Gas poisoning

(Irrespirable gases)

They can be divided into 3

1) Irritant gases
 Causes just irritation of Respiratory tract.
 Ex :- Chlorine, Ammonia, HCl, H2SO4,Formalin

2) Simple asphyxiates

 Interfere with the gaseous exchange only but not absorbed into the blood stream.

 Ex :- Carbon dioxide, Nitrogen

3) Clinical asphyxiates

 They are absorbed into the blood stream through lungs and causes various actions through
combining with Hb.

Asphyxial death

 Is caused by the failure of cells to receive or utilize oxygen

Suffocation

 Asphyxia caused by inadequate oxygen in the environment

Ammonia and Chlorine poisoning

 Irritant of the respiratory tract

 almost always is accidental

Sources

1. Ammonia – Industrial – refrigerator plants, ammonia cylinders

2. Chlorine - Industrial – bleaching powder industry, and chlorination of water.

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Clinical features

A. Local

 Burns on the skin (esp with liquid)

 Eyes – conjunctivitis and tearing

 Hair and cloths – bleaching effect

B. Internal

 Pharynx = pharyngitis with dysphagia

 Larynx –laryngitis with hoarseness

 Trachea and bronchi –tracheitis and bronchitis with productive cough with subsequent
infections

 Bronchioles – bronchiolitis with wheezing

 Alveoli – alveolitis with pulmonary oedema. Later with infection there will be
bronchopneumonia

Carbon dioxide poisoning

 simple asphyxiant gas

Sources

 In anesthesia

 Mine Industry – mines – a mixture of carbon dioxide and carbon monoxide collect at the
bottoms of mines.

 Disused wells, pits.

 Burning of lime

 Breweries (fermenting process)

Clinical features

 0.3% - Normal

 25 – 30% - Minimal fatal concentration

 60 – 80% - Instant collapse and death (tissue anoxia)

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Carbon monoxide poisoning

Carbon monoxide (CO) is a colorless, odorless gas produced by incomplete combustion of carbonaceous
material.

Sources of CO

 Motor vehicle exhaust gases (so can use as a method of suicide, after connecting the exhaust
pipe to a closed cabin)
 Domestic appliances - Carbon monoxide is a by-product of combustion, present whenever fuel is
burned. It is produced by common home appliances, such as gas or oil furnaces, gas refrigerators,
gas clothes dryers, gas water heaters or space heaters, fireplaces, charcoal grills, and wood
burning stoves.
 A structure fire - is a fire involving the structural components of various types of residential,
commercial or industrial buildings.
 With industrial processes

Clinical presentation in patients with CO poisoning ranges from headache and dizziness to coma and
death.

 20% - headache, dizziness and malaise

 30% - giddiness and mild SOB

 40% - confusion, incoordination , staggering and fatigue of muscles

 50% - drunken gait, slurred speech, in coordinate voluntary movements, exhaustion, vomiting,
flushing, sweating and pink colour of skin  MIMICS DRUNKENNESS

 70% - coma and death

PM

DD - CN poisoning, refrigerated body

 Adequate history mostly indicates CO poisoning (colour, where was the victim. eg. Inside a closed
well while attempt entering, cesspit cleaning, burning site etc)
 A number of fatal CO poisoning had been recognized mistakenly as natural illness in the past
 Anyhow with low levels of CO, death can occur in patients with co-morbidities such as IHD
 Most striking feature is the colour of hypostasis
 Classical cherry pink colour of carboxy haemoglobin is evident , when the carboxyHb
saturation exceeds about 30% it is evident
 Internal organs also deeply red in colour including blood
 When the patent is anaemic no obvious colur change
 Rarely blistering of skin similar to so-called barbiturate blisters

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Brain is the most sensitive organ and selective injury to gray matter identified. In case of severe CO
poisoning – necrosis and cavitation of BG in the brain.

 Other signs are non-specific – pulmonary oedema is usually present

Investigations

 Blood – can be collected from anywhere as opposed to the other toxicological analysis in
toxicology. Even heart blood, contaminated cavity blood, BM etc is fine as a % value is
checked.
 Environmental gas analysis
 CO is relatively a stable substance, so possibility of detection even in putrefied bodies if
sophisticated methods are used (unlike CN as it destroys quickly)
 Bodies burnt after death does not absorb any CO. Thus any significant level, more than
10% indicates that the person was inhaling CO. But the reverse is not true (one way
criterion) as the person may die very soon because of the effects of the fire without much
time for inhalation of CO.
 Normal person’s blood – up to 3%
 People living in polluted air, traffic police officers – level up to 5% (and even more
at times) in heavy smokers
 20-25% indicates – severe poisoning indicates
 (in entry wounds of firearm also CO can be found)

Methane poisoning

Methane (CH4) is a colorless, odorless, tasteless, flammable gas that is widely distributed in nature.
Methane Gas is produced whenever organic material is decomposed by bacterial action in the absence of
oxygen.

Methane is further emitted from burning gasoline and fossil fuels, including coal, natural gas, and oil, and
from hydraulic fracturing, landfills, and coal-fired power plants.

Natural sources of methane include termites, bodies of water, wildfires, and digestive processes of
animals.

Methane is released from coal deposits during underground and surface mining and from decomposition
organic wastes.

Its health effects are associated with being a simple asphyxiant displacing oxygen in the lungs.

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Hydrogen sulfide

H2S is a colorless, toxic and flammable gas with a foul odour of rotten eggs and flatulence.

Hydrogen sulphide (H2S) is a gas that is easily produced when three conditions coincide: the presence of
sulphates and sulphate-reducing bacteria, anaerobic conditions and temperatures >20°C. These
conditions are very common during the summer in drains, latrines, septic tanks, sewers and deposits of
dung and other decomposing organic matter.

The most common cases of H2S intoxication occur when someone enters a confined space in which H2S
has accumulated over time due to lack of air exchange.

What do you mean by with the general term of sewer gas?

 Collectively, gases include methane, ammonia, hydrogen sulphide, carbon monoxide, sulphur
dioxide and nitrogen oxides.