embalming artifacts 8 2 34 min Flashcards
Embalming today for two primary reasons:
Adequate time between death and burial to observe social customs: visitations and
funeral services
o Prevent the spread of infection
Embalming fluids
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
Arterial Embalming
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
Mrs. Martin Van Butchell
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
Embalming process
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
Cavity
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
four major types of preservatives in embalming fluids
aldehydes
o alcohols
o phenols
o formaldehyde “donor” compounds
formaldehyde most widely used preservative chemical
Major source of formaldehyde
aqueous soln containing 37% HCHO gas by wt called formalin
methanediol or methylene glycol
Gases mixed w/H2O most converted to formaldehyde monohydrate
Formaldehyde has a strong tendency to polymerize so methanol added as antipolymerize
Mechanism of action
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
Components
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
Exhumations
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?
Challenges
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
Chemical addition or interferences
Target analyte in embalming fluid
Alcohol(s)
o Multiple violate components of embalming fluid
Chromatographic interference with target analyte
Target analyte in embalming fluid
Chemical interferences
o Alcohol embalming
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
Artifactual vitreous methanol conc
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
Vitrous chemistries
o Sodium and chloride
Embalming
Lower values as compared to pre-embalmed specimens
Degree of fall erratic
Not related to times of embalming or obtaining second specimen
Vitreous Chemistries– Embalming
Urea nitrogen and glucose
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
Volatile Compounds–embalming
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
Chemical Interferents
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
Poison Stability in Formalin
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
Formalin-blood solutions
Diazepam and phenytoin loss
Formalin-fixed liver tissue
Phenobarbital and desipramiine sig. loss
phenytoin little change
Embalming-benzo
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
Stability of TCAs in Formalin Solutions
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.
In Vitro Reaction of Barbiturates with Formaldehyde
Barbs quite stable
After death, body begins gradual process of decay and breakdown
Initially
Stability in Fixed Tissues and Formalin
Cingolani et al (2005) studied stability of phenobarbital and butalbital in fixed liver for 6
months
Decomposition of Opiates in the Presence of Formaldehyde
oxycodone - most rapid decomp
Hydromorphone-rapid and morphine significant decomp
Codeine, meperidine and pentazocine
Heroin after embalming
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
Cocaine after embalming
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.
