- Email: [email protected]
Ingestion of lye
kensic Sciince la
Forensic Science International
ELSEVIER
73 (1995)
143-147
Ingestion of lye Charles L. Winek*“, Leon Rozinb, Wagdy W. Wahba”, Vida Rafizadeh b “Allegheny
County
Department
bAllegheny
County
of Laboratories, Coroner’s
Received
OfJce.
22 January
10 Counry 542
Fourth
Office Avenue,
1995; accepted
Building,
Pittsburgh,
Pittsburgh.
3 February
PA
15219,
PA
15219,
USA
USA
1995
Abstract
This paperreportson the caseof a 13-year-oldwhite malewho committedsuicideby ingestion of heavyduty drain and seweropener.He left behinda note indicatinghis suicide.This teenagerwasgrieving over the suicideof one of his friends and wasunder counselingby a mentalhealththerapistat school.Resultsof autopsyand toxicologicalanalysesindicatedthe ingestionof a highly alkaline substancethat is consistentwith the ingredientsof the drain openermentioned. Keywordr:
Lye, ingestionof; Suicide;Drain opener
1. Introduction
Heavy duty drain and sewer openers are widely used, easily available products. The main ingredients of the lye solution in this case are sodium and potassium hydroxide. Lye solution is highly corrosive. Ingestion causes very serious damage to the mucous membranes and other tissues. It can cause perforation and scarring [ 11. Traditional drain cleaners consist of granular lye in very high concentrations, sometimes approaching lOO”/o. Several drain products are available in the American market. Ranging 25-36.5X sodium and/or potassium hydroxide in water, they are less concentrated than the granular products, but it is generally agreed that they are more hazardous [2]. Even products that contain c 10% lye produced severe damage to the esophagus after 30 s of ingestion. In humans, because of the neutralizing effect l
Corresponding
0379-0738/95/$09.50 SD1
0379-0738(95)01730-7
author. 0 1995 Elsevier
Science
Ireland
Ltd. All rights
reserved
144
C.L. Winek et al. /Forensic Science International 73 (199.5) 143-147
of stomach acid and possibly other factors, it is usually true that lye powders and granules elicit an esophagus injury rather than a gastric one [2]. Most of the reported cases (N = 100) involve corrosive esophageal stricture due to ingestion of lye. In one case, massive necrosis and multiple perforation of the large and small intestines to the level of the Sigmoid colon resulted in death [3]. Death after lye ingestion may result from any of several complications: circulatory shock, asphyxia due to glottic or laryngeal edema, perforation of the esophagus or aspiration [2]. We present a case of a 13-year-old male who committed suicide by ingestion of heavy duty drain and sewer opener. 2. Autopsy findings
The autopsy revealed a well-developed and nourished young man. Internal examination revealed bilateral hemothorax and the presence of dark red coffee ground blood in the peritoneal cavity. The organs of the pleural and abdominal cavities were in their usual position in situ, except for the spleen, which protruded into the left pleural cavity via a large defect in the left dome of the diaphragm. Examination of the airway revealed brown discoloration of the mucosa with dark red fluid present. The gastrointestinal system showed gray and firm esophageal mucosa. The mucosa of the stomach were dark brown, with a leather-like consistency. There was a marked hemorrhagic tear of the fundus. The duodenum, jejunum and ileum showed patchy, dark red discoloration with leathery consistency of the adventitia. Microscopic examination of the esophagus, cardia, stomach and pylorus showed extensvie necrosis with perforation of the stomach. 3. Toxicological analyses
Samples collected at autopsy included thoracic cavity blood and urine. Samples collected at the scene included a half-gallon container of heavy duty drain opener containing < 100 ml of colorless viscous liquid, a glass or jar containing < 20 ml of colorless viscous liquid and a plastic cup that contained urine (positive for urea). Sodium and potassium concentrations were determined using a flame photometer (Instrumentation Laboratory 943). Sample analyses were performed in duplicate with blanks and standards included in the same run. The colorless liquids contained in the drain opener bottle and the jar were compared using an ATI-Mattson Genesis series FTIR (Fourier Transform Infrared) spectrometer. 4. Results
Table 1 shows the sodium and potassium concentrations and pH of the liquid obtained from the original bottle of drain fluid and that from the glass jar found at the scene. The values were very similar. The same table shows the pH of the thoracic cavity blood and two urine samples. The values reflect a higher pH value than normal.
C.L. Table I Sodium and potassium
Winek
et al. /Forensic
contents
Sample Liquid in drain opener Liquid in glass jar Urine at the scene Urine at autopsy Thoracic cavity blood -
bottle
Science International
73 (1995)
143-147
and pH values PH
Sodium
Potassium
14.0 13.8 7.6 7.3 II.1
5175 4845
3379 3151
, Test not performed.
Fig. 1. Photograph
of the victim
showing
chemical
burn
on lower
lip.
145
146
C.L. Winek et al. /Forensic Science international 73 (1995) 143-147
C.L.
Winek el al. /Forensic
Science lnrernarional
73 11995)
143-147
147
The FTIR spectrum of the colorless liquid in the jar was consistent with that obtained upon the analysis of a sample from the drain opener bottle. Routine toxicological analyses of the thoracic cavity blood and urine were negative for drugs. 5. Discussion
This 13-year-old white male committed suicide by ingesting heavy duty drain and sewer opener. Fig. 1 is a photograph of the victim with chemical burns to the lower lip. Fig. 2 shows extensive necrosis of the gastric wall. It is obvious that the contents of the jar found next to his bed were poured from the original bottle which was found in the room adjacent to his bedroom. The high pH value of the blood reflects alkalosis and indicates that he ingested this fluid. The autopsy findings confirm this. The combination of sodium hydroxide and potassium hydroxide at high concentrations (Table 1) indicated a highly corrosive solution that caused considerable damage to the gastrointestinal tract. The neutralizing effect of the stomach acid was not enough to prevent stomach perforation. The pathological diagnosis was perforation of the stomach with hemothorax and hemoperitoneum, as well as perforation of the left dome of the diaphragm. The manner of death was ruled as suicide. Liquid drain and sewer opener solutions are readily available commercial products. The present case illustrates the importance of scene investigation and proper sample collection for toxicological analysis in such cases. References [l]
R.J. Lewis, Sr, SaxS Dangerous Properties of Industrial Materials, New York, NY, 8th Edn., Vol. 3, 1992, pp. 3086-3087. [2] R.E. Gosselin, R.P. Smith and H.C. Hodge, Clinical Toxicology of Commercial Products, 5th Edn., Williams and Wilkins, Baltimore, 1984, pp. 245-249. [3] H.V. Sperling and M.J. Wheeler, An unusual complication of lye ingestion. J. Am. Med. Assoc., 228 (1974) 871.
Forensic Science International
ELSEVIER
73 (1995)
143-147
Ingestion of lye Charles L. Winek*“, Leon Rozinb, Wagdy W. Wahba”, Vida Rafizadeh b “Allegheny
County
Department
bAllegheny
County
of Laboratories, Coroner’s
Received
OfJce.
22 January
10 Counry 542
Fourth
Office Avenue,
1995; accepted
Building,
Pittsburgh,
Pittsburgh.
3 February
PA
15219,
PA
15219,
USA
USA
1995
Abstract
This paperreportson the caseof a 13-year-oldwhite malewho committedsuicideby ingestion of heavyduty drain and seweropener.He left behinda note indicatinghis suicide.This teenagerwasgrieving over the suicideof one of his friends and wasunder counselingby a mentalhealththerapistat school.Resultsof autopsyand toxicologicalanalysesindicatedthe ingestionof a highly alkaline substancethat is consistentwith the ingredientsof the drain openermentioned. Keywordr:
Lye, ingestionof; Suicide;Drain opener
1. Introduction
Heavy duty drain and sewer openers are widely used, easily available products. The main ingredients of the lye solution in this case are sodium and potassium hydroxide. Lye solution is highly corrosive. Ingestion causes very serious damage to the mucous membranes and other tissues. It can cause perforation and scarring [ 11. Traditional drain cleaners consist of granular lye in very high concentrations, sometimes approaching lOO”/o. Several drain products are available in the American market. Ranging 25-36.5X sodium and/or potassium hydroxide in water, they are less concentrated than the granular products, but it is generally agreed that they are more hazardous [2]. Even products that contain c 10% lye produced severe damage to the esophagus after 30 s of ingestion. In humans, because of the neutralizing effect l
Corresponding
0379-0738/95/$09.50 SD1
0379-0738(95)01730-7
author. 0 1995 Elsevier
Science
Ireland
Ltd. All rights
reserved
144
C.L. Winek et al. /Forensic Science International 73 (199.5) 143-147
of stomach acid and possibly other factors, it is usually true that lye powders and granules elicit an esophagus injury rather than a gastric one [2]. Most of the reported cases (N = 100) involve corrosive esophageal stricture due to ingestion of lye. In one case, massive necrosis and multiple perforation of the large and small intestines to the level of the Sigmoid colon resulted in death [3]. Death after lye ingestion may result from any of several complications: circulatory shock, asphyxia due to glottic or laryngeal edema, perforation of the esophagus or aspiration [2]. We present a case of a 13-year-old male who committed suicide by ingestion of heavy duty drain and sewer opener. 2. Autopsy findings
The autopsy revealed a well-developed and nourished young man. Internal examination revealed bilateral hemothorax and the presence of dark red coffee ground blood in the peritoneal cavity. The organs of the pleural and abdominal cavities were in their usual position in situ, except for the spleen, which protruded into the left pleural cavity via a large defect in the left dome of the diaphragm. Examination of the airway revealed brown discoloration of the mucosa with dark red fluid present. The gastrointestinal system showed gray and firm esophageal mucosa. The mucosa of the stomach were dark brown, with a leather-like consistency. There was a marked hemorrhagic tear of the fundus. The duodenum, jejunum and ileum showed patchy, dark red discoloration with leathery consistency of the adventitia. Microscopic examination of the esophagus, cardia, stomach and pylorus showed extensvie necrosis with perforation of the stomach. 3. Toxicological analyses
Samples collected at autopsy included thoracic cavity blood and urine. Samples collected at the scene included a half-gallon container of heavy duty drain opener containing < 100 ml of colorless viscous liquid, a glass or jar containing < 20 ml of colorless viscous liquid and a plastic cup that contained urine (positive for urea). Sodium and potassium concentrations were determined using a flame photometer (Instrumentation Laboratory 943). Sample analyses were performed in duplicate with blanks and standards included in the same run. The colorless liquids contained in the drain opener bottle and the jar were compared using an ATI-Mattson Genesis series FTIR (Fourier Transform Infrared) spectrometer. 4. Results
Table 1 shows the sodium and potassium concentrations and pH of the liquid obtained from the original bottle of drain fluid and that from the glass jar found at the scene. The values were very similar. The same table shows the pH of the thoracic cavity blood and two urine samples. The values reflect a higher pH value than normal.
C.L. Table I Sodium and potassium
Winek
et al. /Forensic
contents
Sample Liquid in drain opener Liquid in glass jar Urine at the scene Urine at autopsy Thoracic cavity blood -
bottle
Science International
73 (1995)
143-147
and pH values PH
Sodium
Potassium
14.0 13.8 7.6 7.3 II.1
5175 4845
3379 3151
, Test not performed.
Fig. 1. Photograph
of the victim
showing
chemical
burn
on lower
lip.
145
146
C.L. Winek et al. /Forensic Science international 73 (1995) 143-147
C.L.
Winek el al. /Forensic
Science lnrernarional
73 11995)
143-147
147
The FTIR spectrum of the colorless liquid in the jar was consistent with that obtained upon the analysis of a sample from the drain opener bottle. Routine toxicological analyses of the thoracic cavity blood and urine were negative for drugs. 5. Discussion
This 13-year-old white male committed suicide by ingesting heavy duty drain and sewer opener. Fig. 1 is a photograph of the victim with chemical burns to the lower lip. Fig. 2 shows extensive necrosis of the gastric wall. It is obvious that the contents of the jar found next to his bed were poured from the original bottle which was found in the room adjacent to his bedroom. The high pH value of the blood reflects alkalosis and indicates that he ingested this fluid. The autopsy findings confirm this. The combination of sodium hydroxide and potassium hydroxide at high concentrations (Table 1) indicated a highly corrosive solution that caused considerable damage to the gastrointestinal tract. The neutralizing effect of the stomach acid was not enough to prevent stomach perforation. The pathological diagnosis was perforation of the stomach with hemothorax and hemoperitoneum, as well as perforation of the left dome of the diaphragm. The manner of death was ruled as suicide. Liquid drain and sewer opener solutions are readily available commercial products. The present case illustrates the importance of scene investigation and proper sample collection for toxicological analysis in such cases. References [l]
R.J. Lewis, Sr, SaxS Dangerous Properties of Industrial Materials, New York, NY, 8th Edn., Vol. 3, 1992, pp. 3086-3087. [2] R.E. Gosselin, R.P. Smith and H.C. Hodge, Clinical Toxicology of Commercial Products, 5th Edn., Williams and Wilkins, Baltimore, 1984, pp. 245-249. [3] H.V. Sperling and M.J. Wheeler, An unusual complication of lye ingestion. J. Am. Med. Assoc., 228 (1974) 871.