Consistent with this observation, we found that the best arrays consistently had greater structural diversity (e.g., pore sizes, void fractions, and surface areas) than the worst arrays.
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Affiliation(s)
- Brian A. Day
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, 3700 O’Hara St, Pittsburgh, PA 15261, USA;
| | - Christopher E. Wilmer
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, 3700 O’Hara St, Pittsburgh, PA 15261, USA;
- Department of Electrical and Computer Engineering, University of Pittsburgh, 3700 O’Hara St, Pittsburgh, PA 15261, USA
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Carfora A, Campobasso CP, Cassandro P, La Sala F, Maiellaro A, Perna A, Petrella R, Borriello R. Fatal inhalation of volcanic gases in three tourists of a geothermal area. Forensic Sci Int 2019; 297:e1-e7. [DOI: 10.1016/j.forsciint.2019.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
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5
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Mastrodicasa A, Cuenoud A, Pasquier M, Carron PN. Intoxication aiguë au dioxyde de carbone. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Handlos P, Gebauerová V, Tomková J, Zielinski P, Marecová K. A Fatal Case of Gas Intoxication in Silage Pit. J Forensic Sci 2018; 63:1904-1907. [PMID: 29637562 DOI: 10.1111/1556-4029.13791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
Fatalities due to gas intoxication are rare in routine forensic casework. The most common gas is carbon monoxide, with other gases (ammonia, methane, propane and butane, carbon dioxide, hydrogen sulfide) encountered only very rarely. In this report, we describe the accidental death of two maintenance workers who were found in the silage pit at a biogas plant. The autopsy revealed signs of asphyxia in both the deceased. Analysis of the gaseous mixtures in the tank using an infrared gas analyzer showed slightly elevated concentrations of carbon dioxide. Toxicological examination of the blood of both the deceased using gas chromatography with a flame ionization detector, spectrophotometry and liquid chromatography-mass spectrometry did not detect any toxicologically significant substance that would explain the sudden collapse. Both the autopsy and the toxicology analyses suggest CO2 intoxication as the most likely cause for the collapse of the two men, which then led to sudden asphyxia.
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Affiliation(s)
- Petr Handlos
- Department of Forensic Medicine, University Hospital Ostrava, Ostrava, CZ-708 52, Czech Republic.,Department of Intensive Medicine and Forensic Studies, Ostrava University, Ostrava, CZ-703 00, Czech Republic
| | - Vladimíra Gebauerová
- Department of Forensic Medicine, University Hospital Ostrava, Ostrava, CZ-708 52, Czech Republic.,Department of Intensive Medicine and Forensic Studies, Ostrava University, Ostrava, CZ-703 00, Czech Republic
| | - Jana Tomková
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Olomouc, CZ-779 00, Czech Republic
| | - Petr Zielinski
- OSZT and Laboratories OKD, HBZS a.s., Ostrava, CZ-716 03, Czech Republic
| | - Klára Marecová
- Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Olomouc, CZ-779 00, Czech Republic
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7
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Tod durch Trockeneis. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Carbon dioxide poisoning: a literature review of an often forgotten cause of intoxication in the emergency department. Int J Emerg Med 2017; 10:14. [PMID: 28378268 PMCID: PMC5380556 DOI: 10.1186/s12245-017-0142-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
The goal of this article was to provide an overview of the literature available on carbon dioxide intoxication. Articles were included based on their focus on medical or physiological effects of carbon dioxide. Studies related to decompression sickness were excluded. Mechanisms of carbon dioxide poising (both as an asphyxiant and as a toxicant) were described. Our review suggested that precautions are needed when handling dry ice or while working in confined spaces. Pre-hospital responders also need to pay attention for the possible diagnosis of CO2 intoxication for their own safety. When confronted with a victim, he/she should be removed from the dangerous area as fast as possible and oxygen should be administered. Without adequate treatment, victims may show acute reduced cognitive performance, respiratory failure, and circulatory arrest. Therefore, carbon dioxide poisoning is a rare but not to miss diagnosis in the emergency department.
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Murder-suicide by carbon dioxide (CO2) poisoning: a family case from Berlin, Germany. Forensic Sci Med Pathol 2013; 10:97-102. [PMID: 24114436 DOI: 10.1007/s12024-013-9495-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
This report demonstrates how carbon dioxide (CO(2)) may be a potent weapon in murder-suicide, where the death scene offers virtually no clues as to the lethal modality and the autopsy findings are nonspecific. Four bodies were discovered in an apartment in midsummer 2012 in Berlin, Germany. The bodies were those of a father (a 69-year-old business consultant), his wife (aged 26-years), and two sons (aged 3 and 6 years, respectively). The police found the wife and two sons lying in their beds and the husband in a supine position on the floor with a plastic bag over his head tied loosely around his neck with a rope. A 500 g single-use CO(2) cylinder was standing on the floor. The container was almost empty and according to the label had been sold as a CO(2)-fertilizer for aquarium plants. Two synthetic inhalation face masks and tubing were also found, which tested positive for the DNA of all four deceased family members. It is hypothesized that the husband placed an inhalation mask over the mouths and noses of his wife and children while they were sleeping. Inhalation of pure CO(2) ensured their rapid unconsciousness due to hypercapnia and severe anoxia. The rapid increase in CO(2) concentration would render a victim helpless, with no time to wake and defend themselves, or others. The proximate cause of death in all cases was attributed to CO(2) intoxication, based on the scene findings, the reconstructed sequence of events, the autopsy, and results of toxicological studies.
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Rupp WR, Thierauf A, Nadjem H, Vogt S. Suicide by carbon dioxide. Forensic Sci Int 2013; 231:e30-2. [PMID: 23791381 DOI: 10.1016/j.forsciint.2013.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/10/2013] [Accepted: 05/14/2013] [Indexed: 11/16/2022]
Abstract
Suicides by self-poisoning are common in all parts of the world. Among these intoxications, gases are rarely used, especially carbon dioxide (CO2). Very few cases of self-inflicted and deliberate carbon dioxide poisonings have been reported. This paper presents two uncommon suicides by carbon dioxide intoxication. In one case, a 53-year-old man tightly sealed a small bathroom and locked himself in it likely with dry ice. Warning notices were tagged to the door. In another case, a 48-year-old man working in a restaurant committed suicide by closing himself in a walk-in refrigerator and opening the stored carbon dioxide containers intended for the beverage dispensing equipment. The limited possibilities of proving lethal CO2 intoxications post-mortem necessitate a close cooperation of the involved parties during investigation. Only the synopsis of all findings permits a sound assessment regarding the manner and cause of death.
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Affiliation(s)
- Wolf-Rüdiger Rupp
- Institute of Forensic Medicine, Freiburg University Medical Center, Freiburg, Germany.
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Abstract
Intoxication with carbon dioxide (CO2), a nonexplosive, colorless, and odorless gas does not cause any clinical symptoms or signs, with the occasional exception of sudation. Carbon dioxide is principally used in the food industry (70% of CO2 production), in particular to preserve foods and to carbonate beverages. Most fatalities resulting from CO2 intoxication are accidental and occur either in closed spaces or when dry ice is used in the food industry. In this case report, a 42-year-old male winemaker engineer was found dead, his head inside a wine vat that had been filled with grapes on the previous day and supplemented with dry ice to improve the taste of wine.
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Varlet V, Smith F, de Froidmont S, Dominguez A, Rinaldi A, Augsburger M, Mangin P, Grabherr S. Innovative method for carbon dioxide determination in human postmortem cardiac gas samples using headspace-gas chromatography-mass spectrometry and stable labeled isotope as internal standard. Anal Chim Acta 2013; 784:42-6. [PMID: 23746406 DOI: 10.1016/j.aca.2013.04.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 11/18/2022]
Abstract
A novel approach to measure carbon dioxide (CO2) in gaseous samples, based on a precise and accurate quantification by (13)CO2 internal standard generated in situ is presented. The main goal of this study was to provide an innovative headspace-gas chromatography-mass spectrometry (HS-GC-MS) method applicable in the routine determination of CO2. The main drawback of the GC methods discussed in the literature for CO2 measurement is the lack of a specific internal standard necessary to perform quantification. CO2 measurement is still quantified by external calibration without taking into account analytical problems which can often occur considering gaseous samples. To avoid the manipulation of a stable isotope-labeled gas, we have chosen to generate in situ an internal labeled standard gas ((13)CO2) on the basis of the stoichiometric formation of CO2 by the reaction of hydrochloric acid (HCl) with sodium hydrogen carbonate (NaH(13)CO3). This method allows a precise measurement of CO2 concentration and was validated on various human postmortem gas samples in order to study its efficiency.
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Affiliation(s)
- V Varlet
- Toxicology and Forensic Chemistry Unit, University Center of Legal Medicine Lausanne-Geneva,Lausanne, Switzerland.
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13
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Kettner M, Ramsthaler F, Juhnke C, Bux R, Schmidt P. A fatal case of CO(2) intoxication in a fermentation tank. J Forensic Sci 2013; 58:556-8. [PMID: 23316776 DOI: 10.1111/1556-4029.12058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 02/07/2012] [Accepted: 02/25/2012] [Indexed: 11/30/2022]
Abstract
Carbon dioxide (CO2 ) is an odorless constituent of air. Higher concentrations can be detected in geothermal and automotive emissions, fermentation, and sublimation of dry ice. An unskilled worker entered a fermentation tank to clean it, which had not been done for about 5 months allowing for high concentrations of CO2 to build up. A second worker entered the tank to rescue the first one. Shortly after both were found the first worker was rescued directly whereas the tank had to be rotated to pull the second worker out. Cardiopulmonary resuscitation was successful only for the first worker. Medico-legal autopsy showed bruises, hematoma, myocardial hemorrhage, and edema of the lungs. The right lung was vacuum degassed in an argon atmosphere and quadrupole-mass-spectrometry showed an elevated CO2 content in lung gases. Thus, CO2 intoxication/asphyxia in a vitiated atmosphere due to fermentation of wine mash was established as the cause of death.
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Affiliation(s)
- Mattias Kettner
- Departments of Forensic Medicine, Forensic Toxicology, and Forensic Molecular Biology, Institute of Forensic Medicine, Goethe-University Frankfurt/M., Frankfurt/M, Germany; Department of Experimental Forensic Medicine, Institute of Forensic Medicine, University of Saarland Medical School, Homburg/Saarland, Germany
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Paul C, Lechleuthner A, Lüttecke D. Lungenödem und Spannungspneumothorax nach Suizidversuch mit Kohlendioxid-Feuerlöscher. Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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