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The autopsy in a suspected poisoning

  • Procedure

When a poison is suspected, the autopsy joins the scene, the history, the body's findings and the laboratory; none is enough on its own.

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What it is

In a possible poisoning death, the body's findings are usually few and non-specific (pulmonary oedema, congestion, froth in the airway). So the full autopsy does not look only for "the poison": it also rules out other causes (injuries, natural disease), guides which samples to take and allows the toxicology result to be read in context. The final diagnosis brings together five sources: the scene and circumstances, the medical record, the external and internal examination, histology and toxicology. The samples and their handling are covered on the forensic toxicology page; interpreting concentrations, on the postmortem redistribution page.

What to document

  • The circumstances: who found the body, containers, notes, prescriptions, syringes, earlier messages.
  • Positive findings and also the relevant negative ones (for example, no injuries).
  • The appearance, smell and volume of the gastric contents, and whether undissolved tablets or granules were present.
  • Each sample with its exact site, time of sampling and time since death.
  • The protective measures used and any symptoms in staff during the autopsy.
  • The proposed cause, mechanism and manner of death, with their limits.

How it is done

  1. First review the scene report, the medical record and the drugs given during care and resuscitation.
  2. If a volatile poison or a pesticide is suspected, prepare respiratory protection, gloves, ventilation and decontamination.
  3. External exam: pupils, colour of lividity, froth, burns on the lips and mouth, odours, injection sites, stained clothing.
  4. Photograph and describe any containers, wrappers or product residue that arrive with the body.
  5. Full internal exam: airway, lungs, stomach, oesophagus, liver and kidneys; do not stop at the first finding.
  6. Collect all the gastric contents, describe their smell, colour and appearance, and measure the volume.
  7. Take toxicology samples (peripheral blood, heart blood kept apart, vitreous, urine, tissues) and histology samples.
  8. Label, seal and hand over with chain of custody, with a concrete question for the laboratory.
  9. Bring together scene, history, findings, histology and toxicology before concluding cause and manner of death.

Next step: what to do and document

  • If a patient dies after a possible poisoning, keep the admission samples cold and notify the authorities so the case goes to a medico-legal autopsy.
  • Record in the chart the symptoms, the suspected poison, any containers brought by the family and the treatments given, with times.
  • Hand over the containers and product residue as evidence, with chain of custody.
  • Notify the case to Sivigila as an acute chemical poisoning (event 365); the INS protocol states that these deaths go to a medico-legal autopsy.
  • In the report, keep what was observed apart from what is interpreted, and state which results are still pending.

Common mistakes

  • Concluding "poisoning" from the history alone, without a full autopsy or toxicology.
  • Discarding the gastric contents or mixing them with other samples.
  • Opening the stomach without protection when a pesticide or cyanide is suspected.
  • Requesting "full toxicology" without saying what is suspected.
  • Ruling out poisoning because the autopsy "showed nothing".

Test yourself

Think of the answer, then tap the question to see it.

Why is a full autopsy needed even when the history suggests poisoning?

Because poisoning findings are non-specific: the autopsy rules out other causes (injuries, natural disease), guides sampling and gives context to the laboratory result.

Which samples from a poisoned patient who dies in hospital are the most valuable?

The blood and urine taken on admission, before treatment if possible, because they reflect the state in life; they are kept cold and handed over with chain of custody.

What special precaution does the autopsy of a suspected organophosphate death require?

Protecting staff: the body and gastric contents can give off vapours; respiratory and skin protection, adequate ventilation and decontamination are used.

Which five sources are brought together to conclude a poisoning death?

The scene and circumstances, the medical record, the autopsy findings, histology and toxicology.

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Connections

← All of forensic medicine

Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series (Toxics, 2022); Recommendations for the investigation, diagnosis, and certification of deaths related to opioid drugs (NAME and ACMT position paper) (Journal of Medical Toxicology, 2014); Postmortem redistribution of drugs: a literature review (Forensic Science, Medicine and Pathology, 2024); Acute Organophosphate Poisoning Case Review With Consideration of Off-Gassing During Postmortem Examination (The American Journal of Forensic Medicine and Pathology, 2023); Protocolo de vigilancia en salud pública: intoxicaciones agudas por sustancias químicas (código 365, versión 07) (Instituto Nacional de Salud, 2024).

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