The bizarre death in the couple’s hotel, the forensic doctor revealed the truth of the death…

In a small hotel, a man called 110 and 120 and said he woke up in the morning to find his girlfriend unconscious. When police and doctors arrived, they found the man’s girlfriend dead.

When the police questioned the man, the man also developed dizziness, headache and nausea. The man was then taken to the hospital for treatment.

When investigating the scene, the forensic doctor found that the doors and windows of the scene were closed, the female deceased was lying on the bed wearing pajamas, and there was a small amount of vomit next to the body.

After examination, the female deceased had no trauma. In addition to incontinence, the most unusual thing about her body was that the color of her corpse was close to cherry red.

During the investigation, it was found that a gas water heater was installed in the bathroom of the hotel, but the water heater was turned off.

Is it carbon monoxide poisoning?

The bathroom floor is very dry and shows no signs of showering in a while.

The most strange thing is that in the previous questioning, the man stated that the night before, the two went to bed after eating barbecue, and did not take a bath.

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Could that be food poisoning?

After all, in addition to the bright red corpse spots caused by carbon monoxide poisoning, the cyanide poisoned corpses will also have bright red corpse spots, and it is difficult to distinguish the two from the corpse spots alone.

Just when the forensic doctor was about to return the food residues at the scene to the laboratory, the hospital reported the preliminary test results. The carboxyhemoglobin (COHb) content in the man’s body was 27.5%. The above is in line with the typical manifestations of carbon monoxide poisoning. After hyperbaric oxygen treatment, the symptoms were initially relieved.

The female deceased’s heart blood sample was also sent to the laboratory. After testing, the blood carboxyhemoglobin (COHb) content was 52.6%, and no cyanide was detected.

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Although the evidence points to carbon monoxide poisoning, but it is obvious that there is no water heater to take a bath, why does carbon monoxide poisoning appear?

Forensic doctor Ah Yi came to the scene again to investigate, and found that the room where the poisoned man and woman lived and the next room shared the same gas water heater.

Field experiments found that as long as the next room had hot water, the couple’s in-room water heater would fire. Although the water heater has a strong exhaust pipe, it has been tested that when the doors and windows are closed, the exhaust gas will flow backward in only 20 minutes, and the indoor carbon monoxide content has obviously exceeded the standard.

After investigation, other residents did live next door the night before, and they used the water heater for a long time for many times. The cause and effect of the couple’s carbon monoxide poisoning were revealed.

In winter, gas poisoning is not uncommon. Why is carbon monoxide poisoning frequent in winter?

Carbon monoxide (CO) is a colorless, odorless, non-irritating gas that makes it difficult for people to detect when carbon monoxide is dispersed in the air.

Andcarbon monoxide will replace oxygen and combine with hemoglobin (Hb) in the blood to form carboxyhemoglobin (COHb), which makes the blood lose its ability to transport oxygen, which in turn leads to tissue hypoxia and inhibits cells Breathing, and in severe cases, death[1].

In the early stage of carbon monoxide poisoning, dizziness, headache, nausea, limb weakness and even blurred vision and tinnitus are often seen.

Does this look familiar, and it feels a bit similar to how you behave when you are drunk?

However, unlike the central nervous system depression caused by drunkenness, carbon monoxide poisoning reduces the oxygen content in the blood, which can lead to hypoxic damage to brain tissue [2].

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If at this time, if the poisoning scene is discovered and removed in time, most symptoms will disappear on their own;

If the situation is not detected in time, further symptoms of poisoning may include irritability, rapid heartbeat, unsteady gait, incontinence, confusion, lethargy, seizures;

More severe poisoning will lead to toxic encephalopathy and pulmonary edema, persistent coma, and eventually death due to respiratory and circulatory failure [3].

The symptoms of carbon monoxide poisoning will be significantly relieved in the short term after timely rescue and hyperbaric oxygen treatment, but it should not be taken lightly.

Some people with poisoning experience worsening symptoms days or weeks after symptoms improve. Transient improvement of symptoms is often “deceptive” and is clinically referred to as false convalescence.

After the period of false recovery, the symptoms of poisoned patients suddenly worsened, often manifested as abnormal mental behavior, obvious mental decline, or even dementia, motor incoordination, tremor, increased muscle tone, gait disturbance, and bowel movements. Incontinence, disturbance of consciousness and even coma.

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When these problems arise, the possibility of delayed encephalopathy following carbon monoxide poisoning needs to be considered, a complication of severe white matter damage that is more likely to occur with prolonged and severe carbon monoxide poisoning , untimely treatment, middle-aged and elderly people, and people with underlying intracranial lesions, once they occur, active treatment is required to minimize disability [2,3].

Why is it that in the same room, the man only suffers from discomfort, while the woman causes death? Is there a gender difference in the risk of carbon monoxide poisoning?

There are also many cases of carbon monoxide poisoning in China. Statistics show that under the same poisoning environment, women with mild acute poisoning have a milder degree of poisoning and better prognosis;

But in the case of severe poisoning and even death, women did not show a clear gender advantage. Not only did the studies of severe mortality show no gender differences, but also no significant differences in age were found [3].

In other words,severe carbon monoxide poisoning puts both men, women, and children at the same serious risk of death. Therefore, the prevention of carbon monoxide poisoning is the most critical means to avoid the tragedy.

In 2006, the former Ministry of Health issued the Emergency Plan for Non-occupational Carbon Monoxide Poisoning[4].

The main cause of carbon monoxide poisoning outside the production site is coal-fired heating and coal-fired heating in the north, and the improper use of gas water heaters in the south [5,6] .

In the north, especially in rural areas, when using ordinary simple iron stoves to burn coal, carbon, firewood, etc. for heating in winter, if the doors and windows are tightly closed, it may be caused by insufficient indoor oxygen and poor combustion. Complete and produce carbon monoxide accumulation, leading to carbon monoxide poisoning.

To be safe, we should use safe heating devices, such as heaters, fireplaces, or electric heaters.

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In B&Bs and rentals, it is common to see gas water heaters installed inside bathrooms due to space constraints.

This gas water heater can easily produce a large amount of carbon monoxide when the doors and windows are closed. In winter, due to the cold weather, the bathing time is correspondingly long and the ventilation is insufficient, so there is a risk of poisoning. The bigger is [6].

Therefore, you should avoid installing the gas water heater indoors. If the indoor water heater is installed and cannot be moved, even if there is a strong discharge device, it is recommended to shorten the use time as much as possible, and pay attention when using it. Properly open doors and windows for ventilation.

Carbon monoxide poisoning also occurs from time to time in barbecue and hot pot restaurants that use gas or charcoal fires.

These safety incidents have one thing in common – a lack of indoor exhaust, and closed doors and windows, poor ventilation, and carbon monoxide poisoning.

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If you drink alcohol during meals, it is easy to be ignored because the early symptoms of carbon monoxide poisoning are similar to those of drunkenness, and the best time for treatment is missed.

When a person is exposed to an environment with excessive carbon monoxide, accompanied by alcohol’s inhibition of the central nervous system, it will aggravate hypoxia and cause damage to the whole body, especially the damage to the central nervous system, leading to consciousness Blurredness, cerebral edema, and compensatory respiratory rate increase, the increased respiratory rate leads to increased pulmonary ventilation, further aggravating the degree of carbon monoxide poisoning [5].

In addition, with the popularity of automobiles in the family, the tragedy of carbon monoxide poisoning in automobiles has also occurred frequently.

This situation is mostly due to the fact that the car is in an idling state, or because the exhaust pipe is blocked, the exhaust is not smooth, and the exhaust gas is poured back into the closed car for a long time.

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When the car stops but does not turn off, and the power system is working for a long time, you must pay attention to opening the windows for ventilation to reduce potential risks. If you stay in the car for a long time, the safest option is to stop and turn off the engine.

With the improvement of production technology and the promotion of popular science education, the incidence of carbon monoxide poisoning has generally declined [7,8]. However, the awareness of risk prevention and control needs to keep the alarm bell ringing.

I wish everyone a warm and safe journey through every winter.

Reviewer: Wang Chunxue| Chief Physician, Department of Neuropsychiatry and Clinical Psychology, Beijing Tiantan Hospital


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[3]Hu Huijun. The clinical characteristics of brain injury caused by carbon monoxide poisoning and the protective mechanism of hyperbaric oxygen in improving white matter demyelination[D]. Second Military Medical University, 2017.

[4] Meng Ling, Tu Wenxiao, Wang Dayan, Xie Yiran, Wang Zhe, Xiang Nijuan, Shi Guoqing. Risk assessment of public health emergencies requiring attention in mainland China in November 2020[ J]. Disease Surveillance, 2020, 35(11): 973-976.

[5] Ye Shanshan, Hu Zhuojun, Ruan Hailin, Wang Yao, Deng Wangsheng, Huang Yinghua, Chen Jianbing, Hong Weiliang. Analysis of epidemiological characteristics of patients with non-occupational acute carbon monoxide poisoning in Liuzhou city from 2014 to 2017[ J]. Chinese Disaster Relief Medicine, 2019,7(07):374-379.

[6] Wang Anna, Ji Guoqiang, Shi Wei, Feng Ran. Analysis of non-occupational carbon monoxide poisoning incidents in a suburb of Beijing from 2007 to 2017 [J]. Journal of Preventive Medical Information, 2019, 35(01):95-98.

[7]Martin Janík, Michaela Ublová, tepánka Ku erová, et al. Carbon monoxide-related fatalities: A 60-year single institution experience. 2017, 48:23-29.


[8]Seyed Mohammad Hosseininejad, Hamed Aminiahidashti, Iraj Goli Khatir, et al. Carbon monoxide poisoning in Iran during 1999C2016: A systematic review and meta-analysis. 2018, 53:87-96 .

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