Advertisement

Helium poisoning: new procedure for sampling and analysis

  • Vincent VarletEmail author
  • S. Iwersen-Bergmann
  • M. Alexandre
  • O. Cordes
  • C. Wunder
  • F. Holz
  • H. Andresen-Streichert
  • F. Bevalot
  • V. Dumestre-Toulet
  • S. Malbranque
  • T. Fracasso
  • S. Grabherr
Original Article

Abstract

An increasing number of suicidal asphyxiation with a plastic bag with inert gases, and in particular helium (He), have been reported from numerous countries over the last decade. These cases are differently managed and lead to different and variable interpretations. Based on the 12 last cases analysed in the laboratory and on the review of the most recent literature about this topic, updated autopsy guidelines for sampling have been proposed regarding to the samples choice and analytical challenges required by the gaseous state of this substance. Biological samples from airways (lungs lobe) followed by brain and cardiac blood are the best matrices to take during the autopsy to diagnose He exposure. Gaseous samples from trachea, pulmonary bronchi, gastric and cardiac areas are also recommended as alternative samples. The anatomical site of sampling must be carefully detailed, and to this end, forensic imaging constitutes a beneficial tool. Even if He detection is sufficient to conclude to He exposure, He concentrations in samples may be related to He exposure conditions (duration, breathing rate, etc.). A quantification in biological samples could be helpful to document more precisely the case. He concentrations in gaseous samples are reported up to 6.0 μmol/mL (tracheal gas), 2.4 μmol/mL (pulmonary gas), 0.64 μmol/mL (cardiac gas) and 12 μmol/mL (gastric gas). He concentrations in solid/liquid samples are reported up to 28 μmol/g (lungs) and 0.03 μmol/g (cardiac blood). The other matrices usually sampled during autopsy such as urine, peripheral blood, liver, fat matter and kidney appear as not relevant.

Keywords

Helium Suicide Suffocation Asphyxia GC-MS 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Mughal D, Puri RM (2016) A 20-year-old man with a suicide attempt using helium. Psychiatr Ann 45:570–573.  https://doi.org/10.3928/00485713-20160908-01 CrossRefGoogle Scholar
  2. 2.
    Wolf JS Jr, Carrier S, Stoller ML (1994) Gas embolism: helium is more lethal than carbon dioxide. J Laparoendosc Surg 4:173–177.  https://doi.org/10.1089/lps.1994.4.173 CrossRefPubMedGoogle Scholar
  3. 3.
    Wiergowski M, Kaliszan M, Sumińska-Ziemann B, Gos T, Jankowski Z (2014) Helium detection in the lungs in case of suicide by helium inhalation—case report and literature review. Rom J Leg Med 22:153–156.  https://doi.org/10.4323/rjlm.2014.153 CrossRefGoogle Scholar
  4. 4.
    Grassberger M, Krauskopf A (2007) Suicidal asphyxiation with helium: report of three cases. Wien Klin Wochenschr 119:323–325.  https://doi.org/10.1007/s00508-007-0785-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Whitt A, Garland EL, Howard MO (2012) Helium inhalation in adolescents: characteristics of users and prevalence of use. J Psychoactive Drugs 44:365–371.  https://doi.org/10.1080/02791072.2012.736803 CrossRefPubMedGoogle Scholar
  6. 6.
    Frost J (2013) Death by self-inflicted asphyxia with helium—first case reports from Norway and review of the literature. Scand J Forensic Sci 19:52–54.  https://doi.org/10.2478/sjfs-2013-0010 CrossRefGoogle Scholar
  7. 7.
    Austin A, Winskog C, Van Den Heuvel C, Byard R (2011) Recent trends in suicides utilizing helium. J Forensic Sci 56:649–651.  https://doi.org/10.1111/j.1556-4029.2011.01723.x CrossRefPubMedGoogle Scholar
  8. 8.
    Lim HS, Hahm KW, Kang HW (2013) Observation of 17 asphyxial suicides by helium gas. Korean J Leg Med 37:78–83.  https://doi.org/10.7580/kjlm.2013.37.2.78 CrossRefGoogle Scholar
  9. 9.
    Smedra A, Szutowski S, Jurczyk AP, Klemm J, Szram S, Berent J (2015) Suicidal asphyxiation by using helium—two case reports. Arch Med Sad Kryminol 65:37–46.  https://doi.org/10.5114/amsik.2015.51605 Google Scholar
  10. 10.
    Ogden RD, Hamilton WK, Whitcher C (2010) Assisted suicide by oxygen deprivation with helium at a Swiss right-to-die organization. J Med Ethics 36:174–179.  https://doi.org/10.1136/jme.2009.032490 CrossRefPubMedGoogle Scholar
  11. 11.
    Ogden RD, Hassan S (2011) Suicide by oxygen deprivation with helium: a preliminary study of British Columbia coroner investigations. Death Stud 35:338–364.  https://doi.org/10.1080/07481187.2010.518513 CrossRefPubMedGoogle Scholar
  12. 12.
    Van Den Hondel KE, Buster M, Reijnders UJL (2016) Suicide by asphyxiation with or without helium inhalation in the region of Amsterdam (2005-2014). J Forensic Legal Med 44:24–26.  https://doi.org/10.1016/j.jflm.2016.08.012 CrossRefGoogle Scholar
  13. 13.
    Ogden RD, Wooten RH (2002) Asphyxial suicide with helium and a plastic bag. Am J Forensic Med Pathol 23:234–237.  https://doi.org/10.1097/01.paf.0000022963.33157.9B CrossRefPubMedGoogle Scholar
  14. 14.
    Ogden RD (2010) Observation of two suicides by helium inhalation in a prefilled environment. Am J Forensic Med Pathol 31:156–161.  https://doi.org/10.1097/paf.0b013e3181d749d7 CrossRefPubMedGoogle Scholar
  15. 15.
    Gilson T, Parks BO, Porterfield CM (2003) Suicide with inert gases. Addendum to final exit. Am J Forensic Med Pathol 24:306–308.  https://doi.org/10.1097/01.paf.0000083363.24591.5d CrossRefPubMedGoogle Scholar
  16. 16.
    Gallagher KE, Smith DM, Mellen PF (2003) Suicidal asphyxiation by using pure helium gas. Case report, review, and discussion of the influence of the internet. Am J Forensic Med Pathol 24:361–363.  https://doi.org/10.1097/01.paf.0000097856.31249.ac CrossRefPubMedGoogle Scholar
  17. 17.
    Saint-Martin P, Prat S, Bouyssy M, O’Byrne P (2009) Plastic bag asphyxia—a case report. J Forensic Legal Med 16:40–43.  https://doi.org/10.1016/j.jflm.2008.05.022 CrossRefGoogle Scholar
  18. 18.
    Humphry D (1992) Final exit: the practicalities of self-deliverance and assisted suicide for the dying. Hemlock Society, EugeneGoogle Scholar
  19. 19.
    Byard RW (2018) Changing trends in suicides using helium or nitrogen—a 15-year study. J Forensic Legal Med 58:6–8.  https://doi.org/10.1016/j.jflm.2018.04.007 CrossRefGoogle Scholar
  20. 20.
    Howard MO, Hall MT, Edwards JD, Vaughn MG, Perron BE, Winecker RE (2011) Suicide by asphyxiation due to helium inhalation. Am J Forensic Med Pathol 32:61–70.  https://doi.org/10.1097/paf.0b013e3181ed7a2d CrossRefPubMedGoogle Scholar
  21. 21.
    Ogden RD (2010) The debreather: a report on euthanasia and suicide assistance using adapted scuba technology. Death Stud 34:291–317.  https://doi.org/10.1080/07481181003613792 CrossRefPubMedGoogle Scholar
  22. 22.
    Schön CA, Ketterer T (2007) Asphyxial suicide by inhalation of helium inside a plastic bag. Am J Forensic Med Pathol 28:364–367.  https://doi.org/10.1097/paf.0b013e31815b4c69 CrossRefPubMedGoogle Scholar
  23. 23.
    Madentzoglou MS, Kastanaki AE, Nathena D, Kranioti EF, Michalodimitrakis M (2013) Nitrogen-plastic bag suicide A case report. Am J Forensic Med Pathol 34:311–314.  https://doi.org/10.1097/paf.0000000000000049 CrossRefPubMedGoogle Scholar
  24. 24.
    Musshoff F, Hagemeier L, Kirschbaum K, Madea B (2012) Two cases of suicide by asphyxiation due to helium and argon. Forensic Sci Int 223:e27–e30.  https://doi.org/10.1016/j.forsciint.2012.08.049 CrossRefPubMedGoogle Scholar
  25. 25.
    Rossi R, De-Giorgio F, Grassi VM, Pascali VL, Lancia M (2013) An unusual suicide. Asphyxia by methane gas. Am J Forensic Med Pathol 34:83–85.  https://doi.org/10.1097/paf.0b013e3182886d4e CrossRefPubMedGoogle Scholar
  26. 26.
    Smith F, Augsburger M, Varlet V (2014) Accuracy profile validation of a new analytical method for propane measurement using headspace-gas chromatography-mass spectrometry. J Anal Toxicol 38:73–79.  https://doi.org/10.1093/jat/bkt098 CrossRefPubMedGoogle Scholar
  27. 27.
    Varlet V, Smith F, Augsburger M (2013) Accuracy profile validation of a new analytical method for butane measurement using headspace-gas chromatography-mass spectrometry. J Chromatogr B Anal Technol Biomed Life Sci 15:155–160.  https://doi.org/10.1016/j.jchromb.2012.11.031 CrossRefGoogle Scholar
  28. 28.
    Murty OP (2008) Plastic bag asphyxia with LPG (butane-propane) inhalation—fatal asphyxiphilia or suicide? J Indian Acad Forensic Med 30:216–220Google Scholar
  29. 29.
    Chang SS, Cheng Q, Lee EST, Yip PSF (2016) Suicide by gassing in Hong Kong 2005–2013: emerging trends and characteristics of suicide by helium inhalation. J Affect Disord 192:162–166.  https://doi.org/10.1016/j.jad.2015.12.026 CrossRefPubMedGoogle Scholar
  30. 30.
    Billoch Lima JG, Sannabria-Bellasai D, Rivera-Diez I (2011) New suicide modalities: the use of helium as an oxygen displacement agent. P R Health Sci J 30:157Google Scholar
  31. 31.
    Oosting R, Van Der Hulst R, Peschier L, Verschraagen M (2015) Toxicological findings in three cases of suicidal asphyxiation with helium. Forensic Sci Int 256:38–41.  https://doi.org/10.1016/j.forsciint.2015.06.028 CrossRefPubMedGoogle Scholar
  32. 32.
    Cuypers E, Rosier E, Loix S, Develter W, van den Bogaert W, Wuestenbergs J, van de Voorde W, Tytgat J (2017) Medical findings and toxicological analysis in infant death by balloon gas asphyxia: a case report. J Anal Toxicol 41:347–349.  https://doi.org/10.1093/jat/bkx006 CrossRefPubMedGoogle Scholar
  33. 33.
    Tsujita A, Okazaki H, Nagasaka A, Gohda A, Matsumoto M, Matsui T (2018) A new and sensititve method for quantitative determination of helium in human blood by gas chromatography-mass spectrometry using naturally existing neon-21 as internal standard. Forensic toxicol 37:75–81.  https://doi.org/10.1007/s11419-018-0437-6 CrossRefPubMedGoogle Scholar
  34. 34.
    Snavely K, Subramaniam B (1998) Thermal conductivity detector analysis of hydrogen using helium carrier gas and Hayesep® D columns. J Chromatogr Sci 36:190–196.  https://doi.org/10.1093/chromsci/36.4.191 CrossRefGoogle Scholar
  35. 35.
    Schaff JE, Karas RP, Marinetti L (2012) A gas chromatography-thermal conductivity detection method for helium detection in postmortem blood and tissue specimens. J Anal Toxicol 36:112–115.  https://doi.org/10.1093/jat/bks002 CrossRefPubMedGoogle Scholar
  36. 36.
    Varlet V, Bouvet A, Augsburger M (2012) Argon: uses, toxicity and analytical strategy in forensic toxicology. Ann Toxicol Anal 24:185–192.  https://doi.org/10.1051/ata/2013025 CrossRefGoogle Scholar
  37. 37.
    Malbranque S, Mauillon D, Turcant A, Rougé-Maillart C, Mangin P, Varlet V (2016) Quantification of fatal helium exposure following self-administration. Int J Legal Med 130:1535–1539.  https://doi.org/10.1007/s00414-016-1364-x CrossRefPubMedGoogle Scholar
  38. 38.
    Varlet V, Smith F, Giuliani N, Egger C, Rinaldi A, Dominguez A, Chevallier C, Bruguier C, Augsburger M, Mangin P, Grabherr S (2015) When gas analysis assists with postmortem imaging to diagnose causes of death. Forensic Sci Int 251:1–10.  https://doi.org/10.1016/j.forsciint.2015.03.010 CrossRefPubMedGoogle Scholar
  39. 39.
    Tanaka N, Kinoshita H, Jamal M, Kumihashi M, Tobiume T, Tsutsui K, Ameno K (2013) Usefulness of intratracheal gas analysis in an autopsy case of helium inhalation. Rom J Leg Med 21:237–238.  https://doi.org/10.4323/rjlm.2013.237 CrossRefGoogle Scholar
  40. 40.
    Auwaerter W, Grosse Perdekamp M, Kempf J, Schmidt U, Weinmann W, Pollak S (2007) Toxicological analysis after asphyxial suicide with helium and a plastic bag. Forensic Sci Int 170:139–141.  https://doi.org/10.1016/j.forsciint.2007.03.027 CrossRefPubMedGoogle Scholar
  41. 41.
    Alexandre M, Rondepierre L, Matthieu O, Varlet V, Peyron PA, Baccino E (2016) Suicide with helium: mistakes to avoid. Revue de Médecine Légale 8:68–72.  https://doi.org/10.1016/j.medleg.2016.10.002 CrossRefGoogle Scholar
  42. 42.
    Yashitome K, Ishikawa T, Inagaki S, Yamamoto Y, Miyaishi S, Ishizu H (2002) A case of suffocation by an advertising balloon filled with pure helium gas. Acta Med Okayama 56:53–55.  https://doi.org/10.18926/AMO/31726 Google Scholar
  43. 43.
    Borowska-Solonynko A, Dabkowska A (2018) Gas embolism as a potential cause of death by helium poisoning—postmortem computed tomography changes in two cases of suicidal helium inhalation. Legal Med 31:59–65.  https://doi.org/10.1016/j.legalmed.2018.01.001 CrossRefPubMedGoogle Scholar
  44. 44.
    Živković V, Cvetković D, Nikolić S (2018) Correspondence on: “gas embolism as a potential cause of death by helium poisoning—postmortem computed tomography changes in two cases of suicidal helium inhalation”. Legal Med 35:86–87.  https://doi.org/10.1016/j.legalmed.2018.09.018 CrossRefPubMedGoogle Scholar
  45. 45.
    Comment L, Varlet V, Ducrot K, Grabherr S (2017) A fatal case of oxygen embolism in a hospital. Forensic Sci Res 2:100–106.  https://doi.org/10.1080/20961790.2017.1329695 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Vincent Varlet
    • 1
    • 2
    Email author
  • S. Iwersen-Bergmann
    • 3
  • M. Alexandre
    • 4
  • O. Cordes
    • 5
  • C. Wunder
    • 6
  • F. Holz
    • 6
  • H. Andresen-Streichert
    • 7
  • F. Bevalot
    • 8
  • V. Dumestre-Toulet
    • 9
  • S. Malbranque
    • 10
  • T. Fracasso
    • 11
  • S. Grabherr
    • 11
  1. 1.Forensic Toxicology and Chemistry UnitUniversity Centre of Legal MedicineLausanneSwitzerland
  2. 2.Swiss Human Institute of Forensic TaphonomyUniversity Centre of Legal MedicineLausanneSwitzerland
  3. 3.Department of Legal MedicineUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  4. 4.Department of Forensic MedicineMontpellier University HospitalMontpellierFrance
  5. 5.Bremen Mitte ClinicInstitute of Forensic MedicineBremenGermany
  6. 6.Institute of Legal MedicineUniversity Hospital FrankfurtFrankfurt am MainGermany
  7. 7.Faculty of Medicine, Institute of Legal Medicine, Department of Forensic ToxicologyUniversity of CologneKölnGermany
  8. 8.Laboratoire LAT LUMTOXLyonFrance
  9. 9.Laboratoire TOXGENBordeauxFrance
  10. 10.Department of Forensic MedicineAngers University HospitalAngersFrance
  11. 11.Forensic Pathology UnitUniversity Centre of Legal MedicineGenevaSwitzerland

Personalised recommendations