Death by accidental intravenous administration of gasoline

• Published in: International journal of legal medicine 2024-07, Vol.138 (4), p.1315-1321
• Main Authors: Bubalo, Pero, Nestic, Marina, Martinovic, Slavica, Bakovic, Marija, Mayer, Davor, Mihic, Anita Galic
• Format: Article
• Language: English
• Subjects: Acidosis; Autopsies; Blood; Brain; Case Report; COVID-19; Edema; Fatal Outcome; Fatalities; Fibrosis; Forensic Medicine; Gasoline; Gasoline - poisoning; Hemodialysis; Humans; Hypotension; Injections, Intravenous; Lung - pathology; Lungs; Male; Medical Law; Medicine; Medicine & Public Health; Middle Aged; Renal Dialysis; Respiratory diseases; Sodium chloride; Toxicology
• ISSN: 0937-9827; 1437-1596; 1437-1596
• DOI: 10.1007/s00414-024-03181-8

Herein, we present the case of accidental intravenous injection of gasoline in a 62-year-old male who was admitted to a dialysis center for his regular hemodialysis. Due to previous contact with another SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) positive patient, the hemodialysis was conducted in an isolated room. At the end of the procedure, the nurse, wearing all necessary personal protective equipment (PPE), in the intent to clean the dialysis catheter, applied medical gasoline, instead of 0.9% sodium chloride, intravenously to the patient. Soon afterwards, the patient’s clinical condition deteriorated, and cardiopulmonary resuscitation was started. Despite the immediate reaction of the medical staff, after two successful cardiopulmonary reanimation and necessary intensive care measures, the patient suffered respiratory, metabolic, and lactic acidosis, hypotension, and tachyarrhythmia and ultimately died 7 h after the incident. The autopsy was conducted under the order of the district attorney. Main autopsy findings were marked congestion; right pleural and pericardial effusion; brain and lung edema; enlarged heart with left ventricle thickening and mild perivascular fibrosis; nephrosclerosis; tubular thyroidization; and interstitial fibrosis with inflammation. Gasoline presence was indisputably proven by conducted toxicology analysis in lung, bile, and brain samples. Traces of gasoline could be noted in the patient’s blood sample in comparison to the blood that did not contain gasoline, but it was not possible to confidently claim that gasoline was present in the blood. Based on relevant findings, we concluded that the death of the patient was violent and that the cause of death was acute intoxication by gasoline.