The Role of Venous Blood Gas Analysis in Medicolegal Evaluation of the Poisoning Cases: A Case Report

  • Burçin Gürbeden
  • Gökçe Karaman
  • Devrim Sertaç Özkan
  • Zehra Demiroğlu Uyanıker
  • Mehmet Hakan Özdemir

Abstract

Poison is a substance that may cause permanent damage or death by adverse effects on biological systems when certain amount of this substance is taken.  In medicolegal assessment of poisoning cases, the criteria defined in the part “Assessment of injury severity in poisoning cases” in the guide of “Assessment of mutilation crimes defined in Turkish Criminal Code in terms of forensic medicine” is used. But blood gas measurements don’t exist in these criteria. On the other hand, it is not stated that the measurements in the guide are venous or arterial.

Our case is 26 years old male. He applied to our department in December 2014 after request of legal authorities. According to medical records and history taken by us, he didn’t get any illness and it was seen that in November 2014, after using different type of alcohol, he consulted to the public health center with the complaints of nausea, vomiting, dizziness and numbness in hands and feet. It was understood that he was oriented, cooperative, conscious and his general condition was good, and he was sent to the Dokuz Eylül University Hospital Emergency Service for medical follow-up. System examinations were normal and he was diagnosed as ethyl alcohol intoxication. In medical records; laboratory results of blood alcohol (ethanol) level and venous blood gas measurements were seen. It was observed that there was no problem in medical follow-up of patient and he was discharged at the same day.

The difficulties were experienced in medicolegal assessment of this case because of that the blood gas measurements for determining life-threatening injuries were not stated as venous or arterial in the guide used for determining severity of injury. It will be discussed that is existing of venous blood gas measurements in the guide going to be helpful or not.

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References

1. Motamedian B. Trakya Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi’ne başvuran zehirlenme olgularının analizi. Edirne, Trakya Üniversitesi Sağlık Bilimleri Enstitüsü Tıbbi Farmakoloji Anabilim Dalı Yüksek Lisans Programı. Yüksek Lisans Tezi, 2014:8.
2. Islambulchilar M, Islambulchilar Z, Kargar-Maher MH. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. Human & Experimental Toxicology 2009;28:185-190.
3. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report. Clinical Toxicology 2014;52:1041.
4. Özcan N, İkincioğulları D. Ulusal Zehir Danışma Merkezi 2008 yılı çalışma raporu özeti. Türk Hijyen ve Deneysel Biyoloji Dergisi 2009;66(ER-3):29-58.
5. Birinci Basamağa Yönelik Zehirlenmeler Tanı ve Tedavi Rehberleri. T.C. Sağlık B. Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü. Ankara, 2007.
6. Öğüş C. Arter kan gazları. İçinde: Özlü T, Metintaş M, Karadağ M, Kaya A (editörler). Solunum sistemi hastalıkları: Temel başvuru kitabı. 1.baskı. İstanbul: İstanbul Medikal Yayıncılık; 2010; 475-89.
7. Acıcan T. Arter kan gazları. Yoğun Bakım Dergisi 2003;3:160-75.
8. Karalezli A. Arter kan gazları. Turk Med J 2007;1:44-50.
9. Aygencel G. Arter kan gazlarının yorumlanması. Türk Kardiyol Dern Arş 2014;42(2):195.
10. http://www.atk.gov.tr/Bilimsel_gerekleri_formlar.html (Erişim tarihi: 23.08.2015).
11. Yıldırım N. Kan gazlarının değerlendirilmesi. Ed: Ekim N. Türktaş H. Göğüs Hastalıkları Acilleri. Ankara: Bilimsel Tıp, 2000;65-69.
12. Tosun GA, Tutluoğlu B. Arter kan gazları ve asit baz dengesi. Solunum 2000;2:201-10.
13. Üstün E. Asid-Baz dengesi ve kan gazları analizi. Ed: Şahinoğlu H. Yoğun bakım sorunları ve tedavileri. Ankara: Nobel Tıp Kitabevi, 1992;43-4.
14. Baki Baskın S. Acil serviste kan gazı alımında heparinlenmiş insülin enjektörü ile koruma kapaklı kan gazı enjektörü kullanımının karşılaştırılması. İzmir, Dokuz Eylül Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı. Uzmanlık Tezi, 2013.
15. Malatesha G, Singh NK, Bharija A, Rehani B, Goel A. Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment. Emerg Med J. 2007; 24: 569-71.
16. Gokel Y, Paydas S, Koseoglu Z, Alparslan N, Seydaoglu G. Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol 2000;20(4):319-23.
17. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J 2001;18:340-2.
18. Kelly AM, Kyle E, McAlpine R. Venous PCO2 and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease. The Journal of Emergency Medicine 2002;22(1):15-9.
19. Bakoğlu E, Kebapçıoğlu AS, Ak A, Girişgin AS, Zararsız İ. Acil serviste periferik venöz kan gazının arter kan gazı yerine kullanılabilirliğinin araştırılması. Eur J Basic Med Sci 2013;3(2):29-33.
20. Dilber H, Polat G, Büyükşirin M, Karadağ Polat S, Tibet G. Akut solunum yetmezliği olan KOAH’lı olgularda arteriyel ve venöz kan gazı örneklerinin karşılaştırılması. İzmir Göğüs Hastanesi Dergisi 2005;19(1):7-13.
Published
29-04-2017
How to Cite
GÜRBEDEN, Burçin et al. The Role of Venous Blood Gas Analysis in Medicolegal Evaluation of the Poisoning Cases: A Case Report. The Bulletin of Legal Medicine, [S.l.], v. 22, n. 1, p. 67-71, apr. 2017. ISSN 2149-4533. Available at: <http://www.adlitipbulteni.com/index.php/atb/article/view/949>. Date accessed: 21 july 2017. doi: https://doi.org/10.17986/blm.2017127144.
Section
Case Reports

Keywords

intoxication, venous blood gas, medicolegal assessment