XML Template (2014) [16.12.2014–2:58pm] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/ACBJ/Vol00000/140099/APPFile/SG-ACBJ140099.3d
(ACB)
[1–6] [PREPRINTER stage]
Ann Clin Biochem OnlineFirst, published on December 18, 2014 as doi:10.1177/0004563214559222
Case Report Annals of Clinical Biochemistry 0(0) 1–6 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0004563214559222 acb.sagepub.com
Homicidal arsenic poisoning Andrew Duncan1, Andrew Taylor2, Elizabeth Leese3, Sam Allen4, Jackie Morton3 and Julie McAdam5
Abstract The case of a 50-year-old man who died mysteriously after being admitted to hospital is reported. He had raised the possibility of being poisoned prior to his death. A Coroner’s post-mortem did not reveal the cause of death but this was subsequently established by post-mortem trace element analysis of liver, urine, blood and hair all of which revealed very high arsenic concentrations.
Keywords Toxicology, arsenic, homicide Accepted: 4th October 2014
Introduction In the past, arsenic has been a popular choice of poison used for suicide and homicide; however, more recently its availability in UK and USA has been restricted. Only two cases of intentional arsenic poisoning have been reported in the western literature since 1992.1,2 We present a recent case of unexplained sudden death. The case was reported to the Procurator Fiscal (Scottish equivalent to the Coroner), and a diagnostic forensic process was instigated that supported the conclusion that the man died as a direct result of maleficent arsenic poisoning.
Case report A 50-year-old man of Pakistani origin who had been living in Saudi Arabia with relatives for three months, presented with a six-week history of diarrhoea and vomiting. He also reported general malaise, abdominal tenderness, mild fever, numbness in his arms and legs and blurring of vision. He had lost approximately 15 kg in weight. When his symptoms began, he had volunteered to his partner, a nephew and a friend that he
thought he may have been poisoned as he had felt unwell following a meal. He returned to the UK via Pakistan where he again visited relatives. In Pakistan, he presented to a local hospital with diarrhoea and vomiting. He was diagnosed with Helicobacter pylori infection and was commenced on H. pylori eradication therapy. After returning to the UK and around seven weeks after the onset of his illness, he presented to his GP with diarrhoea, vomiting and a tender abdomen. The patient was referred to hospital.
1 Scottish Trace Element & Micronutrient Reference Laboratory, Glasgow Royal Infirmary, Glasgow, UK 2 Department of Clinical Chemistry, Royal Surrey County Hospital, Guildford, UK 3 Health and Safety Laboratory, Buxton, UK 4 University Hospital Crosshouse, Crosshouse, UK 5 Forensic Medicine and Science, Glasgow University, Glasgow, UK
Corresponding author: Andrew Duncan, Scottish Trace Element & Micronutrient Reference Laboratory, Glasgow Royal Infirmary, Glasgow G4 0SF, UK. Email: [email protected]
Downloaded from acb.sagepub.com at Erciyes Universitesi on December 29, 2014
XML Template (2014) [16.12.2014–2:58pm] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/ACBJ/Vol00000/140099/APPFile/SG-ACBJ140099.3d
(ACB)
[1–6] [PREPRINTER stage]
2
Annals of Clinical Biochemistry 0(0)
There was no significant medical history, but the patient had been shot in the leg, allegedly by a relative during a trip to Pakistan around a year before his death. On general examination, he looked well. His temperature, pulse, blood pressure, respiratory rate and oxygen saturations were normal. He had moderate tenderness over the right hypochondrium. Laboratory findings on admission showed pancytopenia and deranged liver function tests (reference ranges in parentheses): haemoglobin 117 g/L (130– 180 g/L), white blood cells 1.0 109/L (4–11 109/L); platelets 95 109/L (150–400 109/L); mean cell volume 80 fL (78–99 fL); neutrophils 0.4 109/L (2–7.5 109/L); lymphocytes 0.4 109/L (1.5–4 109/ L); vitamin B12 1053 ng/L (200–900 ng/L); folate 4.3 mg/L (3.1–20 mg/L); ferritin 422 mg/L (10–275 mg/L); urea 10.3 mmol/L (2.5–7.8 mmol/L); creatinine 122 mmol/L (40–130 mmol/L); total bilirubin 46 mmol/L (
(ACB)
[1–6] [PREPRINTER stage]
Ann Clin Biochem OnlineFirst, published on December 18, 2014 as doi:10.1177/0004563214559222
Case Report Annals of Clinical Biochemistry 0(0) 1–6 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0004563214559222 acb.sagepub.com
Homicidal arsenic poisoning Andrew Duncan1, Andrew Taylor2, Elizabeth Leese3, Sam Allen4, Jackie Morton3 and Julie McAdam5
Abstract The case of a 50-year-old man who died mysteriously after being admitted to hospital is reported. He had raised the possibility of being poisoned prior to his death. A Coroner’s post-mortem did not reveal the cause of death but this was subsequently established by post-mortem trace element analysis of liver, urine, blood and hair all of which revealed very high arsenic concentrations.
Keywords Toxicology, arsenic, homicide Accepted: 4th October 2014
Introduction In the past, arsenic has been a popular choice of poison used for suicide and homicide; however, more recently its availability in UK and USA has been restricted. Only two cases of intentional arsenic poisoning have been reported in the western literature since 1992.1,2 We present a recent case of unexplained sudden death. The case was reported to the Procurator Fiscal (Scottish equivalent to the Coroner), and a diagnostic forensic process was instigated that supported the conclusion that the man died as a direct result of maleficent arsenic poisoning.
Case report A 50-year-old man of Pakistani origin who had been living in Saudi Arabia with relatives for three months, presented with a six-week history of diarrhoea and vomiting. He also reported general malaise, abdominal tenderness, mild fever, numbness in his arms and legs and blurring of vision. He had lost approximately 15 kg in weight. When his symptoms began, he had volunteered to his partner, a nephew and a friend that he
thought he may have been poisoned as he had felt unwell following a meal. He returned to the UK via Pakistan where he again visited relatives. In Pakistan, he presented to a local hospital with diarrhoea and vomiting. He was diagnosed with Helicobacter pylori infection and was commenced on H. pylori eradication therapy. After returning to the UK and around seven weeks after the onset of his illness, he presented to his GP with diarrhoea, vomiting and a tender abdomen. The patient was referred to hospital.
1 Scottish Trace Element & Micronutrient Reference Laboratory, Glasgow Royal Infirmary, Glasgow, UK 2 Department of Clinical Chemistry, Royal Surrey County Hospital, Guildford, UK 3 Health and Safety Laboratory, Buxton, UK 4 University Hospital Crosshouse, Crosshouse, UK 5 Forensic Medicine and Science, Glasgow University, Glasgow, UK
Corresponding author: Andrew Duncan, Scottish Trace Element & Micronutrient Reference Laboratory, Glasgow Royal Infirmary, Glasgow G4 0SF, UK. Email: [email protected]
Downloaded from acb.sagepub.com at Erciyes Universitesi on December 29, 2014
XML Template (2014) [16.12.2014–2:58pm] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/ACBJ/Vol00000/140099/APPFile/SG-ACBJ140099.3d
(ACB)
[1–6] [PREPRINTER stage]
2
Annals of Clinical Biochemistry 0(0)
There was no significant medical history, but the patient had been shot in the leg, allegedly by a relative during a trip to Pakistan around a year before his death. On general examination, he looked well. His temperature, pulse, blood pressure, respiratory rate and oxygen saturations were normal. He had moderate tenderness over the right hypochondrium. Laboratory findings on admission showed pancytopenia and deranged liver function tests (reference ranges in parentheses): haemoglobin 117 g/L (130– 180 g/L), white blood cells 1.0 109/L (4–11 109/L); platelets 95 109/L (150–400 109/L); mean cell volume 80 fL (78–99 fL); neutrophils 0.4 109/L (2–7.5 109/L); lymphocytes 0.4 109/L (1.5–4 109/ L); vitamin B12 1053 ng/L (200–900 ng/L); folate 4.3 mg/L (3.1–20 mg/L); ferritin 422 mg/L (10–275 mg/L); urea 10.3 mmol/L (2.5–7.8 mmol/L); creatinine 122 mmol/L (40–130 mmol/L); total bilirubin 46 mmol/L (
