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因自杀性摄入专业溶菌酶制剂(Lysoform®)导致延迟死亡的内脏微观模式。

Visceral Microscopic Pattern From Suicidal Ingestion of Professional Lysoform® With Delayed Death.

作者信息

Tambuzzi Stefano, Gentile Guendalina, Andreola Salvatore, Migliorini Arnaldo Stanislao, Zoja Riccardo

出版信息

Acad Forensic Pathol. 2022 Sep;12(3):118-125. doi: 10.1177/19253621221119081. Epub 2022 Aug 12.

Abstract

Lysoform® in the formulation of professional detergent is widely used in several fields, whereas its suicidal ingestion is an unusual occurrence. Therefore, the biological signs of this fatal poisoning remain unclear and elusive, similarly to the histological lesions induced by its main constituent, which is benzalkonium chloride (BZK). Furthermore, since all the deaths that has been reported in the literature occurred immediately, microscopic pictures of BZK lethal toxicity in subjects with prolonged survival have never been reported to date. Specifically, this brief communication reports the unique case of a woman who ingested professional Lysoform® to commit suicide, for which she died two weeks later. The autopsy examination showed either local or systemic signs of caustic ingestion; moreover, the histological analysis showed clear cellular damage of lungs, heart, and kidneys. In our case, toxicological investigations were not authorized as they were no longer considered significant. In this framework, the histological examination has therefore assumed a fundamental role in investigating and demonstrating the lethal effects caused by the systemic dissemination of BZK, which would otherwise no longer be investigable. Therefore, in cases of substance intoxication with prolonged survival where forensic toxicological investigations may be no longer possible or feasible, the histological examination may be the only resource to successfully observe and demonstrate its lethal effects.

摘要

溶菌酶制剂(Lysoform®)在专业洗涤剂配方中广泛应用于多个领域,而其误服情况并不常见。因此,这种致命中毒的生物学体征仍不明确且难以捉摸,与其主要成分苯扎氯铵(BZK)所引发的组织学损伤情况类似。此外,鉴于文献中报道的所有死亡案例均为即时发生,至今尚未有关于长期存活的受试者中BZK致死毒性的微观图像报道。具体而言,本简短通讯报道了一名女性自杀性摄入专业溶菌酶制剂(Lysoform®)并于两周后死亡的独特案例。尸检显示有腐蚀性摄入的局部或全身体征;此外,组织学分析显示肺、心脏和肾脏存在明显的细胞损伤。在我们这个案例中,毒理学调查未获批准,因为认为其已不再具有重要意义。在此背景下,组织学检查在调查和证明由BZK全身扩散所导致的致死效应方面发挥了关键作用,否则这些效应将无法再进行调查。因此,在存活时间延长的物质中毒案例中,法医毒理学调查可能不再可行或无法进行时,组织学检查可能是成功观察和证明其致死效应的唯一手段。

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本文引用的文献

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Pediatr Gastroenterol Hepatol Nutr. 2016 Sep;19(3):207-209. doi: 10.5223/pghn.2016.19.3.207. Epub 2016 Sep 29.
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Toxic effect in the lungs of rats after inhalation exposure to benzalkonium chloride.大鼠吸入苯扎氯铵后肺部的毒性作用。
Int J Occup Med Environ Health. 2013 Aug;26(4):647-56. doi: 10.2478/s13382-013-0137-8. Epub 2014 Jan 25.
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Caustic injury of the upper gastrointestinal tract: a comprehensive review.上消化道腐蚀性损伤:全面综述。
World J Gastroenterol. 2013 Jul 7;19(25):3918-30. doi: 10.3748/wjg.v19.i25.3918.
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