embalming artifacts 8 2 34 min

Question 1

Embalming today for two primary reasons:

Answer 1

Adequate time between death and burial to observe social customs: visitations and
funeral services
o Prevent the spread of infection

Question 2

Embalming fluids

Answer 2

Embalming fluids US Civil War era contained large quantities of arsenic
o Impossible to prove individual died from arsenic
o No longer used
 Switch to modern day “fluids”
o Mixture of numerous compounds

Question 3

Arterial Embalming

Answer 3

Embalming by arterial injection began in the UK in 18 th century
o Century earlier – technique developed by William Harvey in experiments leading
to the discovery of the circulation of blood
 Injected colored solutions into arteries of cadavers
 William Hunter is credited with being the first to report on full arterial and
cavity embalming as a mechanism to preserve bodies

Question 4

Mrs. Martin Van Butchell

Answer 4

Martin van Butchell was an eccentric London dentist, requested William Hunter and
William Cruikshank [his teachers of anatomy and surgery] to embalm the body of his
wife [1775]
o Rumors suggested there was a clause in his marriage settlement that allowed him
access and use of her property and fortune only while she remained above ground,
or maybe it was an extreme publicity stunt
o To meet condition, he had her embalmed, placed her in a fashionably dressed
body in a glass-lidded case in a sitting room and held regular visiting/office hours

Question 5

Embalming process

Answer 5

Modern embalming consists primarily of removing blood and gases from body and
insertion of disinfecting fluid
o Incisions in carotid, subclavian or removal artery and jugular or femoral vein;
fluid injected [under pressure] through artery, and blood drained from vein

 Goal is to have embalming fluid permeate the tissues for preservation

Question 6

Cavity

Answer 6

Autopsy performed; organ removed, immersed in the embalming fluid replaced in the body, often surrounded by a preservative powder
Autopsy not performed; fluids aspirated out of the body cavity by making incision near navel and aspirating bodily fluid-infusing embalming fluid
Trocar
Most descendants in USA and canada are embalmed, though not required by law in most cases

Question 7

four major types of preservatives in embalming fluids

Answer 7

aldehydes
o alcohols
o phenols
o formaldehyde “donor” compounds
 formaldehyde most widely used preservative chemical

Question 8

Major source of formaldehyde

Answer 8

aqueous soln containing 37% HCHO gas by wt called formalin

Question 9

methanediol or methylene glycol

Answer 9

Gases mixed w/H2O most converted to formaldehyde monohydrate
Formaldehyde has a strong tendency to polymerize so methanol added as antipolymerize

Question 10

Mechanism of action

Answer 10

Inactivates reactive chemical groups of proteins or amino acids
 Nitrogen in proteins are potential site of decomposition
 Cross-linking reduces decomposition
o Accomplished by donation of a methylene [CH2] group

Question 11

Components

Answer 11

In addition to formaldehyde is aqueous mixture
Various alcohols: MeOH,EtOH, and IPA
Surfactants: Sulfonates, sodium lauryl sulfate
Chelating Agents: EDTA
Dyes: Eosin [yellowish-orange], erythrosin [red] and ponceau redd
Deodorants: eugenol derivatives, Safrole derivatives.
Disinfectants: Sulfanil

Question 12

Exhumations

Answer 12

Exhumations are preformed in some death investigations:
o Incomplete
o Suspicions of foul play raised after burial
 Toxicologically challenging
o Analytical
o Interpretation
 Question: will drugs be detected?

Question 13

Challenges

Answer 13

Dilutional effects and recovery, chemical interferences, chemical reactions
Dilutional effects and recovery
Potential dehydration-quantitative impact
Cingolani found no appreciable difference in tissue weight
Decreased extraction efficiency from tissues
Fentanyl liver decrease 26%
Extraction of target analyte into formalin
Histology specimens

Question 14

Chemical addition or interferences

Answer 14

Target analyte in embalming fluid
 Alcohol(s)
o Multiple violate components of embalming fluid
 Chromatographic interference with target analyte
 Target analyte in embalming fluid

Question 15

Chemical interferences
o Alcohol embalming

Answer 15

False positive ethanol
 False positive methanol, isopropanol, and acetone
 Improper conclusions
 Ethyl alcohol intoxication
 Toxic alcohol intoxication
 Ketosis (acetone)
 Good correlation between pre and post-embalming
 Exception if embalming fluid contain ethyl alcohol

Question 16

Artifactual vitreous methanol conc

Answer 16

50-year-old male died unexpectedly at home
o Autopsy order, embalmed prior to post
o No blood collected, vitreous collected shortly after embalming
o GC analysis demonstrated methanol @ 340 mg/dL
o Suggestive of methanol intoxication
 Whereas COD was aortic dissection
o Following up with FH found embalming fluid contained 9% methanol

Question 17

Vitrous chemistries
o Sodium and chloride
Embalming

Answer 17

Lower values as compared to pre-embalmed specimens
 Degree of fall erratic
 Not related to times of embalming or obtaining second specimen

Question 18

Vitreous Chemistries– Embalming
Urea nitrogen and glucose

Answer 18

Urea nitrogen some fall [dilutional effect] did not preclude Dx of uremia
[still significant elevation]
 Glucose in out of control diabetics still remained elevated
 Ketosis problematic many embalming fluids contain acetone

Question 19

Volatile Compounds–embalming

Answer 19

Takayasu et al (1994) studied detectability of volatile compounds in formalin-fixed tissue
 You can detect other volatile compounds in vitreous fluid, caveat is you cant tell if its
from embalming fluid or volatile substances

Question 20

Chemical Interferents

Answer 20

Winek et al (1988) describes death due to ethchlorvynol [Placidyl]
 54 year old female died at home, physician husband, signed D/C as CVA/natural and
body was embalming
 Given Hx of various medical problems, conflict between treating physicians and husband
with associated drug abuse, coroner ordered autopsy 52 hours post-embalming
 Ethchlorvynol was qualitatively identified
 Initial quantitative procedure gave questionable conc due to interfering compound from
embalming fluid
 Standard colorimetric test [diphenylamine-H2SO4] was inconclusive due to the reaction
of the embalming fluid with this reagent

Question 21

Poison Stability in Formalin

Answer 21

Cyanide detection was not possible immediately following the addition of the
formalin
Carboxyhemoglobin was difficult to detect after one week
H2C=O → HCN—> H-C=O-CN

Question 22

Formalin-blood solutions

Answer 22

Diazepam and phenytoin loss

Question 23

Formalin-fixed liver tissue

Answer 23

Phenobarbital and desipramiine sig. loss
phenytoin little change

Question 24

Embalming-benzo

Answer 24

Tracy et al (2001)

o Evaluated effects of formaldehyde on 10 benzos in aqueous soln
o Exposed to various conc of formaldehyde and pH
o Decomposition rates of all but one drug were accelerated

Decomp rates of all but one drug were accelerated by formaldehyde and in many cases rxn was pH dependent

Question 25

Stability of TCAs in Formalin Solutions

Answer 25

Parent drug to metabolite ratio is generally >2 in acute tricyclic antidepressant OD
Lesser drug/metabolite ratios suggest a more distant exposure
Changes in ratios could be problematic
Nortriptyline and amitriptyline
Formaldehyde methylating primary amines to secondary amines which could be parent or other metab.

Question 26

In Vitro Reaction of Barbiturates with Formaldehyde

Answer 26

Barbs quite stable
 After death, body begins gradual process of decay and breakdown
 Initially

Question 27

Stability in Fixed Tissues and Formalin

Answer 27

Cingolani et al (2005) studied stability of phenobarbital and butalbital in fixed liver for 6
months

Question 28

Decomposition of Opiates in the Presence of Formaldehyde

Answer 28

oxycodone - most rapid decomp
Hydromorphone-rapid and morphine significant decomp
Codeine, meperidine and pentazocine

Question 29

Heroin after embalming

Answer 29

Described case of 30 yr french male died of heroin OD and died in Thailand
Embalmed and repatriated to France for autopsy
No anatomical cause of death
Toxicological analyses performed on bile and liver
Codeine and morphine detected and 6-AM was not detected
Hair analysis demonstrated the presence of codeine, morphine, and 6-AM

Question 30

Cocaine after embalming

Answer 30

In biological specimens complicated by instability
In vitro and in vivo hydrolysis
Cholinesterase mediated hydrolysis
Only benzoylecgonine was detected in fixed liver and formalin soln.