IIJFMT 2(4) 2004
LETHAL HOMICIDAL POISONING BY ANDA-POTASH INJECTION
Verma SK Professor,
Department of forensic Medicine and Toxicology,
University college of Medical sciences, Dilshad garden, Delhi-110095,
Email: vermasatish2003@yahoo.com
A fatal case of fatal homicidal poisoning though parenteral route is reported. A thirty years young male was injected Anda Potash (Potassium Cyanide) using surgical syringe and needle over rt. side back. He was immediately shifted to a tertiary care teaching hospital, where he was declared brought in dead. Medico-legal autopsy findings corroborated with the alleged history. The toxicological analysis of viscera and blood confirmed poisoning by Potassium Cyanide. The case is reported for its rarity, as it is probably the first case of homicide where Potassium Cyanide has been used through intramuscular route?
KEY WORDS
Homicide, Cyanide poisoning, Injection
INTRODUCTION
In majority cases of poisoning, oral route is the usual mode of administration of poison. This is followed by inhalation and some time parenteral route is also employed. The poisoning by injection is commonly suicidal in nature and substances used are mostly pharmaceutical products like barbiturates, harmones and neuromuscular blockers. Sometimes, even accidental fatal poisoning has been reported due to over dose of a substance administered through injection. The author here repots a rather very rare case (parenteral fatal cyanide poisoning search on Medline showed 0 result), where a fatal injection of Anda Potash (Potassium Cyanide in Lay men’s Language) was given to commit homicide. The case is unusual on three counts: a) agent used for poisoning; b) route of administration; and c) homicidal intend.
CASE DESCRIPTION
As per the inquest papers and inquiry from relatives of the deceased, A 30 years old male was having good property for which, his family members who wanted to grab his property repeatedly threatened him. One of the family members (his brother) hired a contract killer to eliminate the deceased. On the fateful day, the victim was taken by the assailants to a movie and on return was offered beer to drink, in the park near to his residence. After the drinks when the deceased started to move to his house, one of the assailants caught hold of him, while the other one injected anda potash pushing through a surgical syringe and needle in his back. The deceased had severe pain after the injection and call one of his friends thinking that he has been stabbed. By the time his friend and other relative came, it took 45 minutes and he was shifted to the hospital, he was declared brought in dead at this hospital.
AUTOPSY FINDINGS
Medico-legal post-mortem conducted on subsequent day by the author revealed body of a young male, average built and stature. It was wearing a T-shirt and vest (both having a small puncture mark about 1 mm in diameter on backside with blood staining around it and corresponding to the injection prick mark underneath over the body). A post-mortem mark of defibrillator was also present over the precardium. One antemortem puncture wound of size 1mm in diameter surrounded by a blackish discoloration (3.5x3.0 cm) on rt. side back placed 3.5 cm to the rt. of midline and 12 cm above rt. costal margin directed anteriorly, medially and downwards, was also found on external examination. On exploration of the wound it was going upto posterior surface of the rt. kidney. The blood was bright red in color. Stomach contents smelled of alcohol. However, cyanide’s characteristic odour of bitter almonds/ rotten fish could not be appreciated on autopsy. Stomach mucosa was intensely congested with greenish black hue and prominent vasculature. Other autopsy findings were unremarkable. Toxicological analysis of viscera, skin along with subcutaneous tissue from injection site and clothing’s worn by the deceased gave positive test for Potassium Cyanide. The viscera and blood sample of the victim also showed presence of alcohol (conc.4 mg/100ml).
DISCUSSIONAccording to WHO estimate accidents, injuries and poisoning contributed to 7% of mortality in 1990s 1. Incidences of poisoning have shown an upward trend in
The case highlights a potential abuse of cyanide to commit homicide by professional killers’ through parenteral route. As the survival period is very short and chances of survival are negligible after such an episode. Further, if the autopsy is not conducted meticulously, the chances of missing a minute injury mark (a small puncture wound) are quite high. So the culprits may not be apprehended and punished. The assailants of this very particular case, when caught confessed to the police that they had already killed 2 more persons in the similar fashion earlier. No body got suspicious about their death and presumed as natural and there were no evidences against them. To conclude the case highlights a very uncommon poisoning through parenteral route with homicidal intend, and importance of careful autopsy in such cases once again.
REFERENCES
1. Lopez AD. Cause of death: an assessment of global and regional patterns of mortality around 1985, in: WHO 1990 Global Estimates for Health Situation Assessment and Projections, 1990, p.39, WHO Stat. Quart 1990; 43: 21.
2. Lall SB, Peschin SS, Seth SD. Acute poisoning: a ten years retrospective hospital based study. Ann Natl Acad Sci (
3. Singh D, Jit I, Tyagi S. Changing trends in acute poisoning in Chandigarh zone. Am J Forensic Med Pathol 1999; 20: 203-210.
4. Gautami S, Sudershan RV, Bhatt RV, Suhasini G, Bharati M, Gandhi KPC. Chemical poisoning in three Telangana districts of Andhra Pradesh. Forensic Sci International 2001; 122: 167-171.
5. Dean B, Krenzelok EP. Adolescent poisoning a comparison of accidental and intentional exposures. Vet Hum Toxicol 1988; 30: 579-581.
6. McLoone P, Crombie IK. Hospitalization for deliberate self poisoning in
7. Shepherd G, Schatz WK. Accidental and suicidal adolescent poisoning deaths in United States, 1979-1994. Arch Pediatr Adolesc Med 1998; 152:1181-1185.
8. Maltby JR. Criminal poisoning with anaesthetic drugs: murder, manslaughter not guilty. Forensic Sci 1975; 6: 91-108.
9. Maeda H, Fujita MQ, Zhu BL, Ishidam K, Oritani S, Tsuchihashi H, Nishikawa M, Izumi M, Matsumoto F. A case of serial homicide by injection of succinylcholine. Med Sci Law 2000; 40:169-174.
10. Padwell A. Cyanide poisoning- case studies of one homicide and two suicides. Am J Forensic Med Pathol 1997; 18:185-188.
11. Mathiharan K, Patnaik AK (eds.). Modi’s Medical Jurisprudence and Toxicology. 23rd edition. Lexis Nexis Butterworths, N-Delhi, 2005;p.475-483.
12. Gill JR, Marker E, Stajic M. Suicide by cyanide: 17 deaths. J Forensic Sci 49(2004) 826-828.
13. Polson CJ, Tattersall RT. Clinical Toxicology. 2nd edition. Sir Isaac Pitman and Sons Ltd, London, 1973; p-128.
14. DeNapoli J, Hall AH, Drake R, Rumack BH. Cyanide and arsenic poisoning by intravenous injection. Ann Emerg Med 1989; 18: 308-311.
15. Prieto I, Pujol I, Santiuste C, Poyo-Guerrero R, Diego A. Acute cyanide poisoning by subcutaneous injection. Emerg Med J 2005; 22: 389-390.