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Choi, Park, Park, and Jeon: Death from Naphthalene Poisoning Manifesting as Toxic Hepatitis: An Autopsy Case
Original Article

Korean J Leg Med 2017;41(4):137-140.

Published online: 19 January 2017

DOI: https://doi.org/10.7580/kjlm.2017.41.4.137

Death from Naphthalene Poisoning Manifesting as Toxic Hepatitis: An Autopsy Case

Jinhyuk Choi1, Seong Hwan Park1, Min Jee Park2, Seok-Hoon Jeon3

1Department of Legal Medicine, Korea University College of Medicine, Seoul, Korea

2Division of Forensic Medicine, National Forensic Service, Seoul, Korea

3Seoul Clinic of Korea Forensic Investigation, Seoul, Korea

Correspondence to Seok-Hoon Jeon Seoul Clinic of Korea Forensic Investigation, 16 Wangsan-ro, 19ma-gil, Dongdaemun-gu, Seoul 02576, Korea Tel: +82-2-2286-1158 Fax: +82-2-928-3901 E-mail: hyuk929@naver.com

Received 20 October 201731 October 2017       Accepted 27 November 2017

Copyright © 2017 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Suicide through naphthalene poisoning is rare. Prolonged hemolytic anemia and hemoglobinuria are typical symptoms of naphthalene poisoning. We report an unusual case of naphthalene poisoning. The decedent was an 87-year-old female who intentionally ingested over 5 g of naphthalene. After more than 5 hours, she was found in a drowsy state. During initial examination, hemoglobin level and urine test results were normal. Aspartate aminotransferase and alanine aminotransferase levels were elevated (854 and 1,197 U/L, respectively). Metabolic acidosis was found on arterial blood gas analysis. The patient was treated conservatively by administration of activated charcoal, calcium gluconate, insulin, and glucose. However, the patient died after 1 day of hospital admission. On autopsy, the liver showed toxic hepatitis with confluent necrosis. Naphthalene concentrations in the blood and gastric contents were 5.4 and 5.8 mg/L, respectively. In conclusion, the decedent ingested naphthalene and died due to liver failure without hemolysis.

Keywords: Toxic hepatitis, Naphthalenes, Autopsy

REFERENCES

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Fig. 1.
Microscopic finding of liver and kidney. Liver; toxic hepatitis. (A) Perivenular necrosis (zone 3 necrosis) with preserved hepatocytes around portal tracts (H&E, ×40). (B, C) Coagulative-type necrosis of hepatocytes, cholestasis, and congestion (B, H&E, ×200; C, H&E, ×400). (D) Kidney: autolysis without inflammatory reaction and pigment casts (H&E, ×400).
kjlm-41-137-f1.tif
Table 1.
Initial laboratory examination
Variable Value
Peripheral blood  
Hemoglobin (g/dL) 14.2
WBC count (/µL) 23,610
Platelet count (/µL) 358,000
Na (mEq/L) 136
K (mEq/L) 6.1
Cl (mEq/L) 100
Osmolality (mOsm/kg) 295
AST (U/L) 854
ALT (U/L) 1197
Total bilirubin (mg/dL) 0.78
Direct bilirubin (mg/dL) 0.27
Troponin-T (ng/mL) 0.538
CK-MB (ng/mL) 5.48
Urea nitrogen (mg/dL) 29.8
Creatinine (mg/dL) 1.59
ABGA  
pH 7.475
HCO3 (mmol/L) 17
PCO2 (mmol/L) 23.6
O2 saturation (%) 90.70
Urinalysis  
Glucose Normal
Color Yellow
Leukocyte Negative
Occult blood Negative

WBC, white blood cell; AST, aspartate aminotransferase; ALT, alanine transaminase; CK-MB, creatine kinase-MB; ABGA, arterial blood gas analysis.

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