jiafm, 2010-32(2) april-june. - forensic medicine

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ISSN 0971-0973 J Indian Acad Forensic Med, 32(2)Case reportFatal Unintentional Carbon Monoxide Poisoning Inside a GarageA Case Report*Surg Lt Cdr (Dr) Avishek Kumar MBBS MD (Forensic Medicine), **Col (Dr) Ravi Rautji, MBBS, DHHM, MD(Forensic Medicine), Dip in Cyber Law (ASCL),AbstractA young female aged 18 years was found unresponsive in the car by her boyfriend. Both were inside thecar, which was parked inside a closed garage. The engine and air conditioner of the car was switched on. The girlhad complained of giddiness earlier and the boyfriend too was feeling drowsy.The boy had been going out of the car to attend to phone calls and upon returning after one such call, found that hisfriend was not responding. She was immediately brought to the casualty dept of a tertiary care hospital by himwhere she was declared dead on arrival. A police complaint was lodged by the relatives of the girl, accusing the boyof homicide due to the presence of some minor injuries on the body of girl. Medico Legal autopsy on the girlrevealed, death due to carbon monoxide poisoning.Key Words: Carbon Monoxide, Garage, Vehicle, Ventilation, HaemoglobinIntroduction:Carbon monoxide is a ubiquitous product ofincomplete combustion of materials containingcarbon. Faulty domestic heating appliances haveresulted in many accidental poisoning. [1] Deliberateself exposure to car exhaust fumes in enclosed space,which can contains up to 10% of carbon monoxide isa very effective form of suicide. [2] Use of catalyticconverters in vehicles has reduced carbon monoxideemission considerably. However prolong exposurecan lead to death due to hypoxia. A common non fireCO death scene involves an automobile in a garage,workshop or similar enclosed space. Deceasedsuccumbs to carbon monoxide poisoning due torunning of engines and accumulation of carbonmonoxide inside a closed space.Case Report:A young female of 18 yrs age along with herboyfriend were sitting inside a car parked inthegarage of the boy. As it was warm inside thegarage, the engine and AC of the car was kept on andall the windows of the car were closed.Corresponding Author:Col (Dr) Ravi Rautji,**Professor & HeadDepartment of Forensic Medicine & Toxicology,AFMC, Sholapur Road,Pune, 411040, IndiaE-mail: rautjiravi@hotmail.com*Associate ProfThe family members of the boy did notapprove of the relationship between the two and inorder to convince them, boy along with his girlfriendhad come to his house. Both had stayed in the carinside the garage to plan a strategy. The boy keptgoing out of the garage frequently to attend calls onhis cell phone. Meanwhile, the girl complained ofgiddiness to him. After attending to one such call,when the boy went back inside the garage, he saw hisfriend lying unconscious inside the car. She wasimmediately brought to the casualty of a tertiary carehospital where she was declared dead on arrival. Acomplaint was made by the relatives of the girlaccusing the boy of foul play.Autopsy Findings:The body was that of an 18-year-old youngfemale, with fair complexion. Rigor mortis waspresent all over the body. Cherry red postmortemlividity was present on the back and dependent partsof the body in supine position. (Fig.1) Face wascongested and pupils were dilated. Finger nail bedswere cyanosed. (Fig. 2) Two small abrasions werepresent over the left side of forehead and an abrasionwas present over the tragus of left ear. No otherinjuries were noticed on the body. All the internalorgans were congested. Surface of brain and lungsshowed petechial haemorrhage. Blood was cherry redin colour. Spot test in the mortuary showed presenceof carbon monoxide in blood. Chemical analysisreport on blood and viscera, received subsequentlyfrom forensic science lab confirmed presence ofCarbon Monoxide.174
J Indian Acad Forensic Med, 32(2) ISSN 0971-0973Discussion:Carbon monoxide is a colourless, tasteless,non-irritative gas, which is produced by incompletecombustion of materials containing carbon. It is apotent cellular toxin and acts as a chemicalasphyxiant. Carbon monoxide has very high affinityfor haemoglobin, which is about 220 times that ofoxygen. There is also evidence of a synergistic effectof alcohol and carbon monoxide leading to death atlower COHb saturation levels when the blood alcoholconcentration is high. [3]Unintentional carbon monoxide poisoning invehicles can occur due to leaking exhausts andinadequate ventilation. [4] In a study by Susan P etal. in 1972 [5] fatal concentration of CO was foundeven with garage door open and also in the absenceof defective exhaust systems. Possible entry of fumescan be through holes in the floor of the passengercompartment, fender panels, holes in the spare tirewell that were originally plugged with rubber at thetime of manufacture. Since the affinity ofhemoglobin for CO is approximately 220 timesgreater than that for oxygen, even low concentrationof CO can be hazardous during prolonged exposure.In some case the measured carbon monoxidehemoglobin saturation level (COHB) wasconsiderably below the lethal value. Death in suchcases has been attributed to a combination of a highCO 2 and a low O 2 tension. [6] Griffin SM et.al [7]had reported a case of CO poisoning which wasinitially thought to be a case of IHD, but latertoxicological analysis revealed a lethal bloodCOHbg, due to inhalation of vehicular exhaustfumes.In the case presented here inadequateventilation inside the garage along with continuousrunning of AC of the vehicle must have led to theaccumulation of CO inside the garage, which hasentrance into the car affecting the deceased sittinginside. The boy, who was with her girlfriend in thegarage, escaped due to inadequate exposure to CO, ashe was frequently going out of the garage to attendcalls on his cell phone.References:1. Crawford R, Campbell DGD, Ross J. Carbon monoxidepoisoning in the home: recognition and treatment. BMJ 1990;301: 977-9.2. Busuttil A, Obafunwa JO, Ahmed A. Suicidal inhalation ofvehicular exhaust in the Lothian and Borders region ofScotland. Hum exp toxicol 1994; 13: 545-50.3. Mallach, H.J. and Roseler, P. Beobachtungen undUntersuchungen uber die gemeinsame Wirkung von Alkoholand Kohlenmonoxyd. Arzneimittel-Forschung 11:1004-1008,1961.4. Zumwalt RE, Wake MC, Hoffman R. Deaths frommotorvehicle related unintentional carbon monoxidepoisoning- Colorado 1980-1995 and United States, 1979-1992. Morb Mortal Wkly Rep 1996; 45: 1029-32.5. Susan P, Baker MPH, Russel S Fisher, William CMasemore and Irvin M Sopher. Fatal Unintentional CarbonMonoxide poisoning in Motor Vehicles. AJPH 1972; 62(11)1463-67.6. VeveIstad M, Morild I. Lethal methemoglobinemia andautomobile exhaust inhalation. Forensic Sci int. 2009 May30; 187 (1-3): el-5. Epub 2009 Mar 3.7. Griffin SM, Ward MK, Terrell AR, Stewart D. Dieselfumes do kill: a case of fatal carbon monoxide poisoningdirectly attributed to diesel fuel exhaust with a 10-yearretrospective case and literature review. Journal of ForensicSci 2008 Sep; 53(5):1206-11.Fig. 1Cherry Red PM StainingFig. 2Cyanosed Finger Nails175
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