JAFM-33-2, April-June, 2011 [PDF] - forensic medicine

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J Indian Acad Forensic Med. April-June 2011, Vol. 33, No. 2 ISSN 0971-0973Original Research PaperTrends of Poisoning and Gross Stomach MucosalAppearance in Fatal Poisoning Cases: An Autopsy Study*Kishan R Siddapur, **Gurudatta S Pawar, ***Shashidhar C MestriAbstractThe study was of one year duration from 3 rd December 2007 to 2 nd December 2008 on fatalpoisoning cases autopsied at Chigateri Government District hospital mortuary, attached to JJM MedicalCollege, Davangere. The purpose was to know the trends of fatal poisoning cases in the region and alsoto know the gross stomach mucosal appearances in those cases. Material for the study included fatalpoisoning cases autopsied. These poisoning cases included fatal animal bites also. All the data collectedin detail was entered in the Proforma and later critically analyzed, tabulated, & compared with othervarious studies. Significant correlations were seen between- types of poison ingested & survival period,and between treatment intervention & survival period. It was an attempt to try to furnish poison suspectedto the FSL based on case files and autopsy findings so as to hasten analysis and reporting.Key Words: Fatal poisoning; stomach mucosa; Organophosphates; BenzodiazepineIntroduction:“All substances are poisons; there is nosuch thing as a non-poison”- Paracelsus. Theword ‘poison’ is evolved from the Latin word‘potion’ i.e. ‘to drink for health’. But in the duecourse of time , the definition of ‘poison’ haschanged reversibly to its present form i.e. anysubstance , in any amount , by any route ; if itproduces harmful effects (3 Ds – disease ,deleterious effect or death ) over the body ; it willbe labeled as poison.[1] Poisons were known tothe mankind from ancient times. Primitive manwas aware of natural poisons from animal &plants and indeed used them on his weapons.The study of poisons is started by 1500 B.Cthrough Ebers papyrus (the earliest collection ofmedical records). [2]Poisoning is the commonest methodadopted in India to commit suicide. [3] Pesticidepoisoning is an important cause of morbidity andmortality in many countries in the world. It hasbeen estimated that 95% of fatal pesticidepoisonings occur in developing countries, manyof which are in the Asia-Pacific region.Corresponding Author:* Assistant Professor,Department of Forensic Medicine,Karpaga Vinayaga Institute of Medical Sciences &Research, Chinnakolambakkam, Tamil NaduEmail: kishan_rs@yahoo.co.in** Professor & Head, Deptt. of Forensic Medicine,Chennai Medical College, Trichy, Tamil Nadu*** Professor & Head, Deptt. Of Forensic Medicine,K. V. I. M.S. & R., Chinnakolambakkam, Tamil NaduAgriculture based economies, easyavailability of pesticides, poverty relatedsocioeconomic problems, lack of adequateprotective clothing, and limited treatmentfacilities are some of the factors contributing tothe high morbidity and mortality. [4] Theincidence of insecticide poisoning has steadilyincreased in recent past and has reached a levelwhere it can be called “a social calamity. [5]Due to rapid development in the field ofscience and technology, and vast growth inindustrial and agricultural sector, poisoning isspreading like wild fire. [6]Many authors have quoted in literatureabout the stomach mucosa. Colour changes incases of poisoning, like in fatal Arsenicpoisoning, the stomach mucosa has a red velvetappearance. It’s leathery in Phenol (carbolicacid) poisoning and corroded & blackened inCorrosive poisonings.Fatal poisons like oraganophosphorus,organochlorines, carbamates, aluminiumphosphide, and alcohol were the commonestpoisons in the area.Appearance of stomach mucosa in aparticular kind of poisoning might be of immensehelp in making a provisional diagnosis. It helpsone to mention in FSL requisition, poisonsuspected in the given case. This helps FSL toanalyze the suspected poison first and thusfurnish opinion at the earliest. Routinely oneshall have to wait several weeks to get opinionfrom FSL. If suspected poison is furnished, it cannarrow down the waiting period. Keeping in viewof the foresaid facts, it was considered106
J Indian Acad Forensic Med. April-June 2011, Vol. 33, No. 2 ISSN 0971-0973worthwhile studying the trends of fatal poisoningcases and their gross stomach mucosalappearances, which were autopsied in Chigaterihospital mortuary.Material & Methods:The material included the fatal poisoningcases autopsied in the mortuary. Thesepoisoning cases included fatal animal bites also.Total number of cases autopsied in the mortuaryduring the study period was 853, of which, 256were suspected cases of poisoning whosesamples were sent to RFSL (Regional Forensicscience laboratory) Davanagere for chemicalanalysis. Poison was detected in 215 cases.These cases were included in thepresent study. The cases, where no poison wasdetected (28 cases), were excluded. Snake bitecases (13 cases), diagnosed based on history,signs & symptoms, and post-mortemexamination, were also included.To evaluate the trends, following criteriawere considered - Age, Sex, Region(rural/urban), Occupation, Literacy, Maritalstatus, Socioeconomic status, Route ofpoisoning, Treatment status, Survival period,Manner of poisoning, Gross stomach mucosalappearances, and Type of poison.Correlation between ‘Poison detected byChemical analysis’ & ‘Survival period’, ‘Poisonsuspected by case history’ & ‘Survival period’,‘Survival period’& ‘Treatment history’ was doneusing Chi square test. The results, beingsignificant or not, are classified based on Pvalue. P value less than 0.05 is ‘Significant’, lessthan 0.001 is ‘Highly significant’, and more than0.05 is ‘Not significant’.All the data was collected in detail andlater critically analyzed, tabulated, & comparedwith other various studies to analyze the aimsand objectives of the present study.Results:A] Sex wise distribution:In the present study, of total 228 fatalcases of poisoning, 159 cases (69.7%) weremales & 69 cases (30.3%) were females. Male:Female ratio was 2.3:1.B] Age wise distribution:The most commonly affected age groupwas 21-30 years-70 cases (30.7%), followed by31-40 years-48 cases (21.1%) &C] Marital Status:Married were 151 cases (66.2%) andunmarried were 76 cases (33.3%).D] Region:Out of 228 cases, 134 cases (58.8%)were from rural areas, and 93 cases (40.8%)were from urban area.E] Educational Status:Cases with secondary school education-73 cases (32%), were maximally affected,followed by PUC (Pre University education)-65cases (28.5%), & Graduates-62 cases (27.2%).F] Employment Status:Agriculturists, 70 cases (30.7%), weremost commonly affected. Students were almostequally affected-65 cases (28.5%), followed byunemployed-46 cases (20.2G] Socio-Economic Status:Socio-economically lower class clearlyoutnumbered middle class. In lower classcategory, there were 156 cases (68.4%),followed by middle class-70 cases (30.7%) &upper class-1 case (0.4%).H] Route of Poisoning:The commonest route of poisoning wasingestion-214 cases (93.8%). Injected poisonswere 14 cases (6.1%), which included 13 casesof snake bite (5.7%) & 1 case of Benzodiazepinepoisoning (0.5%).I] Manner of Poisoning:The commonest manner of poisoningwas suicidal-208 cases (93.1%), followed byaccidental variety-19 cases (6.5%), whichincluded 13 snake bite cases & 6 of the alcoholiccases.J] Treatment Status:Of the 228 cases autopsied, 101 caseswere brought dead. Treatment intervention wasdone in 127 cases.K] Survival Period:Most of the cases (129 cases) diedwithin 12 Hrs of getting poisoned. Some (49cases) managed to survive until 24 Hrs andsome (50 cases) beyond 24 Hrs. Stomach of theunidentified case contained undigested foodparticles. Therefore the person was categorizedunder less than 12 Hrs survival periods.L] Poison (History):With the help of friends, relatives &police interviews, various poisons involved werenoted & tabulated as follows. Poison consumedwas unknown in most of the cases (83cases).Metacide poisoning was commonest, followedby Tik-20.M] Poison (Chemical Analysis):Poisons detected through chemicalanalysis were noted & tabulated as follows.Organophosphates (OP) were most commonlyused, followed by Organochlorines (OC),Aluminium Phosphide (ALP), Carbamates (CA),Alcohol (ALC), Metallic Poison (MP), &Benzodiazepine (BZD).Amongst all the poisons,Organophosphates (OP) were the mostcommonly used poisons-149 cases (69.3%),107
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JAFM-33-2, April-June, 2011 [PDF] - forensic medicine

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