Another case of diethyl ether intoxication? A case report focusing on toxicological analysis

Abstract

Diethyl ether was widely used as an anesthetic agent in many countries in the second half of the 19th century and the first half of the 20th century. For this reason the majority of lethal cases involving diethyl ether reported during this period were associated with anesthesia. We present a case of asphyxial death by plastic-bag suffocation with additional detection of diethyl ether in autopsy specimens. Autopsy initially failed to reveal the cause of death. Macroscopic and microscopic findings as well as subsequent toxicological examination procedures and results are pointed out in the present case report. Headspace gas chromatography with flame ionization detection (HS-GC–FID) coupled with gas chromatography/mass spectrometry (GC–MS) proved to be the method of choice for fast and reliable analysis of unknown highly volatile substances (other than blood alcohol). In this case the detection of diethyl ether in autopsy specimens led to further investigations by the police at the death scene. During these investigations a bottle bearing a diethyl ether label was found and confiscated, which proved the insufficiency of prior death scene investigation.

In order to evaluate the case from every possible angle, in such cases, especially when plastic-bag suffocation is suspected, we strongly recommend the collection of postmortem specimens in gas-tight vessels as well as the presence of a forensic expert at the death scene.

Introduction

Diethyl ether is a water-like, flammable, highly volatile liquid (boiling point = 35 °C) of characteristic odor. It was introduced as an anesthetic agent in 1842, to allow painless surgery [1]. Because of its characteristics ether was widely used in many countries as an anesthetic agent. However, due to its high solubility in body fluids and tissue, diethyl ether has a slow rate of anesthesia induction and a longer recovery time from anesthesia [2]. Being replaced by halothane in the 1960s, lethal cases with diethyl ether associated with anesthesia are only described in the literature before 1960 [3], [4]. However, industrial accidents are also reported, such as intoxication with diethyl ether during work in a powder mill [5]. Today, diethyl ether is found to be a component of starting fluids for heavy engines and is also used as a solvent in the manufacture of synthetic dyes and plastics [2]. The recent literature described a case of suicidal incorporation of diethyl ether in combination with suffocation and cases including homicides and suicides with different usage of diethyl ether [6], [7], [8], [9], [10]. Blood ether concentrations are generally correlated with central nervous system depression. Blood concentrations between 100 mg/L and 500 mg/L produce analgesia, but not unconsciousness. Surgical anesthesia occurs at blood concentrations in the 500–1500 mg/L range [11]. Only a limited number of reports describing quantitative results for diethyl ether are available in the literature [12].