Fatal combined chloroform, THF, and triazolam poisoning in an industrial workplace.

Abstract

To report a case of fatal acute combined drug poisoning predominantly driven by chloroform, with co-exposure to tetrahydrofuran (THF) and triazolam during a pharmaceutical manufacturing process. This report specifically examines how the physical behavior of organic solvent vapors with high vapor density-which tend to accumulate in low-lying areas-contributed to a localized exposure environment and an exceptionally high tissue distribution. Forensic Autopsy: A comprehensive internal and external examination was performed to identify traumatic injuries or pathological changes. Toxicological Analysis: Qualitative and quantitative analyses of blood, urine, and visceral organs were conducted. Volatile components were analyzed using headspace solid-phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC/MS). Autopsy Findings: Chemical burns were observed on the buttocks and posterior aspects of the lower limbs, attributed to contact with potassium hydroxide. No other lethal traumatic injuries or significant pathological changes were found. Toxicological Data: Triazolam, THF, and chloroform were detected in all specimens. Exceptional Concentrations: Chloroform concentrations were 111.0 µg/ml in peripheral blood, 77.7 µg/g in the brain, and 72.8 µg/g in the liver. These levels significantly exceed typical lethal ranges reported in previous literature. The cause of death was determined to be acute combined drug poisoning, primarily mediated by severe chloroform inhalation. The data suggests that after an initial incident caused the victim to fall, he continued to inhale extremely high concentrations of chloroform vapor that had accumulated near the floor. This case emphasizes the critical industrial risk posed by heavy organic solvent vapors in poorly ventilated spaces and provides important toxicological insights for the forensic diagnosis of acute chloroform poisoning.

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