Abstract
This paper presents an unusual complex suicide case that died of nicotine addiction. The deceased was a 40-year-old male who was found lying dead on the floor in his room. In external findings, many incision wounds on his forearms and skin discoloration with epidermolysis on his cervical region could be seen. In the room, a blood-stained scissors and electric cord hanged on the exercise bike were found. Moreover, nine cigarette residues which were only the filter part and empty bottle of coffee were found on his side. At autopsy, we found that those injuries were not serious enough to lead him to the death. Toxicologically, caffeine, nicotine, cotinine, mirtazapine, and olanzapine could be detected, and the concentrations of nicotine were 3.740, 2.140, 3.100, and 451.100 μg/ml in cardiac blood, peripheral blood, urine, and stomach contents, respectively. These concentrations were evaluated as the fatal levels, and the cause of his death was diagnosed as acute nicotine intoxication.
References
Breen J, Shoko T (2007) Suicide is a social not an individual problem: Japan in international perspective. Asia Pac J 5(8) https://apjjf.org/-JohnBreen/2507/article.html
Jayanth SH, Girish Chandra YP, Hugar S (2014) Secondary combined suicide pact. J Forensic Legal Med 23:76–79
Ateriya N, Kanchan T, Shekhawat RS, Setia P, Saraf A (2018) Unplanned complex suicide: a consideration of multiple methods. J Forensic Sci 63(3):945–946
Shan Y, Kennon J (2012) Complex suicide: self-incineration and acetaminophen overdose. Int J Care Injured 43:124–125
Youssef N, Sami BA, Malek Z, Zouhir H, Samir M (2015) An unusual complex suicide by pesticide ingestion and stabbing: a case report. Austin J Forensic Sci Criminol 2(4):id1039
Dogan KH, Demirci S, Deniz I (2014) An unusual complex suicide by corrosive ingestion and stabbing. Clin Pathol 1(1):8–13
Kudo K, Usumoto Y, Usui K, Hayashida M, Kurisaki E, Saka K, Tsuji A, Ikeda N (2014) Rapid and simultaneous extraction of acidic and basic drugs from human whole blood for reliable semi-quantitative NAGINATA drug screening by GC-MS. Forensic Toxicol 32:97–104
Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A (2012) Therapeutic and toxic blood concentration of nearly 1,000 drugs and other xenobiotics. Crit Care 16(136)
Solarino B, Rosenbaum F, Riebelmann B, Buschmann CT, Tsokos M (2010) Death due to ingestion of nicotine- containing solution: case report and review of the literature. Forensic Sci Int 195:e19–e22
Corkery JM, Button J, Vento AE, Schifano F (2010) Two UK suicides using nicotine extracted from tobacco employing instructions available on the internet. Forensic Sci Int 199:e9–e13
Simonit F, Bassan F, Scorretti C, Desinan L (2018) Complex suicides; a review of the literature with considerations on a single case of abdominal self-stabbing and plastic bag suffocation. Forensic Sci Int 290:297–302
Toro K, Pollak S (2009) Complex suicide versus complicated suicide. Forensic Sci Int 184:6–9
Demirch S, Dogan KH, Erkol ZE, Deniz I (2009) A series of complex suicide. Am J Forensic Med Pathol 30(2):152–154
Barranco R, Diana C, Ventura F (2019) Forensic pathological study of complex and complicated suicides: a twelve-year case series in Genoa (Italy). J Forensic Legal Med 65:5–8
Zribi M, Dhoueb R, Benamar W, Jammell K, Feki N, Bardaa S, Hammami Z, Maatoug S (2016) Complex suicide: unusual combination. J Forensic Med 1(2). https://doi.org/10.4172/2472-1026.100011
Cascini F, Longo F, Polacco M, Scafetta I (2012) Foreign object ingestion in complex suicide: a case report and review of the literature. Forensic Sci 219:e1–e3
Martinez MA, Ballesteros S (2009) Toxicologigal finding in two planned complex suicide cases: ingestion of petroleum distillates and subsequent hanging. J Anal Toxicol 33:336–342
Pelissier-Alicot A, Gavaudan G, Bartoli C, Kintz P, Piercecchi-Marti M, Desfeux J, Leonetti G (2008) Planned complex suicide: an unusual case. J Forensic Sci 53(4). https://doi.org/10.1111/j.1556-4029.2008.00754.x
Lardi C, Vogt S, Pollak S, Thierauf A (2014) Complex suicide with homemade nicotine patches. Forensic Sci Int 236:e14–e18
Neal LB, Janne H, Peyton J III (2009) Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol 192:29–60
Schneider S, Diederich N, Appenzeller B, Schartz A (2009) Internet suicide guidelines: report of life-threatening poisoning using tobacco extract. J Emerg Med 38(5):610–613
You G, Rhee J, Park Y, Park S (2016) Determination of nicotine, cotinine and trans-3′-hydroxycotinine using LC/MS/MS in forensic samples of a nicotine fatal case by oral ingestion of e-cigarette liquid. J Forensic Sci 61(4):1149–1154
Kubo K, Chishiro T (2008) Six-year review of cigarette ingestion in children – gastric lavage versus medical observation. Chudoku Kenkyu 21(2):115–122 [article in Japanese]
Goto K, Endoh Y, Kuroki Y, Yoshioka T (1997) Poisoning in children in Japan. Indian J Pediatr 64:461–468
Ivey KJ, Triggs EJ (1978) Absorption of nicotine by the human stomach and its effect on gastric ion fluxes and potential difference. Dig Dis 23(9):809–814
Zhang L et al (2012) Cotinine: beyond that expected, more than a biomarker of tobacco consumption. Front Pharmacol 173:1–9
Nakajima M (2013) Factors causing interindividual variability in nicotine metabolism. Showa Univ J Pharm Sci 4(2):129–141 [Japanese with abstract in English]
Novotny TE, Hardin SN, Hovda LR, Novotny DJ, Mclean MK, Khan S (2011) Tobacco and cigarette butt consumption in humans and animals. Tob Control 20(1):i17–i20
Baselt RC (2015) Disposition of toxic drugs and chemicals in man, 10th edition
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with animals performed by any of the authors.
Informed consent
The article does not include participants from whom informed consent was required.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yamamoto, H., Takayasu, T., Ishida, Y. et al. A case of complex suicide due to acute nicotine intoxication caused by cigarette ingestion. Int J Legal Med 134, 997–1002 (2020). https://doi.org/10.1007/s00414-019-02228-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-019-02228-5