Suffocation caused by plastic wrap covering the face combined with nitrous oxide inhalation

Abstract

Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.

Complex and complicated suicides in Friuli (1993–2017)

“…Plastic-bag suffocation is a widespread suicide method, 21,22 and it is often associated with inhalation of volatile compounds to ensure death. 23–27 Internet sites and publications have played an important role in the spread of this suicide technique. 28–30 Bohnert 2 highlighted that plastic-bag suffocation was used in 13/70 (18.57%) cases of planned complex suicides: 8/13 (61.54%) in association with inhalation of gases and 5/13 (38.46%) with drugs and in no case of unplanned complex suicide.…”

Wie der Sonntags-Tatort zum Tode führte …

“…Grundsätzlich scheint es sich bei der gezeigten Suizidmethode nicht um eine Rarität zu handeln; so berichten Crudele et al [10] allein über 101 Fälle von ähnlich gearteten Suiziden im Raum Mailand zwischen 1993 und 2013, in diesem Zusammenhang hätten auch Alkohol und andere sedierende Substanzen eine Rolle gespielt. Es finden sich auch eine Vielzahl von Einzelfallberichten von Erstickungen mittels Plastiktüten bei gleichzeitiger Inhalation von toxischen Gasen wie Äther oder NO oder Edelgasen wie Helium oder Argon [11][12][13].…”

Two Cases of Fatal Inhalation of Easily Available “Recreational” Substances

“…For recreational purposes, it is inhaled, usually out of filled balloons, and due to the short half-life of the substance, the effects wear off quickly 3 . The toxicity of the gas is low; however, if inhalation occurs in a limited space, displacement of oxygen may lead to hypoxia, and, ultimately, death 3,9–11 . In chronic users, nitrous oxide is known to interact with vitamin B12 containing enzyme systems, and N 2 O abuse may lead to hematological, immunological, and neurological symptoms, 3,12,13 whereas acute afflictions may affect the airways and the gastrointestinal tract 14,15 …”

“…3 The toxicity of the gas is low; however, if inhalation occurs in a limited space, displacement of oxygen may lead to hypoxia, and, ultimately, death. 3,[9][10][11] In chronic users, nitrous oxide is known to interact with vitamin B12 containing enzyme systems, and N 2 O abuse may lead to hematological, immunological, and neurological symptoms, 3,12,13 whereas acute afflictions may affect the airways and the gastrointestinal tract. 14,15 Ethyl chloride (C 2 H 5 Cl), or chloroethane, is more toxic than nitrous oxide.…”