title: Death due to acute tetrachloroethylene intoxication in a chronic abuser.
abstract: Volatile substances are used widespread, especially among young people, as a cheap and easily accessible drug. Tetrachloroethylene is one of the solvents exerting effects on the central nervous system with experiences of disinhibition and euphoria. The case presented is that of a 27-year-old female, found dead by her father at home with cotton swabs dipped in the nostrils. She was already known for this type of abuse and previously admitted twice to the hospital for nonfatal acute poisonings. The swabs were still soaked in tetrachloroethylene. Toxicological and histological investigations demonstrated the presence of an overlap between chronic intake of the substance (with high concentrations in sites of accumulation, e.g., the adipose tissue, and contemporary tissue damage, as histologically highlighted) and acute intoxication as final cause of death, with a concentration of 158 mg/L in cardiac blood and 4915 mg/kg in the adipose tissue. No other drugs or medicines were detected in body fluids or tissues, and to our knowledge, this is the highest concentration ever detected in forensic cases. This peculiar case confirms the toxicity of this substance and focuses on the importance of complete histological and toxicological investigations in the distinction between chronic abuse and acute intoxication.
authors.affiliation: Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy, albertoamadasi@libero.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Amadasi
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mastroluca
authors.forename: Laura
authors.initials: L
authors.lastname: Marasciuolo
authors.forename: Marina
authors.initials: M
authors.lastname: Caligara
authors.forename: Luca
authors.initials: L
authors.lastname: Sironi
authors.forename: Guendalina
authors.initials: G
authors.lastname: Gentile
authors.forename: Riccardo
authors.initials: R
authors.lastname: Zoja
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000150:complications / Q000523:psychology; D002423:Cause of Death; D002908:Chronic Disease; D001068:Feeding and Eating Disorders / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D058545:Inhalant Abuse / Q000097:blood / Q000401:mortality*; D013750:Tetrachloroethylene / Q000493:pharmacokinetics / Q000506:poisoning*; D014018:Tissue Distribution
chemical_list: D013750:Tetrachloroethylene