Pathomorphological changes in internal organs in acute poisoning with 4-hydroxybutanoic acid (according to the data of the Bureau of forensic medical expertise)

Abstract

The aim of the study was to establish objective reliable morphological signs of fatal poisoning with 4-hydroxybutanoic acid (4-HBA).Material and methods. The 49 acts of forensic medical examination of corpses with «Acute poisoning with 4-hydroxybutanoic acid» as the main cause of death were analyzed. The work was done in the Saint Petersburg Bureau of Forensic Medical Expertise.The results of morphological (macro - and microscopic) as well as forensic chemical studies of biological tissues were evaluated.The results were statistically processed using Statistic for Windows software (version 10). The numerical characteristics of the variables (M ± SD, Me [Q25; Q75]), χ2 — Pearson's criterion, and Spearman's correlation coefficient were applied for statistical processing.Results. The average lethal dose of 4-HBA in arterial blood was found to be equal to 273,6 ± 125,1 mg/l. In a forensic chemical study the combined use of 4-HBA and other narcotic substances (NS) and psychoactive substances (PAS) was diagnosed in 48.9% of cases. Of the causes leading to death, non-violent and «non-criminal» death due to 4-HBA poisoning was established more often - in 67.3% (33) of cases, a fall of the victim from a height with a fatal outcome - in 22.4% (11), less often violent death as a result of blunt and acute trauma - in 4.09% (2) cases.Among the macroscopic signs of acute lethal poisoning with 4-HBA were an increased mass of internal organs (heart, lungs, spleen, liver) in direct connection with the concentration of the toxicant in the blood. Microscopic signs of acute lethal poisoning by a toxicant included blood circulation features characteristic of sudden death.Concomitant pathology was diagnosed in 32.6% of cases in the form of degenerative changes in internal organs. In turn, hepatitis C and human immunodeficiency virus (HIV) were detected in 26.5% (13) of the dead.Conclusions. Thus, the signs characteristic for acute fatal poisoning with 4-HBA include the features of hemocirculation characteristic of sudden death. The brain is most severely affected, which is manifested by destructive edema. Poisoning is also characterized by the presence of serous pulmonary edema. Macroscopic signs of poisoning were revealed, including an increase in the weight of the heart, lungs, spleen and liver in direct connection with the concentration of the toxicant in the blood.It should be noted that the concomitant pathology in the form of dystrophic changes in the internal organs indicates the long-term nature of the use of the toxicant leading to pronounced metabolic disorders.