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Other Asphyxial Deaths
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Infants dying due to accidental suffocation because of heavy bedding is common. Infants can also turn over while asleep, resulting in accidental smothering. This is one of the causes of sudden infant death syndrome (SIDS), and smothering comes under category 2 of the San Diego definition of SIDS. Overlaying by an intoxicated mother can also cause smothering in infants. Children playing with plastic bags are more prone to accidental suffocation. Sometimes, a plastic sheet might adhere to the mouth and the nose due to electrostatic forces, causing accidental smothering. Adults can also get accidentally smothered while involved in acts of bondage, which can also be considered as autoerotic asphyxiation. Adults involved in inhalant abuse such as glue sniffing can also get accidentally smothered. Other than in the above-mentioned scenarios and in some other rare circumstances, adults commonly are not victims of smothering unless otherwise inebriated or suffering from diseases like epilepsy. Elderly people are more prone to homicidal smothering along with infants and children. Hands, pillows, adhesive tapes, plastic sheets/bags, wet toilet papers, glue, coal dust, sand, mud, grains, etc. are the various means that can be used to cause smothering.
Novel psychoactive substances and inhalants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Although most cardiotoxic effects of volatile substance use occur acutely, case reports suggest that irreversible myocardial damage may result from chronic glue sniffing (Meadows and Verghese, 1996). Congestive heart failure, from chronic myocarditis and fibrosis (Wiseman and Banim, 1987) and myocardial degenerative changes (Banathy and Chan, 1983) have been reported in the adolescent population.
Licit and illicit drugs
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
Solvents such as toluene volatize at room temperature, allowing users to inhale the fumes, a practice referred to as ‘huffing’. Use of these agents and others such as glue, or gas fuel for cigarette lighters is much less common now than previously. Glue-sniffing was more frequent in the 1980s but still occurs. Clinical examination may reveal traces of the inhalant, such as glue, around an individual's mouth and face, with the persistent odour of the relevant inhalant. Some individuals may have evidence of singeing of beard or hair, or evidence of old burn injury to the face, as many of the agents used for such practices are highly flammable and do not associate well with lighted cigarettes. Toluene, as opposed to the solvents found in hair spray, dry-cleaning fluid and gasoline, is the agent most often responsible for fatal intoxication. The mechanism seems to be the disruption of normal cardiac electrical activity. Inhalation of any solvent will result in transient euphoria, headache and ataxia. Members of this group selectively destroy brain white matter, and a distinctive pattern can be identified in the MRI scans of chronic abusers. Solvents share some properties with other depressants such as barbiturates, benzodiazepines and even alcohol. However, the solvents, as a group, interact with so many different receptor subtypes that their actual mechanism of action remains unclear.
Treating potassium disturbances: kill the killers but avoid overkill
Published in Acta Clinica Belgica, 2019
R. Vanholder, W. Van Biesen, E. V. Nagler
Liddle’s syndrome is a rare autosomal dominant disease resulting in a hyperaldosteronism-like syndrome, combining excess tubular reabsorption of sodium and tubular potassium losses. Also excessive dietary sodium intake and polyuria (e.g. in polydipsia or osmotic diuresis) by enhancing urinary potassium losses [1], toluene inhalation (glue sniffing) and ureterosigmoidostomy may cause renal hypokalemia.