Simple asphyxiant gases, such as helium and hydrogen, simply replace oxygen, whereas chemical asphyxiants, like hydrogen cyanide, prevent cellular respiration. Asphyxiant gases interfere with the supply and utilization of oxygen by the body. They can be divided into primary irritants, which have little or no systemic toxic effects, and secondary irritants, which do. They irritate mucosal surfaces and cause inflammation in the airways. Irritant gases are substances that as a rule are corrosive.
Gases can be divided into irritant gases, asphyxiant gases, and drug-like gases and vapors ( 3). The environment may have a low oxygen content or the oxygen content may have been replaced by another irrespirable gas. This may be in a work or nonwork-related incident ( 2). However, a more difficult investigation can involve deaths associated with environmental hypoxia, and all forensic pathologists are likely to encounter such deaths in their careers. The identification of these deaths typically requires a coordinated investigation with safety inspectors and other experts in industrial- and work-related deaths.ĭeaths associated with a depleted atmosphere are not uncommon and are encountered in such scenarios as plastic bag asphyxia with accompanying inhalation of helium ( 1). Such environments may be encountered in industrial settings, but also occur in natural disasters such as the Lake Nyos disaster. Environments rich in carbon dioxide can also cause death, even with a high oxygen concentration. When an atmosphere low in oxygen is entered, collapse can be rapid, or immediate if the environmental oxygen is below 6%. Transportation incidents may also be associated with hypoxic events, particularly aircraft and submarines. Environments that have been associated with these events include mines, tunnels, sewers, and pits. Typically these are accidents, but suicides may be encountered and criminal charges may follow these events. Deaths from hypoxia and raised carbon dioxide may be encountered in work-and nonwork-related environments. These deaths present problems to autopsy pathologists, as the autopsy is typically negative and postmortem toxicology cannot be used to detect the effects of hypoxia and raised levels of carbon dioxide. This paper reviews deaths in which there is an environment that is low in oxygen and/or has elevated levels of carbon dioxide.
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