Another case of diethyl ether intoxication?: a case report focusing on toxicological analysis.

Diethyl ether was widely used as an anesthetic agent in many countries in the second half of the 19th century and the first half of the 20th century. For this reason the majority of lethal cases involving diethyl ether reported during this period were associated with anesthesia. We present a case of asphyxial death by plastic-bag suffocation with additional detection of diethyl ether in autopsy specimens. Autopsy initially failed to reveal the cause of death. Macroscopic and microscopic findings as well as subsequent toxicological examination procedures and results are pointed out in the present case report. Headspace gas chromatography with flame ionization detection (HS-GC-FID) coupled with gas chromatography/mass spectrometry (GC-MS) proved to be the method of choice for fast and reliable analysis of unknown highly volatile substances (other than blood alcohol). In this case the detection of diethyl ether in autopsy specimens led to further investigations by the police at the death scene. During these investigations a bottle bearing a diethyl ether label was found and confiscated, which proved the insufficiency of prior death scene investigation. In order to evaluate the case from every possible angle, in such cases, especially when plastic-bag suffocation is suspected, we strongly recommend the collection of postmortem specimens in gas-tight vessels as well as the presence of a forensic expert at the death scene.

Distribution of ether in two postmortem cases.

Diethyl ether (ether) is a volatile liquid that was used in the 1800s as an anesthetic agent; however, it is no longer used for this purpose, partly because of its odor and flammability. Two postmortem cases in which ether was detected are presented. The first case was an 18-year-old male found hanging from a basement ceiling brace in a semi-sitting position with a gas mask covering his face. A container of Prestone starting fluid and a bong were found on the floor close to the body. The second case was a 20-year-old male found unresponsive in his dormitory room with two black plastic trash bags secured over his head. Two saturated rags and a resealable bag containing a clear liquid were contained within these trash bags. An almost empty can of Tradco starting fluid was also found at the scene. Ether concentrations were determined by headspace gas chromatography-mass spectrometry in the selective ion monitoring mode. In case #1, the medical examiner ruled that the cause of death was asphyxia due to hanging; the manner of death was undetermined. In case #2, the medical examiner ruled that the cause of death was asphyxia and the manner of death was suicide.

Ether: stability in preserved blood samples and a case of ether-assisted suicide.

Ethyl ether was detected in the blood of a deceased individual who had inhaled it from a mask while hanging himself. This case led to an investigation into the stability of ether in stored blood samples as described herein. Ether was spiked, at three concentrations, into batches of porcine blood. The blood was apportioned into grey-stoppered collection tubes and stored refrigerated until analysis. The concentration of ether in the blood was assessed at intervals over a two-month period. Analysis was performed by headspace gas chromatography. This study has shown, for a concentration range of 0.1 to 5.0 mg/mL, ether is stable in preserved, refrigerated blood for at least two months.

[Phenomenology of ether administration. With a review of the literature]. / Zur Phänomenologie bei Etherapplikation. Mit einer Literaturübersicht.

A 45-year-old man was found dead lying on a sofa in his house. He had pulled a plastic bag over his head, the bag containing a pad of cotton-wool soaked with diethylether. Different aspects are discussed in this paper including a review of the literature: anamnesis, scene of death, utensils used for inhalation and autopsy findings. There are especially pointed out the results of chemical-toxicological analyses in many body compartments. Furthermore are interpreted the manners and the relations of the distribution of ether as well as possible effects on the consciousness. In consideration of other published cases, the analytical results concerning ether are discussed with regard to the presumed cause of death (e.g. asphyxia) and other potential competitive mechanisms.

Near fatal respiratory distress following massive ether intravenous injection.

To the best of our knowledge, no case of ether-induced acute respiratory distress syndrome (ARDS) has been published as yet. A 36-year-old female developed pneumonitis which showed all the characteristics of a chemical-associated ARDS due to intravenous self-administration of ether: the hemodynamic investigation demonstrated a normal blood flow pattern with low left-heart filling pressure while the anteroposterior roentgenogram evidenced disseminated bilateral lung edema. Advanced symptomatic respiratory support including inhaled nitric oxide and steroidal anti-inflammatory use was the treatment of choice.

Diethyl ether, a chemical asphyxiant used as a prelude to homicide: a report of three cases.

Homicides in which the victims are first subdued with a chemical asphyxiant rare unusual and quite rare. We report three cases in which victims were first overcome by ether containing compounds and then killed by other means of asphyxiation. The ether containing compounds used in these three cases were readily available commercial products. In two cases, the distinctive spectra of the volatile compounds in the decedents' blood, from the gas chromatograph and from the gas chromatograph/mass spectrometer, were compared with suspect ether containing products recovered during the scene investigations. In one case, an identical match was obtained. In the other case, the chromatographic spectra differed slightly from the compounds found at the scene, but the difference was explainable by metabolic breakdown of the compounds in vivo.

Toxicological analysis of drugs and poisons in formalin-fixed organ tissues. 2. Volatile substances.

Diethylether, chloroform and toluene were administered by inhalation and ethanol intravenously to rabbits. As soon as possible after death, tissue specimens were collected from the brain, lung, liver, kidney and skeletal muscle and fixed in non-buffered 10% formalin at room temperature (10-20 degrees C) for 4 different periods (1, 2, 5 and 14 days). The volatile substances were analyzed and identified by gas chromatography/mass spectrometry (GC-MS). The measured concentrations of ethanol, diethylether, chloroform and toluene in the brain tissue 1 day after fixation decreased to 8, 23, 73 and 84% respectively compared with those in the non-fixed brain tissue (100%). The rank order of the rate of decrease in the fixed state was: ethanol > diethylether >> chloroform > toluene. These volatile substances could be detected clearly in all the tissue specimens, even after a 14-day fixation period. These results provide useful toxicological information that will help to differentiate whether volatile substances have been administered antemortem or postmortem.

An unfortunate complication of self-therapy for seborrheic dermatitis.

The death of a young boy who practiced self-therapy of seborrheic dermatitis of the scalp is reported. Practitioners should be aware that peer pressure in today's teenage society, coupled with misinterpretation of therapeutic protocols, may result in the application of unorthodox treatment regimens.

[Changes in substance P concentration in rat plasma under different conditions of blood letting]. / Das Verhalten der Substanz P-Konzentration im Rattenplasma bei verschiedenen Bedingungen der Blutgewinnung.

The influence of various conditions at blood-letting on the concentration of SP in the plasma was investigated in male Wistar rats as background for following studies on effects of noxae. Narcotic substance (hexobarbital, ether), CO2-suffocation and the mechanical kinds of killing (cervical dislocation, occipital hit, decapitation) influence the SP concentration in different ways. It is assumed SP concentration in plasma after cervical dislocation to be the best corresponding value for physiological conditions.

Experimental evaluation of rigor mortis. VI. Effect of various causes of death on the evolution of rigor mortis.

The evolution of rigor mortis was studied in cases of nitrogen asphyxia, drowning and strangulation, as well as in fatal intoxications due to strychnine, carbon monoxide and curariform drugs, using a modified method of measurement. Our experiments demonstrated that: (1) Strychnine intoxication hastens the onset and passing of rigor mortis. (2) CO intoxication delays the resolution of rigor mortis. (3) The intensity of rigor may vary depending upon the cause of death. (4) If the stage of rigidity is to be used to estimate the time of death, it is necessary: (a) to perform a succession of objective measurements of rigor mortis intensity; and (b) to verify the eventual presence of factors that could play a role in the modification of its development.

Sniffing-associated deaths in Denmark.

An account is given of 20 deaths, which occurred in association with sniffing during the period 1959--1978. The annual number of deaths was almost constant during the period. Most of the deaths occurred in males. Ether and trichloroethylene were the predominant toxic substances. The material was divided into two groups. Group A, 14 cases, included real sniffing deaths, the cause of death being poisoning by the substance inhaled. In group B, 6 cases, sniffing was a contributory factor to death: 2 cases of suffocation by obstruction, one case of carbon monoxide poisoning during fire, one case of septicemia/severe anemia caused by bone marrow depression, and one case of bleeding to death from stab wounds inflicted by a sniffer against a non-sniffer. The circumstances before and at the time of death are reported, together with the autopsy and toxicological findings when these were performed.

[Comparative intensity of oxidative phosphorylation in different regions of the cerebral cortex of intact animals during anesthesia and hypoxia]. / Sravnitel'naia intensivnost' okislitel'nogo fosforilirovaniia v razlichnykh otdelakh kory golovnogo mozga intaktnykh zhivotnykh v usloviiakh narkoza i gipoksii.

Experiments on 54 dogs with the use of the manometric method of Warburg proved that the level of oxidative phosphorylation in the brain cortex segments differing in the level of their phylogenic development is dissimilar. In the new cortex segment (sensomotor region) the oxygen and inorganic phosphorus uptake as well as the degree of their conjugation, as compared to the energy exchange intensity in the tissues of the old cortex (hippocampus), were found to show a higher level. Anesthetics, such as ether and sodium hexobarbital caused dissociation of the oxidative phosphorylation, more pronounced in the elements of the old cortical segments than in the new ones. The suppression of biochemical processes was especially profound under the effect of sodium hexobarbital and less marked under an ether poisoning. Hypoxia and combined action of an anesthetic and hypoxia produced inhibition of the energy exchange, more intensive in the new cortical segments.