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Chlorfenvinphos (CFVP) is an organophosporus insecticide designated as a threat agent by the National Institutes of Health (NIH). However, there are very few reported cases of poisonings in humans and none with postmortem toxicological analysis. We report the first two fatalities due to suicidal massive ingestion of a veterinary formulation containing CFVP and petroleum distillates. Case 1: A 24-year-old woman was found dead by her mother. According to the police records, the room was filled with an odor of solvents or pesticides and feces. There was an empty bottle of Supona(®) near the body and a suicide note on a Bible on a table. The only relevant postmortem finding was that the lungs appeared congested and edematous. Case 2: A 60-year-old man committed in his van by ingesting an unknown product. The vehicle was locked and had an odor that resembled an acid, sulfate, or solvent according to different witnesses. There was a suicide note as well as multiple containers containing automobile products nearby. The stomach of the victim was filled with abundant pale greenish fluid with a similar odor to that presented in the vehicle. The simultaneous toxicological screening and quantitation of CFVP and petroleum distillates [a mixture of trimethylbenzene isomers (TMBs)] was performed by means of gas chromatography with flame-ionization detection (GC-FID) and confirmation was performed using gas chromatography-mass spectrometry (GC-MS). Disposition of CFVP and TMBs in different tissues were, respectively, as follows: Case 1: heart blood, 8.6 and 3.7 mg/L; liver, 60.0 and 33.4 mg/kg; and stomach contents, 1132 mg/L (792.4 mg total) and 377.0 mg/L (263.9 mg total). Case 2: heart blood, 4.4 and 6.5 mg/L; urine, 1.4 and detected (LOQ); bile 7.8 and 12.2 mg/L; vitreous 0.3 mg/L and detected (LOQ); liver, 139.2 and 172.1 mg/kg; and stomach contents, 76,168 mg/L (72,359 mg total) and 108,109 mg/L (102,703 mg total). Results of alcohol, other volatiles, abused and therapeutic drugs were negative in both cases. The proposed analytical method allows the simultaneous determination of a wide variety of pesticides and additives, including petroleum distillates suitable for toxicological investigation in forensic and clinical cases. This is crucial to solving poisoning cases in which the poisoning source is uncertain.

This paper describes two fatal cases of planned complex suicide by two male individuals, 86 and 51 years old, involving ingestion of petroleum distillates and hanging. Remarkable internal findings during autopsy of both cases included the intense odor of petroleum distillates that alerted authorities to the suspicion of ingestion. The initial toxicological screening and quantitation of these compounds were performed by gas chromatography with flame-ionization detection, and confirmation was performed using gas chromatography-mass spectrometry in total ion chromatogram mode after liquid-liquid extraction of biological samples following a previously published analytical method. In Case 1, diesel fuel No. 2 concentrations were < 5 mg/L heart blood and 18,160 mg/L gastric content (total amount 6356 mg); therapeutic concentrations of citalopram were also found in blood. In Case 2, xylene (mixture of isomers) concentrations were 0.3 mg/L in heart blood and 0.1 mg/L in gastric content (total amount 0.006 mg); ethanol (1.12 g/L) and therapeutic concentrations of nordiazepam, oxcarbazepine, ibuprofen, and metamizol were also found in blood. The medical examiners in both cases reported the cause of death as hanging, and based upon examination of the scenes and the anatomopathological and toxicological data, the manners of death were determined to be planned complex suicide. We would like to alert toxicologists of the importance of testing for petroleum distillates when there is a suspicion of ingestion of these products due to the odor observed at the scene of death and/or during autopsy. The results of these toxicological investigations can help to determine the manner of death and the medicolegal interpretation.

We would like to alert toxicologists to the importance of testing for gasoline, and for volatile hydrocarbons in general, in deaths involving inhalation of exhaust fumes occurring in closed spaces with running motors or machinery. We present here a case of suicidal inhalation of motorbike exhaust, a mixture of carbon monoxide (CO) and gasoline vapor, by a 38-year-old female. She was found in her closed home garage with a hose extending from the exhaust pipe of a motorbike through a cellophane plastic device into a closed tent in which the victim lay. She left two suicide notes nearby. The carboxyhemoglobin (COHb) was measured using visible spectrophotometry. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame-ionization detector and confirmation was performed using gas chromatography-mass spectrometry. The %COHb determined in blood was 73%. Gasoline concentrations in heart blood and vitreous humor were 22.3 and 1.0 mg/L, respectively. Although fatalities with CO at this rate are common, we would like to highlight the role of gasoline and add new quantitative data of this toxic substance to the scarce literature. Based upon the toxicological data, along with the information provided by the medical examiner, the cause of death was determined to be CO and gasoline poisoning and the manner of death suicide.

This report documents a case of drug-facilitated sexual assault (DFSA) under the influence of solvents. The victim was a 13-year-old female. Upon contact with law enforcement, she was still confused and could hardly explain the facts. She told authorities that she had been kidnapped 4 h previously when two individuals with covered faces put a cloth soaked in a solvent over her mouth. She spent a few hours in a room, during which she lost consciousness. The girl awakened semi-nude in the street with memory loss. No alcohol was present in the subject's body; no odor of alcohol was detected on the subject's breath. No lesions were observed during a gynecological exam. A blood sample was taken with the intent to investigate the use of chloroform or similar anesthetics. Toxicological analysis of the victim's blood revealed the presence of 7.6 mg/L of benzene, 24.8 mg/L of toluene, and 0.6 mg/L of xylene (mixture of isomers). As for other analytical findings, diazepam (0.02 mg/L) was also found. The aromatic solvents involved in this case were detected using gas chromatography with flame-ionization detection (GC-FID) and confirmed using GC-mass spectrometry (MS) in full scan mode after liquid-liquid extraction of the whole blood sample. Quantitation of the aromatic solvents was carried out using GC-FID. Diazepam was detected using GC with nitrogen-phosphorus detection (NPD) and confirmed using GC-MS with full scan mode after solid-phase extraction of the whole blood sample using Bond-Elut Certify columns. Quantitation of diazepam was carried out using GC-NPD. No other drugs, including ethanol, were detected. Recoveries for benzene, toluene, and xylene (mixture of isomers) in whole blood at 5 mg/L were 89.2%, 90.8%, and 93.4%, respectively. Intraday precisions were 5.3%, 5.0%, and 4.9%, respectively, and interday precisions were 12.1%, 11.6%, and 11.5%, respectively. The limits of detection (LOD) and quantitation (LOQ) were 30 and 100 microg/L, respectively. The linearity of the blood calibration curves was excellent with r(2) values of > 0.999 (range 0.1-10 mg/L). Recovery for diazepam in whole blood at 0.5 mg/L was 88.2% with intraday and interday precisions of 2.0% and 10.8%, respectively. The LOD and LOQ were 6 and 20 microg/L, respectively. The linearity of the blood calibration curve was excellent with r(2) values of > 0.999 (range 0.1-2 mg/L). We want to alert other toxicologists about new or unexpected products that should be taken into account when the surreptitious use of substances in DFSA is suspected.

Atracurium is a nondepolarizing skeletal muscle relaxant used to facilitate endotracheal intubation and to induce skeletal muscle relaxation during surgery or mechanical ventilation. The drug undergoes a spontaneous non-enzymatic biotransformation, yielding laudanosine and an acrylate moiety. This report documents the case of a 45-year-old anesthesiologist who was found dead at the hospital where he worked. The victim was known to be depressed and undergoing treatment with venlafaxine. An empty syringe was found near the body. Toxicological analysis revealed the presence of laudanosine in the syringe, 0.6 mg/L of laudanosine in heart blood, 0.3 mg/L in urine, and 0.02 mg/L in vitreous humor. Meanwhile, concentrations of venlafaxine and O-desmethyl-venlafaxine, its active metabolite, were 0.7 and 1.1 mg/L in heart blood, 1.7 and 5.2 mg/L in urine, 0.5 and 0.7 mg/L in vitreous humor, and 400 and 20 mg in gastric content, respectively. All drugs and metabolites involved in the case were detected using gas chromatography with nitrogen-phosphorus detection (GC-NPD) and confirmed using GC-mass spectrometry in full scan mode after solid-phase extraction using Bond-Elut Certify columns. Additional high-performance liquid chromatography coupled to diode-array detection screening also obtained the same results. Quantitation of laudanosine and venlafaxine together with its metabolite was carried out using GC-NPD. No other drugs, including ethanol, were detected. Recoveries for laudanosine and venlafaxine were 89% and 86%, respectively, at 0.5 mg/L; intraday and interday precisions were 2% and 6%, and 3% and 7%, respectively; and limits of detection and quantitation were 6 and 20 ng/mL and 18 and 59 ng/mL, respectively. The linearity of the blood calibration curves was excellent for both drugs with r(2) values of > 0.999 (range 0.1-2.0 mg/L). Based on the autopsy findings, case history, and toxicology results, the forensic pathologists ruled that the cause of death was an overdose of atracurium, and the manner of death was suicide.

Introduction Trazodone is an antidepressant agent used in Spain since 1975. There are few documented reports of fatalities solely attributed to trazodone and none in which the main metabolite is analyzed. A fatal case of self-poisoning following oral ingestion is reported along with a description of the validated analytical methods involved, a discussion of poisoning characteristics, and a review of reports describing trazodone overdose cases with analytical results. The deceased was an 86-year-old man with cancer, who suffered depression. He went to see his doctor in a primary health care unit and told him he had just taken an unknown amount of tablets of Deprax | to commit suicide. The doctor induced emesis as a first emergency measure. His death occurred before arriving to the hospital, and he left a suicide note nearby. Systematic toxicological analysis of postmortem blood used routinely in our laboratory revealed the presence of trazodone 4.9 mg/L and m-chlorophenyl-piperazine (m-CPP) 0.6 rag/L, its active and major metabolite. In addition, metamizol 19.6 mg/L and 4-methyl-amino-antlpyrine (4-MAA) 40.7 rag/L, its active metabolite, were also found in blood. All drugs and metabolites involved in the case were detected using gas chromatography-nitrogen-phosphorus detection (GC-NPD) and confirmed using gas chromatography-mass spectrometry (GC-MS) mode total ion chromatogram. An additional high-performance liquid chromatography-diode array detection (HPLC-DAD) screening also obtained the same results. Quantitation of trazodone together with its metabolite in blood was carried out using GC-NPD, while quantitation of metamizol was performed using HPLC-DAD. Limits of detection for trazodone and m-CPP were 33 and 11 pg/L, respectively, absolute recoveries were more than 86% and 75%, respectively, intra-assay precisions less than 4%, interassay precisions less than 5%, and linearity up to 2.0 mg/L. Limit of detection for metamizol was 1117 pg/L, absolute recovery more than 84%, intra-assay precision less than 8%, interassay precision less than 12%, and linearity up to 48 mg/L. Based on the autopsy findings, patient history, toxicology results, and previously reported trazodone intoxications, the forensic pathologists ruled that the cause of death was due to an overdose of trazodone, and the manner of death was listed as suicide.

A mild case of self-poisoning with a chlorpyrifos formulation following oral ingestion is reported. A 15-year-old female went to the emergency room after the ingestion of a product from a bottle marked with a label "Poison". On admission, she was obtunded, with normal vital signs and a strong smell of solvent. Therapeutic measures included the application of decontamination procedures, oxygen, and gastric protectors. She had a good outcome with mild CNS depression and bradycardia. Two hours after ingestion, biological samples were collected in the emergency room and sent for analysis to our laboratory with instructions to investigate the presence of solvents. The serum and gastric content contained 5.3 and 9.4 microg/mL of unmetabolized chlorpyrifos, 4.6 and 6.9 microg/mL of toluene, and 2.5 and 7.9 microg/mL of butyl acetate, respectively. Small traces of other solvents and tetradifon were also detected. Toxicological analyses were negative for ethanol, other volatile solvents, and common drugs of abuse. The simultaneous determination of chlorpyrifos, toluene, and butyl acetate was performed using the combination of gas chromatography (GC)-flame ionization detection for screening analysis and GC-mass spectrometry for confirmation of the obtained results. The method provides an excellent and rapid tool for use in cases of pesticide poisonings, allowing the simultaneous detection of the pesticide and distillates in the performance of systematic toxicological analysis in forensic and clinical laboratories.

A rare fatal case of self-poisoning with nitrobenzene following oral ingestion is reported. On presentation to the hospital, severe methemoglobinemia (70%) was observed in an 82-year-old male who had ingested 250 mL of an unknown substance in the previous 24 h. Methylene blue and exchange transfusion were the therapeutic methods applied in the treatment of the methemoglobinemia. Forty-eight hours after ingestion, a blood sample was collected in ICU and sent to our laboratory. We detected that the blood contained 3.2 microg/mL of nitrobenzene. The determination of nitrobenzene was performed using the combination of GC-FID for screening analysis and quantitation and GC-MS for confirmation of the obtained results.