Postmortem forensic toxicology cases: A retrospective review from Milan, Italy

Abstract

We are presenting a study on 136 cases performed in a 2-year period (2018-2019) at the Bureau of Legal Medicine of the University of Milan for which toxicological analyses were requested and we are making a detailed interpretation of clinical records and discussing toxicological results from each case included in the study. Total number of autopsies was 1323 and in 10.3% of the cases, toxicological analyses were requested to obtain further information. Analyses were assessed with High-Performance Liquid Chromatography-Mass Spectrometry system and Gas Chromatography-Mass Spectrometry analyses. Additionally, Blood Alcohol Concentration and detection of volatile substances were obtained with Head Space-Gas Chromatography-Mass Spectrometry system. From these analyses, 101 cases out of 136 provided positive results (74.3%). Main substances detected were cocaine, diazepam, morphine, and ethanol. The most representative profiles of individuals that emerged from this study were: a Caucasian male, age 41-50, that died for cocaine acute intoxication or was killed; a Caucasian male or female with a range-of-age of 31-50 deceased for simple suicide caused by acute intoxication or by complex suicide caused by acute intoxication and suffocation; and finally, a Caucasian male with a range-of-age 21-40 that died in a car accident without any toxicological evidence. From the results, acute intoxication at the time of death was confirmed in 54 cases and in 57 cases the toxicological analyses helped in the determination of the cause and manner of death. From this study, the importance of toxicological data among forensic sciences is confirmed.

Keywords: acute intoxication; autopsy; forensic toxicology; homicide; retrospective study; suicide.

FIGURE 1

Graphic representation of toxicological analyses performed from the 2018 to the 2020 at the Bureau of Legal Medicine of Milan. In table are represented in “first column” the total number of cases investigated in the 2 years under examination, in “second column” the positive results, in “third column” the negative results and in “fourth column” the number of cases, compared with the total number of toxicological cases analyzed (136), in which the cause of death was due to “acute intoxication” of some prescription drugs or illicit drugs.

FIGURE 2

Positive results and acute intoxication cases in females and males’ groups; in “first column” the total number of females and males' cases; in “second column” the total number of positive results; in “third column” the negative results; in “fourth column” the cases in which the acute intoxication was the cause of death.