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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.

Updated Nov 13, 2026

## Key points

- A full autopsy is the reference standard: it rules out other causes and guides sampling.
- Poisoning findings are usually non-specific; the diagnosis is one of integration.
- Samples taken in life, on admission, are worth more than any postmortem sample.
- Gastric contents: describe smell, colour and any tablet or granule residue, and keep them whole.
- Some poisons (organophosphates, cyanide) can affect staff: protection before opening the body.
- No single figure proves the cause of death; nor does a negative toxicology screen exclude poisoning.

## 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

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

## Related 11

- [Forensic toxicology: which samples and how](https://durgical.com/en/forensic-medicine/forensic-toxicology-which-samples-and-how/)
- [Interpreting postmortem drug levels](https://durgical.com/en/forensic-medicine/interpreting-postmortem-drug-levels/)
- [The medico-legal autopsy: when it is mandatory in Colombia](https://durgical.com/en/forensic-medicine/the-medico-legal-autopsy-when-it-is-mandatory-in-colombia/)
- [The death scene: inspección técnica a cadáver (levantamiento)](https://durgical.com/en/forensic-medicine/the-death-scene-inspeccion-tecnica-a-cadaver/)
- [Cause, mechanism and manner of death](https://durgical.com/en/forensic-medicine/cause-mechanism-and-manner-of-death/)
- [Chain of custody (cadena de custodia) in the hospital or rural post](https://durgical.com/en/forensic-medicine/chain-of-custody-in-the-hospital-or-rural-post/)
- [Pesticide and agricultural chemical deaths](https://durgical.com/en/forensic-medicine/pesticide-and-agricultural-chemical-deaths/)
- [Deaths from medicines](https://durgical.com/en/forensic-medicine/deaths-from-medicines/)
- [Deaths from illicit drugs](https://durgical.com/en/forensic-medicine/deaths-from-illicit-drugs/)
- [Corrosives, metals, cyanide and toxic alcohols](https://durgical.com/en/forensic-medicine/corrosives-metals-cyanide-and-toxic-alcohols/)
- [Solvent and inhalant deaths](https://durgical.com/en/forensic-medicine/solvent-and-inhalant-deaths/)

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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](https://pmc.ncbi.nlm.nih.gov/articles/PMC9024928/) (Toxics, 2022); [Recommendations for the investigation, diagnosis, and certification of deaths related to opioid drugs (NAME and ACMT position paper)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3951636/) (Journal of Medical Toxicology, 2014); [Postmortem redistribution of drugs: a literature review](https://pmc.ncbi.nlm.nih.gov/articles/PMC11790690/) (Forensic Science, Medicine and Pathology, 2024); [Acute Organophosphate Poisoning Case Review With Consideration of Off-Gassing During Postmortem Examination](https://pmc.ncbi.nlm.nih.gov/articles/PMC10662577/) (The American Journal of Forensic Medicine and Pathology, 2023); [Protocolo de vigilancia en salud pública: intoxicaciones agudas por sustancias químicas (código 365, versión 07)](https://www.ins.gov.co/buscador-eventos/Lineamientos/Pro_Intoxicaciones%20agudas%20por%20sustancias%20qu%C3%ADmicas%202024.pdf) (Instituto Nacional de Salud, 2024).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/the-autopsy-in-a-suspected-poisoning/