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Fatal and non-fatal methomyl intoxication in an attempted double suicide
T Miyazaki1, M Yashiki, T Kojima
1Department of Legal Medicine, Hiroshima University School of Medicine, Japan.
Abstract:
A 79-year-old man and his 73-year-old wife attempted double suicide by ingesting methomyl powder. The woman died 19 h after ingestion in spite of intensive care. At autopsy a large number of miliary hemorrhages were found in both thalami of the brain. Her husband, however, recovered after 10 days of treatment. Methomyl (CAS No. 16752-77-5, Lannate) in the biological materials was analyzed by gas chromatography-mass spectrometry. The methomyl concentration was 44 micrograms/g in the wife's serum sample collected 1 h after ingestion, and 0.2 microgram/g in the blood sample collected at autopsy. The methomyl concentration in the husband's blood sample collected 28 h after ingestion was from 0.01 to 0.1 microgram/g. It is suggested that prompt and adequate intensive care including a direct hemoperfusion is necessary to effect the recovery of patients with lethal blood levels of methomyl. The miliary hemorrhages found in the thalami of the brain are suspected to have been caused by asphyxia induced by methomyl intoxication.
Insights
This case study highlights a double suicide attempt involving methomyl ingestion. Prompt intensive care, including hemoperfusion, is crucial for survival in severe methomyl poisoning cases.
Area of Science:
- Toxicology
- Neuroscience
- Emergency Medicine
Background:
- Pesticide ingestion, particularly carbamates like methomyl, presents significant toxicological challenges.
- Methomyl poisoning can lead to severe neurological and physiological effects, with high mortality rates.
- Understanding the toxicokinetics and clinical management of methomyl overdose is critical for patient outcomes.
Observation:
- A couple ingested methomyl powder in a suicide attempt.
- The wife died 19 hours post-ingestion, with autopsy revealing miliary hemorrhages in the thalami.
- The husband recovered after 10 days of treatment.
Findings:
- Methomyl concentrations were significantly higher in the deceased wife (44 µg/g serum at 1h) compared to the recovered husband (0.01-0.1 µg/g blood at 28h).
- Gas chromatography-mass spectrometry confirmed methomyl in biological samples.
- Miliary hemorrhages in the thalami are suspected to result from methomyl-induced asphyxia.
Implications:
- Early and aggressive intensive care, including hemoperfusion, may be life-saving in severe methomyl poisoning.
- The study underscores the neurotoxic effects of methomyl, potentially leading to fatal outcomes.
- Accurate toxicological analysis is essential for diagnosis and guiding treatment in pesticide poisoning cases.