Forensic Science International 231 (2013) 172177

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Forensic Science International

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A retrospective analysis of data from toxic substance-related cases in

Northeast China (Heilongjiang) between 2000 and 2010
Dalei Zhang a,b, Jilin Zhang b, Zhong Zuo c, Linchuan Liao a,*
a
West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, PR China
b
Forensic Science and Technology Division, The Department of Public Security of Heilongjiang, Harbin 150008, PR China
c
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region

A R T I C L E I N F O A B S T R A C T

Article history: The aim of this study was to analyze data from toxic substance-related cases in Northeast China
Received 28 November 2012 (Heilongjiang Province) reported between 2000 and 2010, and to investigate the associations among the
Received in revised form 13 May 2013 classes of toxic substances detected with gender, age, season, district of occurrence, and type of case.
Accepted 14 May 2013
Pesticides, drugs, and alcohol were detected using gas chromatographymass spectrometry or ame
Available online 7 June 2013
ionization detection. Carbon monoxide levels were measured using ultraviolet spectrometry, and levels
of cyanides, nitrites, and acid were monitored using the chemical colorimetry method. Among a total of
Keywords:
565 cases, 208 (36.8%) were related to accidental injury/death, 175 (31.0%) to suicide, 80 (14.2%) to
Toxic substance
homicide, 43 (7.6%) to robbery, 29 (5.1%) to re or arson, 20 (3.5%) to intentional injury/death, 7 (1.2%) to
Poisoning
Alcohol rape, and 3 (0.5%) to kidnapping. Men constituted 65.3% of the total 565 victims, most of who were
Pesticide between the ages of 31 and 50 years, with the average age being 44 years. The highest number of cases
Drug (126) was reported from Harbin, the capital of Heilongjiang Province. Pesticide-related cases accounted
Carbon monoxide for 37.9% of the cases, with more cases occurring between April and August. Methomyl (48 cases) and
uoroacetamide (38 cases) were the most common pesticides involved in these cases. Drug-related cases
accounted for 19.5% of the total poisoning cases, with benzodiazepines being the most commonly
detected drugs (45 cases). More than 70% of alcohol-related cases involved the use of alcohol in crime (or
affair) execution, with the blood alcohol concentration being less than 350 mg/100 mL in these cases.
Carbon monoxide was detected in 16.1% of the cases, with a higher yearly incidence noted in winter. To
our knowledge, this is the rst study to provide an overall analysis of toxic substance-related cases in
Northeast China. Similar to the ndings observed in Central China (Hubei), our ndings indicated that
pesticides were the major cause of poisoning in the Heilongjiang Province of Northeast China.
2013 Elsevier Ireland Ltd. All rights reserved.

1. Introduction Thus far, no forensic science reports summarizing or analyzing

Every year, a signicant number of poisoning cases are reported
worldwide [14]. According to the WHO, approximately 370,000
deaths are caused by deliberate ingestion of chemicals each year
[5]. Pesticides, drugs, and alcohol were found most commonly in
toxic substances-related cases [6]. In China, accidental death and
suicide were the most common cause of death related to toxic
substances [7]. Of the total poisoning-related deaths in 2005, about
21% poisonings were related to drugs and 38.7% to pesticides [7,8].
Pesticides remain the most common poisoning substances in
China, as in other low- and middle-income countries [2,9,10]. The
collection and analysis of data from toxic substance-related cases
may help reduce the occurrence of poisonings.
* Corresponding author. Tel.: +86 138 0808 4803; fax: +86 28 8550 1636.
E-mail address: linchuanliao@126.com (L. Liao).
forensic toxic substance-related cases in Northeast China have
been published. The objective of the present study was to analyze
data from toxic substance-related cases in the region of
Heilongjiang, Northeast China, in order to identify the trends
and characteristics as well as to provide guidance on the
investigation of such cases and help develop strategies to prevent
the occurrence of poisoning. The results of this study will allow for
comparisons over time and between districts and countries.
Heilongjiang in Northeast China has a population of about
38,000,000 inhabitants [11]. In Heilongjiang, 3 authorized
laboratories are permitted to examine forensic samples. The
Forensic Science and Technology Division (FSTD) of the Public
Security Bureau is responsible for the investigation and examina-
tion of toxic substances in crimes and cases of poisoning or death in
which the cause is unclear; the other 2 laboratories are responsible
for cases related to trafc accidents and cases related to illicit
drugs, respectively. Each year, about 400 cases related to toxic
substance are investigated by the FSTD.

0379-0738/$ see front matter 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.forsciint.2013.05.014
 D. Zhang et al. / Forensic Science International 231 (2013) 172177 173

2. Materials and methods

Data from toxic substance-related cases were collected by inspecting the 2000
2010 records of FSTD. The scope of the data was limited to crime and other types of
cases related to toxic substances, including accidental injury/death, suicide,
homicide, intentional injury, kidnapping, rape, re, and other toxic substance-
related cases, with a focus on cases in which death did and did not occur. Data from
trafc accidents, road investigations, drug abuse cases, and negative examinations
were not included in the current study. Data were obtained on gender, age, time of
occurrence, city of occurrence, type of case, and the type/level of toxic substances
detected. The Case Management System (CMS) of the FSTD was used to manage and
analyze these data.
In cases in which death had occurred, the samples analyzed were mainly
stomach contents, the liver, urine, and blood from the heart, and in cases in which
no death occurred, venous blood and urine were collected by investigators and
stored at 18 8C until analysis. These samples were then sent to the toxicology
laboratory of FSTD within 12 h, and analyzed in the following 5 days.
For alcohol-related cases, blood samples were considered positive if quantitative
analysis using headspace gas chromatography with a ame ionization detector Fig. 1. Geographical distribution of the positive toxic substance-related cases
revealed a blood alcohol concentration (BAC) of 10 mg/100 mL [12]. For the examined (number per 105 inhabitants in parentheses) between 2000 and 2010 in
analysis of pesticides, hypnotics, anesthetics, drugs, or other organic poisoning Heilongjiang, China. Harbin, the capital of Heilongjiang, had the highest number of
substances, blood, the liver, stomach contents, and other samples were pretreated toxic substance-related cases, whereas Qitaihe and Daxinganling had the lowest
with a mixture of acetone and water (4:1, v/v) for 30 min by using an ultrasonic numbers of cases. However, the lowest incidence of toxic substance-related cases
extractor. After centrifugation and ltration, the ltrate was evaporated to a volume was observed in Yichun.
of 23 mL. This concentrated ltrate was extracted twice by using 5 mL of
acetoacetate. The solutions of acidic or alkaline target substances needed
adjustment to the appropriate pH before extraction with acetoacetate. The
extracted solution was then evaporated to 0.5 mL by airow for gas chromatogra- toxic substance-related cases, and accounted for 208 (36.8%), 175
phy (GC) or GCmass spectrometry (GCMS) analysis [1321]. Some samples (31.0%), and 80 (14.2%) of all toxic substance-related cases,
needed to be derivatized in order to achieve the required sensitivity before
respectively (Table 1).
instrument analysis. Carbon monoxide was quantied by dual-wavelength
ultraviolet spectrometry after dilution of blood with water (1:200) [22]. For The geographic distributions of toxic substance-related cases
cyanides, after the pulverization of samples and adjustment to pH 23 by using for each city in Heilongjiang are shown in Fig. 1. Harbin, the capital
tartaric acid (10%, w/w), the mouth of the erlenmeyer ask was immediately of Heilongjiang, had the highest number of toxic substance-related
overlaid by a test paper of ferrous sulfate (20%, w/w)sodium hydroxide (10%, w/w).
cases (126), accounting for 22.3% of all the cases. Qitaihe and
Then, after heating the ask until boiling, the test paper was soaked in sulforic acid
(10%, w/w) and the Prussian Blue Reaction was used for determination [13]. For Daxinganling had the lowest number of cases (8 each). However,
nitrites, samples were mixed by deionized water and the water solutions were the lowest frequency of occurrence was observed in Yichun (0.85
analyzed by the Griess Reagent colorimetric method [13]. For acids, after lixiviating per 105 inhabitants). More than 54% of suicides occurred in rural
samples by using deionized water, the samples were further analyzed by conducted areas. In urban areas, accidental injury/death (117 cases), robbery
barium chloride, silver nitrate, and brucinesulfuric acid reactions to determine
(43 cases), rape (7 cases), and kidnapping (3 cases) were the
sulfuric acid, hydrochloric acid, and nitric acid, respectively [13]. According to the
case history, the determinations for pesticides, drugs, and other toxic substances common types of toxic substance-related cases.
were carried out on a case-by-case basis. The concentration of alcohol was No obvious difference was observed in the frequency of toxic
ascertained for all samples. substance-related cases from January to December in 2000 to
2010. However, each year, the number of carbon monoxide- and
pesticide-related cases increased from November to February and
3. Results from April to August, respectively. The exact number of cases
recorded per month is shown in Fig. 2.
3.1. General analysis Of the total toxic substance-related cases examined, 369
(65.3%) involved men and 196 (34.7%) involved women
During the 11-year period examined, the total number of toxic (Table 2). The median age was 44 years for men (range, 571
substance-related cases identied positively in our laboratory was years) and 42 years for women (range, 174 years). The number of
565 (Table 1). The number increased from 62 to 285 in 3 years victims showed an age-related increase, with the maximum
(Table 1). Therefore, a general increasing tendency in the number number corresponding to the 3150 years age group and
of cases was observed. Among these cases, accidental injury/death, accounting for 288 (51.0%) of the total victims (Table 2). Regarding
suicide, and homicide were the more frequently observed types of suicide, the number of cases involving women (93 cases) was
slightly higher than that involving men (82 cases). All rape victims
Table 1
The total number and types of positive toxic substance-related cases from 2000 to were women.
2010 in Heilongjiang, China.

Type of case Number of positive toxic substance-related cases (% of

total positive toxic substance-related cases)

20002010 20002003 20042007 20082010

Accidental 208 (36.8) 27 (4.8) 61 (10.8) 120 (21.2)

injury/death
Suicide 175 (31.0) 21 (3.7) 67 (11.9) 87 (15.4)
Homicide 80 (14.2) 4 (0.7) 49 (8.7) 27 (4.8)
Robbery 43 (7.6) 5 (0.9) 24 (4.2) 14 (2.5)
Fire and arson 29 (5.1) 3 (0.5) 6 (1.1) 20 (3.5)
Intentional 20 (3.5) 1 (0.2) 7 (1.2) 12 (2.1)
injury/death
Rape 7 (1.2) 0 (0.0) 3 (0.5) 4 (0.7) Fig. 2. Seasonal variations in positive pesticide, drug, and carbon monoxide
Kidnapping 3 (0.5) 1 (0.2) 1 (0.2) 1 (0.2) poisoning cases from 2000 to 2010 in Heilongjiang, China. The incidence of
pesticide- and carbon monoxide-related cases was high in the summer and winter,
Total 565 (100.0) 62 (11.0) 218 (38.6) 285 (50.4)
respectively.
174 D. Zhang et al. / Forensic Science International 231 (2013) 172177

Table 2
The gender and age distribution of victims.

Age group (years) Total Men Women

Number of victims % Number of victims % Number of victims %

<18 62 11.0 35 6.2 27 4.8

1830 123 21.8 56 9.9 67 11.8
3150 288 51.0 207 36.6 81 14.3
5170 74 13.0 59 10.5 15 2.7
>71 18 3.2 12 2.1 6 1.1

Total 565 100.0 369 65.3 196 34.7

3.2. Toxic substances
In the 565 toxic substance-related cases reported between 2000
and 2010, pesticides (214, 37.9%), alcohol (114, 20.2%), drugs (110,
19.5%), and carbon monoxide (91, 16.1%) were the most common
toxic substances involved (Table 3).
3.2.1. Pesticides
During the study period, pesticides were the main toxic
substances detected, with carbamates, organophosphates, roden-
ticides, pyrethroids, herbicides being detected in 77, 58, 52, 12, and
10 cases, respectively (Table 4). Methomyl (48 cases) and
uoroacetamide (38 cases) were the most commonly used in
the pesticide-related cases, accounting for 22.4% and 17.8% of the
total 214 pesticide-related cases, respectively (Table 4). Carbo-
furan (28 cases), phorate (20 cases), dichlorvos (18 cases), and
omethoate (16 cases) were also identied (Table 4). Cases of
suicide with methomyl, carbofuran, and dichlorvos (139 cases in
all) accounted for the most number of pesticide-related cases
(Table 3).
3.2.2. Drugs
Drugs were the second most commonly observed substances in
toxicity related-cases, with sedative-hypnotic drugs such as
benzodiazepines (45 cases) and psychotolytics (8 cases) being
involved most frequently (Table 4). Furthermore, a frequency of
prescription drug use, including aminopyrine (15 cases), caffeine
(12 cases), and zopiclone (8 cases), was noted among the toxicity
related-cases (Table 4). The most common hallucinogens were
illicit drugs such as methamphetamine (3 cases) and ketamine (2
cases). Accidental injury/death, homicide, and suicide were
recorded in 32, 17, and 12 drug-related cases, respectively
(Table 3). Illicit drugs were commonly used to help the assailants
in robberies and rapes (Table 3).
3.2.3. Alcohol
In 114 alcohol-related cases, alcohols levels ranged from 17 to
669 mg/100 mL. Approximately 25% of the total alcohol-related
cases were found to be associated with use of drugs such as
diazepam and triazolam, as well as illicit drugs; the BAC was less
than 350 mg/mL in these cases. In toxic substance-related cases in
which only alcohol was used, the lowest BAC was 143 mg/100 mL,
and the BAC exceeded 350 mg/100 mL in 6 tested cases. In about
70% of the alcohol-related cases, alcohol was not found to be the
main cause of injury/death. Men were involved in approximately
80% of the alcohol-related cases, and the most frequent types of
alcohol-related cases involved accidental injury/death (80 cases),
intentional injury/death (17 cases), and homicide (12 cases)
(Table 3).
3.2.4. Other toxic substances
As indicated in Table 3, carbon monoxide (91 cases), cyanides
(24 cases), sulfuric acid (8 cases), nitrites (2 cases), and other
chemicals were also detected in the toxic substance-related cases
(Table 4). In carbon monoxide-related cases, accidental injury/
death, such as that due to exposure to coal gas leakage, was
recorded in the majority of cases (63 cases). Cyanide-related cases
were mainly related to suicides (15 cases) and homicides (10
cases). In addition, sulfuric acid was mainly associated with
intentional injury, whereas chemicals such as nitrites and
methanol were predominantly implicated in accidental injury/
death.
4. Discussion
The aim of this study was to analyze the toxic substance-related
cases in the Heilongjiang Province of Northeast China from 2000 to
2010 and to investigate associations with gender, age, season,
district of occurrence, type of case, and the class of toxic substances
detected. From 2000 to 2010, a general increasing trend was
observed in the number of cases. One reason for this increase might
be a lack of strict restrictions on the use of toxic substances such as
sedative-hypnotic drugs and pesticides. Another reason for the use
of these substances may be the effects that these substances have,
with the criminals selecting that toxic substances that help
facilitate their crimes by rendering the victims unconscious.
Similar ndings have been reported in China and several other
countries [2,3,7]. Given the increasing yearly trend in the number

Table 3
The total number of positive toxic substance-related cases associated with different types of cases.

Type of case Number of positive toxic substance-related cases (% of total positive toxic substance-related cases)

20002010 Pesticides Drugs Alcohol Carbon monoxide Others

Accidental injury/death 208 (36.8) 26 (4.6) 32 (6.7) 80 (14.2) 63 (11.2) 7 (1.2)

Suicide 175 (31.0) 139 (24.6) 12 (2.1) 8 (1.4) 1 (0.2) 15 (2.7)
Homicide 80 (14.2) 47 (8.3) 17 (3.0) 10 (1.8) 0 (0.0) 6 (1.1)
Robbery 43 (7.6) 2 (0.4) 38 (6.7) 2 (0.4) 0 (0.0) 1 (0.2)
Fire and arson 29 (5.1) 0 (0.0) 0 (0.0) 2 (0.4) 27 (4.8) 0 (0.0)
Intentional injury/death 20 (3.5) 0 (0.0) 1 (0.2) 12 (2.1) 0 (0.0) 7 (1.2)
Rape 7 (1.2) 0 (0.0) 7 (1.2) 0 (0.0) 0 (0.0) 0 (0.0)
Kidnapping 3 (0.5) 0 (0.0) 3 (0.5) 0 (0.0) 0 (0.0) 0 (0.0)

Total 565 (100.0) 214 (37.9) 110 (19.5) 114 (20.2) 91 (16.1) 36 (6.4)
 D. Zhang et al. / Forensic Science International 231 (2013) 172177
Table 4
Summary of the most commonly detected toxic substances and the number of positive cases identied during the study period.
Category Names of toxic substances positively detected (number of positive exams)
Classication
Pesticides Carbamates (77)
Organophosphates (58)
Rodenticides (52)
Pyrethroids (12)
Herbicides (10)
Others (5)
Drugs Pharmaceuticals (47)
Benzodiazepines (45)
Psychotolytics (8)
Illicit drugs (7)
Barbiturates (3)
Other toxic substances Alcohol (114)
a
The most commonly detected toxic substances in each classication.
of cases reported and new toxic substances used in these cases,
high-throughput analytical methods with high specicity and
sensitivity should be applied.
In the present study, nearly all of the victims were deceased in
suicide, homicide, and re-related cases. A lower death rate was
found in cases of robbery, intentional injury, and rape. When
comparing the incidence of these cases between men and women,
the majority of the victims were men in all types of cases, except
for suicide and rape. This nding was in agreement with those of
several studies indicating that men are more likely to be attacked
[2325]. The underlying reason is thought to be mainly male
characteristics, with men being more likely to intensify conicts
and face retaliation by others. The results of this study indicated
that the majority of victims were in the age group of 3150 years,
with the average age being 44 years for men and 42 years for
women; this nding is consistent with the ndings of Zhou et al.
[7], who in their study reported that more than 50% of victims were
aged 3050 years. This result may be explained by the fact that
people aged 3150 years are likely to lead more social lives, and
may therefore, experience more conicts with others.
Accidental injury/death and suicide were the main causes of
human poisonings in Heilongjiang. Such events have been the
subject of many studies worldwide. In Hungary, drug ingestion
was found to be the most common suicide method, with a
signicant increase in the number of cases reported between 1991
and 2000 [26]. In Egypt, rodenticide ingestion was the most
commonly reported suicide method, and in China, 58% of the total
number of suicide cases were attributed to poisoning [27,28]. In
cases of accidental injury/death, similar results were found, with
poisoning being reported in 64.7% of accidental deaths in Hubei,
China and in 69.6% of accidental deaths in Greece from 1998 to
2004 [7,29]. Our ndings are in accordance with the results
described in these reports. Our study also analyzed the incidence of
robbery, rape, kidnapping, and intentional injury in relation to
toxic substances. Since 2001, the tendency to use toxic substances
in the execution of such crimes has been identied, with criminals
becoming slyer and more knowledgeable about how to use more
tools to commit crimes or hurt victims along with societal
developments. Shbair et al. [30] also reported the use of drugs in
crime and indicated the wide use of drugs in robberies.
In the current study, the highest number of toxic substance-
related cases was reported from Harbin, the capital of Heilongjiang
with more than one-third of its population. The lowest numbers of
cases were found in Qitaihe and Daxinganling, given their small
population and insufcient forensic laboratories. The lowest
frequency, which was observed in Yichun, could be due to the
175
Most commonly detected toxic substancesa
Methomyl (48) Carbofuran (28)
Phorate (20) Dichlorvos (18) Omethoate (16)
Fluoroacetamide (38) Tetramine (13)
Fenpropathrin (5) Cypermethrin (5)
2,4-D-butyl ester (8)
Endosulfan (2)
Aminopyrine (15) Caffeine (12) Zopiclone (8)
Diazepam (15) Estazolam (14) Triazolam (13)
Clozapine (4)
Methamphetamine (3) Ketamine (2) Pethidine (1)
Phenobarbital (2)
Carbon monoxide (91) Cyanides (32)
scattered living pattern of the inhabitants that reduces the chance
of conicts.
Pesticides were the most signicant source of intoxication.
Approximately 3 million cases of pesticide poisonings occur each
year, resulting in 220,000 deaths, and 95% of pesticide poisonings
are fatal in developing countries and severe disaster areas [6].
These results agreed well with our ndings for Heilongjiang, with
pesticides accounting for 37.9% of all poisonings along with high
fatality; the incidence of pesticide poisonings in other districts of
China has been reported to be 5186% [7,8]. In some developing
countries, such as Iran and Brazil, similar ndings were reported
[1,2]. The reason for these high rates was the large consumption of
pesticides in these countries, where highly hazardous pesticides
are easily available because of their low price, widespread use, and
loose control in sale or use. However, in some countries, pesticides
were not the main source of poisoning, and instead, drugs, carbon
monoxide, and alcohol were involved in most fatal poisonings
[3,4,25].
Among the pesticides identied in the toxic substance-related
cases in Heilongjiang, methomyl and uoroacetamide were the
most commonly used. Methomyl is a highly efcient insecticide
that is used most widely for agriculture in Heilongjiang. Therefore,
the high incidence of methomyl-induced poisoning is because of
the ease of obtaining methomyl. Although prohibitive legislation
for uoroacetamide and tetramine was established in 1982,
uoroacetamide can still be easily obtained from the market
because of its cheap price and high efciency against rats. The
government should also emphasize that the manufacturing of
highly toxic rodenticides such as uoroacetamide and tetramine is
prohibited and take measures to eliminate their application. In
addition, strict control on the sale and use of pesticides during the
cultivation and harvest seasons from April to August is another
important strategy in.
Drug poisoning was the other main source of intoxication. In
Sweden, almost all fatal intoxications were reported to be related
to drugs [25]. In Denmark, 30% of those who committed suicide did
so by intoxication with prescription drugs, and in New South
Wales, Australia, the corresponding gure was 26.5% [31,32]. In
our study, although prescription drugs were one of the main causes
of intoxication, they were also used to execute crimes such as
robbery, kidnapping, rape, and homicide. Benzodiazepines were
most commonly used drugs in the execution of crimes, with
diazepam, estazolam, and triazolam being favored because of their
fast sedative-hypnotic action. This nding was different from the
results of some studies, which reported that abuse or death by
benzodiazepines was the most important cause of drug poisoning
176 D. Zhang et al. / Forensic Science International 231 (2013) 172177
[30,33]. Zopiclone, a new sleep-inducing drug, was used in
robberies, as it can be easily obtained because of insufcient
monitoring in China. Moreover, the study revealed that, the
number of accidental deaths caused by aminopyrine and caffeine,
as the main components of Nao Qing Pian, was higher than that
caused by other pharmaceutical agents. In many countries,
aminopyrine has already been prohibited by governments because
of its severe side effects, but it is still used in China. In the future,
the prohibition of aminopyrine should be enacted to avoid such
accidental deaths.
Alcohol was often detected in toxic substance-related cases.
Except for alcohol-related driving and trafc accidents, there were
usually 3 possibilities for the incidence of alcohol-related cases: (1)
poisoning or death caused by alcohol: alcohol allergy or excessive
intake of alcohol; (2) poisoning or death caused by other toxic
substances: detection of alcohol and another toxic substance
simultaneously, with alcohol not being the main cause of
poisoning or death; and (3) poisoning or death caused by other
means: positive alcohol test without it being the direct cause of
injury or death, with the actual cause being hypothermia,
drowning, intentional injury, etc. In the present study, alcohol
was not the main cause of injury, poisoning, or death in more than
70% of alcohol-related cases. These ndings suggest that alcohol
was not likely the rst cause of injury, poisoning, or death, but may
have facilitated it in toxic substance-related cases. In New South
Wales, Australia, alcohol with cannabis and opioids were the most
detected toxic substances in homicide victims [32]. Additionally, in
Jordan, the proportion of positive alcohol examinations was 50% in
the 60 cases investigated [34]. Although several results similar to
those of the present study were found, differences also existed
between countries. These differences in alcohol-related cases are
very difcult to explain, but may result from the different social
and historical inuences of liquor in every country.
Every year, many people die because of carbon monoxide
poisoning. Its inhalation results in the fast and fatal inhibition of
oxygen transportation in blood [35]. In Cuyahoga, USA, the main
cause of carbon monoxide-induced death was accident due to re
or arson in the home [36]. In this study, similar to the Morocco
report, accidental carbon monoxide-induced death because of
exposure to a heating stove was the main cause in the winter
months of November to February [37]. The stove was found to still
be the main heating device used in many developing countries, and
if the stove was not well maintained, carbon monoxide poisoning
would occur frequently. However, a signicant reduction in the
incidence of carbon monoxide poisoning has been observed in
recent years. The reasons for this include increasing awareness of
the problem and the conversion to central heating supply systems,
along with social and economic developments.
Similar to some previous reports [3840], cyanides, sulfuric
acid, and nitrites were the other toxic substances identied in this
study. Although some suicides involving cyanide were identied,
the number of such cases has decreased because of the difculties
in obtaining the compound owing to the strict management and
prohibition by the government. Due to limited data, statistical
analysis on data related to sulfuric acid and nitrites was not
possible. However, the list of toxic substances provided in the
current study is expected to be an important reference for future
studies.
The results of this study showed a relatively fewer number of
cases related to toxic substances compared with those in studies in
other countries and districts [2,4,25]. One reason for this may be
the lack of focus on evidence by investigators, as the symptoms of
poisoning may have been obvious and identication was
unnecessary. Another reason would be the lack of identication
laboratories. Currently, the Supreme Peoples Court and the Public
Security Ministry of China request that all of the evidence must be
identied before prosecution. Therefore, issues with lack of
evidence will not be a problem in the future.
5. Conclusions
Data from a total of 565 positive cases related to toxic
substances were retrospectively analyzed in this study. Accidental
injury/death, suicide, and homicide accounted for the major types
of poisoning- or death-related cases. Except for suicide and rape,
the incidence of cases involving men was higher than that of the
cases involving women, with the average age being 44 years for
men and 42 years for women (age range, 3150 years). Pesticides
were the most common toxic substances in the cases we examined.
Prescription drugs, particularly benzodiazepines, were the most
commonly detected drugs, and alcohol were usually used to help
carry out crimes in related cases. Carbon monoxide poisoning was
found to occur more frequently in the winter, and its incidence has
decreased in recent years. Although all of the results in this study
reected some similar aspects to those of the results from other
studies performed in China and other countries, some differences
were observed.
Acknowledgements
The authors thank all of the criminal and scientic laboratory
employees from the 14 cities and districts in Heilongjiang for their
exactitude and the overall case data standards. We also appreciate
the help from the investigators in the Forensic Science and
Technology Division of the Department of Public Security of
Heilongjiang.
References
[1] K. Soltaninejad, M. Faryadi, F. Sardari, Acute pesticide poisoning related deaths in
Tehran during the period 20032004, J. Forensic Legal Med. 14 (2007) 352354.
[2] E.L.C. Campelo, E.D. Caldas, Postmortem data related to drug and toxic substance
use in the Federal District, Brazil, from 2006 to 2008, Forensic Sci. Int. 200 (2010)
136140.
[3] A. Seymour, M. Black, J.S. Oliver, Drug related deaths in the Strathclyde region of
Scotland, 19951998, Forensic Sci. Int. 122 (2001) 5259.
[4] E. Below, E. Lignitz, Cases of fatal poisoning in postmortem examinations at the
Institute of Forensic Medicine in Greifswaldanalysis of ve decades of post-
mortems, Forensic Sci. Int. 133 (2003) 125131.
[5] The International Programme on Chemical Safety, Poisoning Prevention and
Management, http://www.who.int/ipcs/poisons/en/ (retrieved 10.10.10).
[6] M.J. Ellenhorns, S. Schonwald, G. Ordog, J. Wasserberger, Ellenhorns Medical
Toxicology: Diagnosis and Treatment of Human Poisoning, 2nd ed., Williams &
Wilkins, MD, 1997.
[7] Q. Liu, L. Zhou, N. Zheng, L. Zhuo, Y. Liu, L. Liu, Poisoning deaths in China: type and
prevalence detected at the Tongji Forensic Medical Center in Hubei, Forensic Sci.
Int. 193 (2009) 8894.
[8] L.J. Xie, H.S. Zhang, C.S. Meng, S.L. Zhang, J. Zhou, S.F. Jiang, M.L. Wang, C.Y. Sun,
Survey on Poisoning cases in emergency department of general hospital in China,
Chin. J. Ind. Med. 23 (2010) 357358.
[9] M.R. Phillips, G. Yang, Y. Zhang, L. Wang, H. Ji, M. Zhou, Risk factors for suicide in
China: a national case-control psychological autopsy study, Lancet 9347 (2002)
17281736.
[10] L. Senarathna, S.F. Jayamanna, P.J. Kelly, N.A. Backley, M.J. Dibley, A.H. Dawson,
Changing epidemiologic patterns of deliberate self poisoning in a rural district of
Sri Lanka, BMC Public Health 593 (2012), http://dx.doi.org/10.1186/1471-2458/
12/593, http://www.biomedcentral.com (retrieved 2.08.12).
[11] National Bureau of Statistics of China, Communique of the National Bureau of
Statistics of Peoples Republic of China on Major Figures of the 2010 Population
Census (No. 2), 2010 http://www.stats.gov.cn/english/newsandcomingevents/
t20110429_402722516.htm (retrieved 29.04.11).
[12] T. Macchia, R. Mancinelli, S. Gentili, E.C. Lugaresi, A. Raponi, Ethanol in biological
uids: headspace GC measurement, J. Anal. Toxicol. 19 (1994) 241246.
[13] S.C. Hu, L. Yao, Forensic Chemistry, Peoples Publishing House, Beijing, 1988.
[14] W. Xu, X.P. Cao, C.H. Hu, C.X. Yang, Method for detection and measurement of
organophosphorus pesticide compounds poisoning by GC, Chin. J. Forensic Med. 2
(1986) 1115.
[15] S. Zeng, Analysis of barbiturates in biological specimen by GC/MSD, J. Forensic
Med. 10 (1994) 158159.
[16] A. Ramesh, P.E. Ravi, Electron ionization gas chromatographymass spectromet-
ric determination of residues of thirteen pyrethroid insecticides in whole blood, J.
Chromatogr. B 802 (2004) 371376.
 D. Zhang et al. / Forensic Science International 231 (2013) 172177
[17] Y.L. Li, J.Z. Xu, Y. Liu, Analysis of diazepam clordiazepoxed, oxazepam and their
metabolites and degradation-products in biological tissues by GC/MS, Modern
Inst. 5 (1996) 1115.
[18] F. Stanke, N. Jourdil, J. Bessard, G. Bessard, Simultaneous determination of
zolpidem and zopiclone in human plasma by gas chromatographynitrogen
phosphorus detection, J. Chromatogr. B 675 (1996) 4351.
[19] T. Ohshima, T. Takayasu, Simultaneous determination of local anesthetics includ-
ing ester-type anesthetics in human plasma and urine by gas chromatography
mass spectrometry with solid-phase extraction, J. Chromatogr. B 726 (1999)
185194.
[20] W.K. Niu, C.W. Sun, B.H. Wang, The determination of tetramine in blood of acute
poisoning patients by GC/MS and clinical application, Chin. J. Med. 41 (2006)
284285.
[21] W.J. Allender, Determination of sodium uoroacetate (compound 1080) in bio-
logical tissues, J. Anal. Toxicol. 14 (1990) 4549.
[22] Y.Q. Feng, Q.H. Kong, J.R. Zhang, W.D. He, J.Y. Hu, M.Y. Hu, First derivative
spectrophotometry for the determination of carbon monoxide in blood, Anal.
Chem. 16 (1988) 10611064.
[23] K. Worm, A. Steentoft, Fatal poisonings in East Denmark 19841991, Ugesskr.
Laeger 161 (1999) 66226625.
[24] R.A. Lahti, E. Vuori, Fatal drug poisonings: medico-legal reports and mortality
statistics, Forensic Sci. Int. 136 (2003) 3546.
[25] A. Jonsson, P. Holmgren, J. Ahlner, Fatal intoxications in a Swedish forensic
autopsy material during 19922002, Forensic Sci. Int. 143 (2004) 5359.
[26] B. Havasia, K. Magori, A. Toth, L. Kiss, Fatal suicide cases from 1991 to 2000 in
Szeged, Hungary, Forensic Sci. Int. 147S (2005) S25S28.
[27] S.A.G. Elhak, A.M. El-Ghazali, M.M. Salama, A.Y. Aboelyazeed, Fatal suicide cases in
Port Said city, Egypt, J. Forensic Legal Med. 16 (2009) 266268.
[28] L.P. Fei, Current situation and solving direction of suicide in China, Chin. J.
Epidemiol. 25 (2004) 277279.
177
[29] T. Vougiouklakis, V.A. Boumba, A. Mitselou, Fatal poisoning in the region of Epirus
Greece, during the period 19982004, J. Clin. Forensic Med. 13 (2006) 321325.
[30] M.K.S. Shbair, S. Eljabour, M. Lhermitte, Drugs involved in drug-facilitated crimes:
Part I. Alcohol, sedative-hypnotic drugs, gamma-hydroxybutyrate and ketamine.
A review, Ann. Pharm. Fran. 68 (2010) 275285.
[31] S. Rogde, H.P. Hougen, K. Poulsen, Suicides in two Scandinavian capitalsa
comparative study, Forensic Sci. Int. 80 (1996) 211219.
[32] S. Darke, J. Duou, Toxicology and circumstances of death of homicide victims in
New South Wales, Australia 19962005, J. Forensic Sci. 54 (2009) 490494.
[33] A. Steentoft, K. Linnet, Blood concentrations of clonazepam and 7-aminoclona-
zepam in forensic cases in Denmark for the period 20022007, Forensic Sci. Int.
184 (2009) 7479.
[34] S.Y.A. Ragheb, K.A. Hadidi, Fatal poisoning with alcohol and drugs in the Greater
Amman County, Forensic Sci. Int. 99 (1999) 209215.
[35] K.R. Olson, Carbon monoxide poisoning: mechanisms, presentation, and contro-
versies in management, J. Emerg. Med. 1 (1984) 233243.
[36] C.D. Homer, D.A. Engelhart, E.S. Lavins, A.J. Jenkins, Carbon monoxide-related
deaths in a metropolitan county in the USA: an 11year study, Forensic Sci. Int.
149 (2005) 159165.
[37] M.A.E. Cadi, Y. Khabbal, L. Idrissi, Carbon monoxide poisoning in Morocco during
19992007, J. Forensic Legal Med. 16 (2009) 385387.
[38] N.L. Abeyasinghe, H.J.M. Perera, D.S.K. Weerasinghe, Case reportdeath by sub-
cutaneous injection of cyanide in Sri Lanka, J. Forensic Legal Med. 18 (2011)
182183.
[39] A. Mannan, S. Ghani, A. Clarke, P. White, S. Salmanta, P.E.M. Butler, Psychosocial
outcomes derived from an acid burned population in Bangladesh, and comparison
with Western norms, Burns 32 (2006) 235241.
[40] S.N. Kales, G.N. Polyhronopoulos, M.J. Castro, R.H. Goldman, D.C. Christiani,
Injuries caused by hazardous materials accidents, Ann. Emerg. Med. 30 (1997)
598603.