Exsanguination from a puncture wound to arteriovenous fistula as the method of suicide in a chronic kidney disease patient.

In this paper we present a case of a 65-year-old man, with chronic kidney insufficiency treated with hemodialysis, found dead by his wife, lying in his bed. Based on autopsy findings, toxicological analysis, the police report and circumstances of death, it was concluded that the death was suicidal and that the cause of death was hemorrhagic shock due to fatal blood loss through a small puncture wound in an arteriovenous fistula of the left forearm, inflicted by a small Swiss Army knife. Similarly to occupation-related suicides, the victim had used his knowledge about chronic kidney disease and the relatively high pressure in an arteriovenous fistula to inform his suicidal actions, and, thus, this case might be considered a disease-knowledge-related or medical-knowledge-related suicide.