Unusual Autoerotic Fatality Associated With Chloroform Inhalation

Journal of Analytical Toxicology, Vol. 30, April 2006 [ Case Report An Unusual Autoerotic Fatality AssociatedWith Chloroform Inhalation Peter P. Singer* and Graham R. Jones Office of the Chief Medical Examiner, 7007 - 116 Street NW, Edmonton, Alberta, Canada T6H 5R8 Abstract I Case History We report the death of a young male attributed to chloroform The decedent was an otherwise healthy young male who worked in a local research laboratory with access to a variety of solvents and chemicals. He was found lying prone on a piece of foam and a towel on the floor of his apartment. His eyes were bound with a towel, and his lower face and nose were almost entirely covered with duct tape surrounding a rubber hose in his mouth. The other end of the hose was sitting loosely inside an open bottle that was in a box beside him. He was bound with an intricate system of ropes, handles, and rods that ended with a noose around his neck. Strips of duct tape and plastic food-wrap and a roll of duct tape were present in the bathroom closet. Also in the closet were bondage-related paraphernalia, including leather strapping, a ball with a rope tied through, and additional ropes and chains. No drugs were found at the scene. The victim was last seen about three days prior to being found. An external examination was performed, but an autopsy was not performed because of the obvious nature of the scene. Femoral blood, vitreous, and urine were taken at examination for toxicology testing and stored at 4-6~ prior to analysis. poisoning during autoerotic asphyxia. He was found lying on the floor of his apartment, prone on a piece of foam and a towel. His eyes were bound with a towel, his lower face and nose were almost entirely covered with duct tape surrounding a rubber hose in his mouth. The other end of the hose was loosely sitting inside an open bottle which was in a box beside him. He was bound-up by an intricate system of ropes, handles, and rods, ending with a noose around his neck. Toxicology testing indicated chloroform concentrations of 18.1 mg/L in femoral blood and 1.5 mg/L in urine. Chloroform was measured by headspace gas chromatography with flame-ionization detection using 1,1,1-trichloroethane as the internal standard. The cause of death was recorded as "chloroform toxicity" with "autoerotic asphyxia" as a contributing factor, and the manner of death was "accidental". Introduction Deaths due to autoerotic activity are relatively uncommon but are very well-documented in the forensic literature. They usually involve males, although autoerotic deaths of females have been reported (1). Because the circumstances can look so unusual, investigators unfamiliar with autoerotic deaths might mistake them for suicides or even homicides. Autoerotic deaths usually involve rigging a device with ropes and sometimes pulleys to partially asphyxiate the individual. Masturbation during a hypoxic state is reputed to intensify the resulting orgasm. A safety release mechanism is usually incorporated so that if the individual loses consciousness, pressure on the rope causing the asphyxia is released, allowing the individual to breath normally. Although self-induction of asphyxia is usually attained using ropes, the hypoxic state may occasionally be augmented by the inhalation of solvents. We report an unusual case of autoerotic asphyxia associated with the use of chloroform. * Author to whom correspondence should be addressed. 216 Experimental Specimens were screened by headspace gas chromatography with flame-ionization detection (GC-FID) for the presence of ethanol and other volatiles. Bloodwas screened for the presence of drugs by immunoassay (ELISA and Abbott TDx) for acetaminophen, salicylate, benzodiazepines, barbiturates, cocaine metabolites, opiates, and amphetamines. Blood and urine were also screened by GC-mass spectrometry (MS) in combination with nitrogen-phosphorus detection (NPD). No drugs were detected, although chloroform was detected by headspace GC-FID. Chloroform was quantitatively measured by headspace GC-FID using an Agilent 5890II GC and 7694 headspace unit. The following parameters were recorded: GC oven 60~ for Reproduction(photocopying)of editorial contentof this journal is prohibitedwithout publisher'spermission. Journal of Analytical Toxicology, Vol. 30, April 2006 1 rain, ramped at 15~ to 150~ for I rain; injector 120~ detector 200~ valve temp 65~ line temp 70~ and platen temp 60~ Separations were accomplished using a 30-m Restek RTX BAC-1 capillary column. To 0.1 mL blood or other specimen, 1,1,1-trichloroethane was added as the internal standard (30 laL of a solution containing 0.2 I~L/mLmethanol). Chloroform eluted at 1.8 rain, and 1,1,1-trichloroethane eluted at 2.17 rain. Six blood-based calibrators ranging from 0.5 to 20 mg/L were prepared by adding appropriate amounts of a methanolic solution of chloroform (Caledon, distilled-in-glass). A similar volume of methanol was added to case specimens and controls. The calibration curve deviated only slightly from linearity, with a correlation coefficient (quadratic fit) of better than 0.999 and an intercept of less than 0.1 mg/L. An independently prepared blood-based chloroform control was also run, and it read within • 10% of the target (10.9 mg/L). The blood sample was opened only once prior to chloroform analysis; the vitreous and urine samples were unopened prior to analysis. restricts the term to accidental deaths during individual sexual activity in which the prop used to enhance the stimulation causes the unintended death (27). In the case we report, the hypoxia probably resulted from both the noose and the chloroform. However, the chloroform is in the range associated with fatalities, and the recorded cause of death was "Chloroform Toxicity"with "AutoeroticAsphyxiation"as a contributing factor, and the manner of death was "Accidental." It is acknowledged that the concentrations of chloroform at the time of death probably would have been higher than those measured because of the extended postmortem interval and possible in vitro losses. However, these changes would not be sufficient to affect the determination of the cause and manner of death. Acknowledgments We would like to thank Terrie Wispinski for her technical expertise in performing the chloroform quantitation. Results and Discussion Chloroform was identified and quantified in femoral blood at 18.1 mg/L and in urine at 1.5 mg/L. No other volatiles, alcohol, or drugs were detected by routine screening. Autoerotic deaths using solvents to enhance the hypoxia are relatively uncommon, but quite well-documented in the literature. There have been several reports of the use of chloroform or other halogenated hydrocarbons to enhance sexual activity (2-5), as well as other volatile agents such as propane (6), tetrachloroethylene (7), and nitrous oxide (8). The use of chloroform has also been extensively reported in both homicides (9-15) and suicides (16-18) (...truncated)