Flammable gastric contents: A case of fatal gasoline ingestion

Petroleum poisoning occurs through accidental, occupational, or intentional exposure. Low-viscosity, lipophilic hydrocarbons can rapidly affect the central nervous and cardiovascular systems. While cases of therapeutic oral ingestion have been described in the literature, such exposures in elderly individuals with cognitive impairment are frequently associated with accidental mixing of hazardous substances with common food items. This report details a fatal accidental gasoline ingestion case in a patient who likely mistook the fuel for a traditional, viscous food product, integrating findings from scene investigation, autopsy, histopathology, and toxicology.

A 71-year-old male with reported neurocognitive impairment was found unresponsive in his basement, holding a gasoline canister. Scene investigation suggested that the victim, due to cognitive disorientation, had likely mistaken the gasoline for a traditional fruit-based syrup (grape molasses), a common dietary staple stored in the vicinity. Physical examination revealed fixed dilated pupils, cold extremities, and muscular rigidity as recorded in clinical notes. Laboratory investigations showed elevated levels of creatine kinase-MB, sodium, aspartate aminotransferase, and blood urea nitrogen, alongside decreased albumin, calcium, and borderline-low potassium. Cardiopulmonary resuscitation was performed for approximately 35 minutes; despite intensive medical interventions, the patient succumbed to his condition. Subsequent autopsy findings confirmed the absence of traumatic lesions, while a characteristic gasoline odor and an oily fluid were noted within the gastric contents. The stomach contained approximately 55-58 g of a yellow oily liquid layered over food remnants, with similar material identified in the intestines. Histopathological examination revealed brain microhemorrhages, gastric autolysis with focal hemorrhage, pulmonary findings including bronchopneumonia and intra-alveolar edema consistent with terminal aspiration, and histological features resembling fat embolism, the latter most likely attributable to prolonged cardiopulmonary resuscitation. Headspace gas chromatography-mass spectrometry detected benzene in the blood and gasoline-associated hydrocarbons in the organs and gastric contents. The diagnosis was established through qualitative detection of gasoline components and a positive flammability test confirming the presence of flammable gastric contents.

The integration of scene investigation, macroscopic findings, histopathology, and qualitative toxicology strongly supports gasoline ingestion as the cause of death, with CNS depression as the most likely mechanism; however, cardiac toxicity and multi-organ failure cannot be excluded as contributing factors. This case highlights the high risk of accidental poisoning in elderly populations with cognitive decline and emphasises the utility of a rapid bench-side flammability test as a confirmatory tool for flammable gastric contents, and the importance of comprehensive tissue sampling in forensic practice, even in the absence of quantitative toxicological data.