Læknablaðið - 15.05.1994, Page 24

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LÆKNABLAÐIÐ
Athyglisvert er að í erlendum greinum um
dauðsföll af völdum eldsvoða er áfengisneyslu
oft lítill gaumur gefinn og er niðurstöðum
etanólmælinga í blóði stundum sleppt (12,14).
Er þetta þeim mun undarlegra þegar tekið er
tillit til þess, að ölvun er bæði algeng og oft
mikil við dauðsföll af þessu tagi þegar þessara
niðurstöðutalna er getið á annað borð (1-4,11).
Kemur þetta vel fram í safni okkar, en þar
voru tveir af hverjum þremur með etanól í
blóðinu og flestir mjög ölvaðir (etanól í blóði
>2%c, samanber mynd 2). Má leiða líkur að
því að þeir sem voru með svo mikið etanól
í blóðinu, hafi með öllu verið ófærir um að
skynja hættuna og forða sér Ur eldinum. Ölvun
kann því oft að hafa ráðið jafnmiklu um örlög
þessara einstaklinga og eitranir af völdum
koloxíðs. Við samanburð kom einnig í ljós
að ölvun var hér bæði meiri og algengari en
í öðrum banaslysum sem rannsökuð voru á
tímabilinu (samanburðarhópur II). Eru þannig
fáar tegundir slysa sem tengjast áfengisneyslu
jafn mikið og þessi.
SUMMARY
Tlie role of carbon monoxide and ethaiiol
in fire casualties: A retrospective study of
carboxyhemoglobin aitd blood etlianol levels in
fire victims.
The study included 36 fire casualties that were
submitted to post-mortem pathological and
toxicological examination at the Departments of
Forensic Medicine and Pharmacology, University
of Iceland, during the period 1971-1990. Twenty
eight were males and eigth females. The ntean age
was 45.3 years (range 3-74 years).
Carboxyhemoglobin levels ranged from 0-84%,
mean 53.5% (fig.l) and were considered fatal
(> approximately 50%) in 24 cases. Fourteen
victims with fatal carboxyhemoglobin levels had
no significant burn injuries. Death was therefore
attributed to carbon monoxide poisoning alone.
In these cases carboxyhemoglobin levels (rnean
65.5%, range 49-84) were lower than those found
in cases of fatal car exhaust poisonings (mean
73.0%, range 47-87%) investigated by us in the
sarne period (8). The difference was statistically
signilicant (t-test, P<0.01). It supports the idea that
combustion products, other than carbon monoxide,
may contribute to the toxic effect of tíres.
Ethanol was found in blood in two thirds (24) of
the cases. Blood ethanol levels were in the range
0.47-4.37%o (mean 2.34%o). Blood ethanol levels
and prevalence of inebriation were compared to
those found in other fatal accidents investigated
by us in the same period. Ethanol levels were
significantly higher in the fire cases and inebriation
more common than in the reference group (t-test,
P<0.01; Chi-square, P<0.001, df=l).
Although poisoning with carbon monoxide is of
major importance in fire casualties it should not
be disregarded that inebriation may often be an
equally important factor. This was in fact strongly
indicated by our results.
HEIMILDIR
1. Jóhannesson Þ. Bjarnason O. Dauðsföll af völdum
koloxíðs. Læknablaðið 1971; 57: 245-51.
2. Teigc B. Lundevall J, Fleischer E.
Carboxyhemoglobin concentrations in fire victims
and in cases of fatal carbon monoxide poisoning. Z
Rechtsmedizin 1977; 80; 17-21.
3. Anderson RA, Watson AA. Harland WA. Fire deaths
in thc Glasgow area: II The role of carbon monoxide.
Med Sci Law 1981; 21: 288-94.
4. Gormsen H, Jeppesen N, Lund A. The causes of
death in fire victims. For Sci Intern 1984; 24: 107-
11.
5. Heibrigðisskýrslur 1970-1990. Reykjavík:
Landlæknisembættið, 1990.
6. Maehly AC. Analyse von Kohlenoxydvergiftungen.
Dtsch Zeitschr Gerichtl Medizin 1962; 52: 369-82.
7. Skaftason J, Jóhannesson Þ. Akvarðanir á alkóhóli
(etanóli) í blóði. Tímarit Iögfræðinga 1975; 25: 1-13.
8. Curry AS. Walker GW, Simpson GS. Determination
of ethanol in blood by gas chromatography. Analyst
1966; 91: 742-3.
9. Kristinsson J, Jóhannesson Þ, Bjarnason Ó. Dauðsföll
af völdum koloxíðeitrana af útblásturslofti bifreiða
1971-1990. Læknablaðið 1992; 78: 373-8.
10. Davies JWL. Toxic chemicals versus lung tissue -
an aspecl of inhalation injury revisited. J Bum Care
1986; 7: 213-22.
11. Lundquist P, Rammer L, Sörbo B. The role of
hydrogen cyanide and carbon monoxide in fire
casualities: A prospective study. For Sci Intem 1989;
43: 9-14.
12. Yoshida M, Adachi J, Watabiki T, Tatsuno Y.
Ishida N. A study on house fire victims: Age,
carboxyhemoglobin, hydrogen cyanide and hemolysis.
For Sci Intem 1991; 52: 13-20.
13. Wazawa H, Okae M, Yamamoto K. Yamamoto Y,
Fukui Y. Can death at a low COHb concentration
frequently observed in firc victims be explained by
hypoxic hypoxia? Jpn J Legal Med 1992; 46: 287-92.
14. Birky M. Malek D, Paabo M. Study of biological
samples obtained from victims of MGM Grand Hotel
fire. J Anal Toxicol 1983; 7: 265-71.