EFFECTS OF COMBINED EXPOSURE TO CARBON MONOXIDE AND HYDROGEN CYANIDE IN FORENSIC CASES: A LITERATURE STUDY
Abstract
Background: Carbon monoxide (CO) and hydrogen cyanide (HCN) are two toxic gases commonly released during fires, especially in enclosed spaces. Combined exposure to both gases can lead to synergistic toxic effects, causing systemic hypoxia and rapid death. This study aims to review the toxicological effects of combined CO and HCN exposure in the context of forensic toxicology. Methods: This study used a literature study method through searching articles in the PubMed, ScienceDirect, and Google Scholar databases. The articles analyzed were selected based on inclusion criteria in the form of publication years 2018–2023and discussions on the combination of CO and HCN toxicity, as well as exclusion of articles before 2020 and those not relevant to the topic of fire poisoning. Results:From the results of the study, CO exposure causes the formation of carboxyhemoglobin (COHb) which inhibits oxygen transport, while HCN inhibits oxygen utilization at the cellular level. The combination of the two exacerbates hypoxia, increasing the risk of sudden death, especially in confined spaces with poor ventilation. The study showed that COHb levels> 30% and HCN> 2 mg/L correlated with death from fire. Conclusion:Combined exposure to CO and HCN is rapidly lethal. Detection of COHb and HCN levels is very important for the diagnosis and forensic evaluation of fire victims.
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