Suicidal Ingestion of a Caustic Substance: A Case Report

Case Report

Austin J Forensic Sci Criminol. 2015;2(3): 1027.

Suicidal Ingestion of a Caustic Substance: A Case Report

Focardi M¹*, Grifoni R¹, Pinchi V¹, Pieri L¹, Bonari A², Pompilio I², Arcangeli G², Castiglione F³ and Norelli GA¹

¹Department of Health Sciences, Forensic Medicine Section, Forensic Medicine Section, University of Florence, Italy

²Department of Clinical and Experimental Medicine, Health Services Research Section, Laboratory of Hygiene and Industrial Toxicology, Italy

³Department of Biomedicine, Careggi Hospital, University of Florence, Italy

*Corresponding author: Focardi M, Department of Health Sciences, Forensic Medicine Section, University of Florence, 50134 Florence, Italy

Received: May 06, 2015; Accepted: June 15, 2015; Published: June 19, 2015


In infants and children accidental ingestion of caustic substances can occur, in adults otherwise chemical exposure may be related to suicidal behaviors. Acid or alkali agents can cause chemical burns from mild to extensive injuries in digestive tract mucosa. Sometimes death due to an organ perforation occurs. The authors present a case of a 48-year-old man, found dead in his apartment, wearing only pants and socks. Near the body no objects or substances. A caustic substance was then found inside his car. Autopsy and chemical investigations were performed. The external examination of the body showed no traumatic injuries, except for some burn perioral lesions. At the autopsy, were found esophageal brownish mucosa, necrosis of the stomach, thrombosis of the gastric vessels and dark peritoneal fluid coating the bowels. Histological analyses of gastric mucosa showed cells with intensely eosinophilic cytoplasm and with condensation and fragmentation of nuclei and their progressive loss. Chemical investigations were made but did not provide useful information. Considering the circumstantial data and the autopsy findings, death was attributed to caustic ingestion. Severity of caustic exposure depends on the type of the substances but alkali may play a direct role in the lethal process by digestive burns, producing liquefaction necrosis.

Keywords: Caustic ingestion; Suicidal; Chemical injuries


Substances with a pH of less than 2 (strong acids) or higher than 12 (strong alkalis) are corrosives. Caustic ingestion represents a health public problem worldwide, despite the efforts and the educational campaigns to reduce its occurrence. Ingestion is the most frequent route of exposure [1]. Accidental ingestion occurs in infants and children of less of six years old, especially between 1 and 4. Otherwise in adolescents and adults may be related to suicidal behaviors [2-4]. In the United States an incidence of 5000 to 15000 cases per year is estimated [5-7]. The type of corrosive agents varies country to country. Reports from Denmark, Israel, UK, Spain, and Australia showed that alkaline agents are most commonly used [8]; in developing countries the majority of caustic ingestion is due to acids [9]. Caustic ingestion induces a local toxicity leading to damage for the upper gastrointestinal system, ranging from mild to extensive injuries [10]. Corrosive substances may cause massive hemorrhage and acutely gastrointestinal tract perforation or lead to aortoenteric, gastrocolic or gastrobronchial fistulas in the longer term. The latter may occur 2 to 10 weeks after ingestion [11-12]. Long-term complications include an increased risk of esophageal carcinoma and esophageal and/or gastric stenosis. The mortality rate after caustic ingestion has been reported between 7 and 14% [13].

Severe caustic exposure can lead to an organ perforation or directly to death [14]. Patients may present a combination of various symptoms or none at all depending on the pH of the agent, its concentration, physical properties, contact time, route of exposure and tissues involved [15]. Voluntary ingestion usually causes more extensive burns due to the high quantity taken.

Case Presentation

The Authors present a case of a 48-year-old married man, found dead in his parents’ apartment. The corpse was slumped on the kitchen floor, in a crouched position, near to the boiler, wearing only pants and socks. The man was suffering from depression because of work and his physical condition (loss of short term memory after viral encephalitis) and had already announced several times his intention to commit suicide. The last time he was seen by his wife was in the morning of the day before. During the first inspection of the site, no objects or substances were found in the apartment. About two days later, caustic substances were then noticed inside his car: they were contained in some jars that resulted half empty. The substance was constituted by sodium hydroxide and potassium hydroxide. The autopsy was ordered.

Materials and Methods

A complete autopsy was performed including external, internal, histochemical and toxicological investigations. Histological samples were fixed with 10% formaldehyde for more than 1 week and embedded in paraffin; the blocks were sectioned to 4-5 micron thickness and analyzed by hematoxylin-eosin stain. Chemical analyses were performed to detect the concentration of sodium and potassium on samples of ascites fluid collected from the abdominal cavity, stored frozen at − 20°C until time of testing. After thawing and centrifugation at 1300 ×g for 10 min at room temperature, the surnatant of each sample was analyzed with a V-Lyte Integrated Multisensor® electrolyte detector on Dimension Vista1500® System (Siemens Healthcare Diagnostics, Germany) (Sample Control: Liquid Assayed Multiqual® Level 1,2, Biorad Laboratories Ltd, USA).


At the external examination, no traumatic injuries were found, except for some blackish burn perioral lesions especially on the chin (Figure 1), blackish liquid coming out from oral cavity and a excoriation on the back due to the contact with the radiator in the kitchen as he fell on the floor.