Suicide by exposure to sulfuryl fluoride.

The insecticide fumigant, sulfuryl fluoride, was used as an instrument of self destruction in at least two of the three fatal exposures detailed in this report. The autopsy findings, while nonspecific, have a confirmatory value. Toxicologic analysis should include a plasma and a urine fluoride level, since the toxic effects of exposure are probably related to this ion. Concentrations of fluoride in our cases were: 50.42 mg/L (Case 1) and 20 mg/L (Case 3). However, the values must be interpreted in light of all known information as a result of the paucity of reported cases of fatal sulfuryl fluoride exposures. The cases described provide a model for the investigation of tent fumigation deaths. Proper investigation of fumigant deaths requires knowledge of the insecticide, the fumigation procedure, and the implementation of warning devices. Guidelines are offered along with a procedural checklist for the investigation of tent fumigation deaths.