A -40 year old- woman was admitted to the Intensive Care Unit with coma and apnea. There was insufficient information about the manner and the speed of coma onset, as she had been found by her relatives, in her room, where she was laying unconcious, on the floor.The woman was under treatment with antidepresive and ansyolitics drugs prescribed by a psychiatrist doctor.The patient was treated with hemoperfusion and was pronounced dead due to multiorganic failure, two hours later. A legal autopsy was done.Turpentine ingestion was suspected from the beginning of the autopsy due to the pine odor of the corpse.The relatives said that they found a bottle of Turpentine beside the patient's bed.
The more important findings during the autopsy were relative to the gastrointestinal system, specially at the oesophagus and the stomach; both organs show dark blood on the mucosa surface and the stomach was dilated and contained 120 ml of a dark bloody liquid.The organ show several perforations and can be seen gastric contents in the peritoneum with necrosis of the spleen capsule. Samples of gastric fluid and blood contain cyclic terpenos, normal components of pine oil. Turpentine is a colorless thin transparent oily liquid with a strong specific odor (pine odor; violet odor), insoluble in water but soluble in numerous organic solvents. It is used to dissolve oil-based paints, varnish and grease stains. During acute poisoning with Turpentine, the more important clinical manifestations occur in the gastrointestinal system -nausea, vomiting and diarrhea- and in the Nervous System, as coma or stupor. The acute toxic oral dose has been estimated in excess of 2 mL/kg. Systemic toxicity, when it appears, ocurs two or three hours after the exposure. The main metabolite of monoterpenes (the main constituents in turpentine solutions), named bornylacetate, has a peak excretion in urine the 5th and 6th post-exposure day. Hemoperfusion eliminates turpentine constituents effectively from the blood and only should be applied at an early stage of intoxication before accumulation of the toxins in tissues be established. Inmediate and continous gastric lavage is the most effective therapy.
Foto A.- Show a very important gastric dilation due to the colliquative necrosis and gastromalacia of the organ.
Foto B.- Exposed gastric mucosa, after the opening, showing the colliquative necrosis and the gastric hemorrhage.