Liu Huine, Liang Man, Yang Yi, Ma Jinghong, Zhou Yiwu, Dong Hongmei, Duan Yijie
Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Wuhan Public Security Bureau, Wuhan, 430012, China.
Forensic Sci Med Pathol. 2025 Jan 28. doi: 10.1007/s12024-025-00946-4.
Nitrous oxide (NO) abuse is becoming increasingly popular worldwide. Moreover, the use of NO combined with other substances, such as alcohol, is also common. Accidental deaths associated with NO abuse are rare in forensic practice, with most fatal cases involving continuous inhalation equipment or exposure in a confined space. In contrast, the inhalation of NO using balloons is traditionally regarded as a relatively safe method. In this report, we present an unusual fatal case of a 16-year-old girl who died after drinking alcohol and inhaling NO from balloons. The decedent was found in a prone position with the nose and mouth compressed against the bed. Cyanosis of nails, pulmonary and cerebral edema, and the positive expression of HIF-1α in lung, myocardium and brain, were indicative of asphyxiation. Toxicological analysis revealed a peripheral blood ethanol concentration of 140 mg/dL and cardiac blood NO concentration of 74.5 μL/mL. NO was also positively detected in the lungs, stomach contents, gastric air, and the brain. In conclusion, we determined that the decedent died from accidental asphyxia related to NO inhalation, prone positioning, and alcohol consumption. We also investigated chronic NO abuse from a forensic perspective. This report aims to help forensic pathologists manage similar cases. It also reminds NO abusers of potential dangers.
一氧化二氮（NO）滥用在全球范围内正变得越来越普遍。此外，将NO与其他物质（如酒精）混合使用也很常见。在法医实践中，与NO滥用相关的意外死亡很少见，大多数致命案例涉及持续吸入设备或在密闭空间中接触。相比之下，使用气球吸入NO传统上被认为是一种相对安全的方法。在本报告中，我们呈现了一例不同寻常的致命案例，一名16岁女孩在饮酒并从气球中吸入NO后死亡。死者被发现呈俯卧位，鼻子和嘴巴压在床上。指甲发绀、肺水肿和脑水肿，以及肺、心肌和脑中HIF-1α的阳性表达，均表明存在窒息。毒理学分析显示外周血乙醇浓度为140mg/dL，心脏血中NO浓度为74.5μL/mL。在肺、胃内容物、胃内气体和脑中也检测到了NO呈阳性。总之，我们确定死者死于与吸入NO、俯卧体位和饮酒相关的意外窒息。我们还从法医角度调查了长期滥用NO的情况。本报告旨在帮助法医病理学家处理类似案件。它也提醒NO滥用者注意潜在危险。
