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Category Archives: Q&A

Q and A: Will Ingestion of Bee Venom Kill Someone Who Is Allergic to Bees?

Q: If a person is allergic to bee venom and the venom is ingested, would the person be likely to die? Would the venom show up on a tox screen at autopsy?

Bee-apis

A: Bee venom is a protein toxin and would be digested by the acids in the stomach if swallowed. And once digested it would not likely cause an allergic reaction. However, an allergic reaction would happen once the venom contacted the buccal mucosa—big word for the lining of the mouth. This could cause an anaphylactic reaction and kill the victim.

Anaphylaxis is a rapid allergic reaction to some antigen. These antigens are typically foods, drugs, or insect venoms. Common foods are peanuts and shellfish; common drugs are penicillin and iodine, which is found in many radiographic dyes; and common insects are bees as in your story. There a myriad other foods, drugs, and bugs that can cause anaphylaxis in the allergic person.

This rapid immune (or allergic) reaction involves antigens (the food, drug, the bee venom, etc.) and antibodies, which are manufactured by the body and react to the specific antigen that they are directed against. This reaction is a critical part of our defense against bacteria and viruses. The body recognizes the antigen (virus, let’s say) as foreign and builds antibodies that will recognize and attach to the virus. This reaction attracts white blood cells (WBCs), which release chemicals that kill or harm the virus, which is then consumed by the WBCs and destroyed.  This process is essential for each of us to survive in our bacteria and virus-filled world.

But, in allergic individuals, this reaction is rapid and massive and causes a release of large amounts of the chemicals from the WBCs and it is these chemicals that cause the problems. They cause dilatation (opening up) of the blood vessels, which leads to a drop in blood pressure (BP) and shock. They cause the bronchial tubes (airways) to constrict (narrow severely), which leads to shortness of breath, wheezing, and cough. This is basically a severe asthmatic attack and prevents adequate air intake and the oxygen level in the blood drops rapidly. The chemicals also cause what is known as capillary leak. This means that the tiny microscopic blood vessels in the tissues begin to leak fluids into the tissues. This leads to swelling and various skin lesions such as a red rash, hives (actually these are called bullae and are fluid-filled, blister-like areas), and what are called wheel-and-flare lesions (pale areas surrounded by a reddish ring). These are also called Target Lesions because they look like targets with a pale center and red ring.

In the lungs this capillary leaking causes swelling of the airways, which along with the constriction of the airways, prevents air intake. In the tissues it causes swelling of the hands, face, eyes, and lips. The net result of an anaphylactic reaction is a dramatic fall in BP, severe wheezing, swelling and hives, shock (basically respiratory and cardiac failure), and death.

Usually anaphylaxis onsets within minutes (10 to 20) after contact with the chemical, but sometimes, particularly with ingested foods, it may be delayed for hours—even up to 24 hours. With a bee sting it would begin in a matter of minutes. Bee venom in the mouth might take only a few minutes to instigate the reaction.

Your victim would suffer swelling of the tongue and face—particularly of the lips and around the eyes—as well as swelling of his hands. Hives and wheel-and-flare lesions would pop out over the skin. He would begin to gasp for breath and develop progressively louder wheezing. As the oxygen content of his blood began to drop he would appear bluish around his lips, ears, fingers, and toes. This would progress until his skin was dusky blue. He would sweat, weaken, and finally when his BP dropped far enough would lose consciousness, lapse into a coma and die. Unless treatment was swift and effect that is.

Untreated anaphylaxis leads to shock and death in anywhere from a very few minutes to an hour or more, depending upon the severity of the reaction and the overall health of the victim. Treatment consists of blood pressure (BP) and respiratory support, while giving drugs that counter the allergic reaction. BP support may come from intravenous (IV) drips of drugs called vasopressors. The most common would be Dopamine, Dobutamine, epinephrine, and neosynephrine. Respiratory support may require the placement of an endotracheal (ET) tube and artificial ventilation. The victim would then be given epinephrine IV or subcutaneously (SubQ) and IV Benadryl and steroids. Common steroids would be Medrol, Solumedrol, and Decadron. These drugs work at different areas of the overall allergic reaction and reverse many of its consequences. The victim could survive with these interventions. Or not. Your call.

If you decide that your victim will die, then at autopsy, the findings are non-specific. That is, they are not absolutely diagnostic that an anaphylactic reaction occurred. The ME would expect to find swelling of the throat and airways and perhaps fluid in the lungs (pulmonary edema) and maybe some bleeding in the lungs. He may also find some congestion of the internal organs such as the liver. He must however couple these findings with a history of the individual having eaten a certain food, having ingested or being given a certain drug, or having receives an insect bite or sting and then developing symptoms and signs consistent with anaphylaxis. And in the case of insects, such as the bee you are using, he may be able to find antibodies to the insect’s venom in the victim’s blood. Maybe not. So you can have it either way—yes he finds the antibodies or no he doesn’t.

Originally published in the October, 2014 issue of Suspense Magazine

 
6 Comments

Posted by on December 14, 2014 in Medical Issues, Poisons & Drugs, Q&A

 

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

Q and A: What Would My Victim of Scaphism Look Like After Two Weeks in a Pond?

Q: My question is what would a corpse be like, a victim of scaphism and encased in leather with only the head, hands and feet protruding, discovered after about two weeks in a stagnant pond in summer in England.

Alicat

 

Scaphism

 

A: This is a very complex situation which means that almost anything can happen. Particularly in face of your killer employing scaphism in your poor victim’s ordeal. There are many forces in this circumstance conspiring to destroy the body. After two weeks the decay process would be well along and the body should be swollen and discolored and there might already be some sloughing of tissues, particularly in the hands and the feet so that the fingernails and toenails might have slipped away. The leather binding might lessen the degree of abdominal swelling but maybe not.

Or the decay might be a little less and the body might appear only slightly swollen and discolored. Either is possible. When you add the insects and marine predators such as fish to the picture, tissue destruction could be significant—-or again very mild. Once the body floated or if it were placed on a wooden float of some sort, the insects would easily reach the corpse. These insects prefer warmer and moister areas so they tend to accumulate around the eyes, nose, mouth, groin, and any wounds such as an open abdomen or a stab wound.

Their activity could be significant or minimal, often depending on the weather. If it has rained a lot or if it is windy or if there has been a great deal of fog, insect activity would be diminished as insects do not like these conditions. But, i the weather was warm and sunny, they would be more active. Often when the medical examiner is determining the time of death in bodies that are several weeks old, he will consult a forensic climatologist to assess the weather effects in play and from this make his best guess as to insect activity and this in turn will tell him how long it took for the insects to reach the level of infestation seen. Again is always only his best estimate. And then you throw in predators, both marine and otherwise, and his problems multiply.

At the end of the day, your body would likely have a great deal of decay as described above as well as insect activity. The latter could be everywhere but would be particularly pronounced in the exposed areas where the tissues were easier for the insects to get to. Still they find their way beneath leather bindings and clothing and coverings in order to get to their next meal.

You have a great deal to work with here in that the body can either be slightly or severely decayed and the insect activity can be great or small and anywhere in between. The old adage is that whatever happens, happens. This actually gives you great leeway in how you construct your plot.

 

Q and A: How Could My Character Keep Blood In a Liquid State For Later Consumption?

Q: I have a killer who drinks the blood of his victims. If he wants to bleed out a victim and wind up with blood in his freezer that he can reheat in a Mr. Coffee, I assume he’ll need some sort of anticoagulant. Is that right? Would he have to use it immediately at the murder scene? What would the average person have access to that could serve this purpose, especially if he didn’t preplan his first kill. Better still, is there some way to reconstitute the blood after it coagulates?

Craig Faustus Buck, Sherman Oaks CA

 

LEFT: Clotted and Separated Blood RIGHT: Unclotted Blood

LEFT: Clotted and Separated Blood
RIGHT: Unclotted Blood

 

A: Actually there are several ways to accomplish this. If your killer has access to the victim for several days or weeks prior to the event, he could slip some Coumadin into his food daily for two or three weeks prior to the killing. Coumadin, or warfarin, is an oral anticoagulant that works mostly in the liver to prevent blood clotting. It takes a week or so to build up to levels that would keep the blood liquid.

That might be cumbersome for your story, so there is another choice. Heparin. Heparin should be given intravenously but it works immediately as an anticoagulant. Your killer could inject a large dose of heparin right before the killing. This would of course require that he have full control of the victim or at least convince the victim that the injection was harmless. Either way, if he gave 100,000 to 200,000 units of heparin intravenously the victim’s blood would be anti-coagulated within seconds and he could then bleed him and store the blood as a liquid for an extended period of time.

Lastly, as he drained the blood he could put it into a container that contained EDTA. This is what is used in the blood vials when blood is drawn that needs to be anti-coagulated for certain tests. It’s a white powder that is available from pharmaceutical supply houses. Mixing some of this with the blood would prevent it from coagulating so it could be stored as a liquid.

As far a reconstituting it, once blood clots it immediately begins to separate into the reddish clot and the yellowish serum. Vigorous shaking or running it through a blender could remix the blood, resulting in a red liquid that he could then consume.

 
4 Comments

Posted by on July 18, 2014 in Blood Analysis, Medical Issues, Q&A

 

Q and A: How Would the Time of Death Be Determined in a Corpse Found in Snow?

Q: In my story, the body of a young woman is found by cross-country skiers in high-mountain country. (Average temps in December: 20 degrees/low to 40 degrees/high;  elevation about 9000 ft.) If the person had been dressed in heavy clothes, and the body had been there about 24 hours, would it be completely frozen? Partially? Would there be any way to determine when death had occurred?

MT, Albuquerque, NM

Jack-Frozen

A: The corpse would be at least partially and could be completely frozen–perhaps with some of the deeper internal organs only partially frozen. It depends on the clothing, exposure, moisture, wind, etc. Also the old rule that whatever happens, happens comes into play here. So the freezing could be either complete or partial.

Under these conditions, rigor and lividity would be delayed to an unpredictable degree so these would be very crude indicators and not very useful in determining the time of death (TOD). Body temperature might be more useful—emphasis on might—but this would not be very accurate either. If the core body temp had reached the ambient temperature, this determination is of no use, since once the corpse reaches the ambient temperature it will remain stable at that temperature, making body temperature useless. For example, if the corpse reached the ambient temp after 18 hours then 24 hours would look like 36 or 48 as far as body temp is concerned.

But if the corpse hasn’t reached ambient temperature, core body temp can be used to estimate the TOD. Not very accurately but at least in the ballpark. Under “normal” circumstances, a body loses heat at about 1.5 degrees per hour, but this depends on many variables. Your scenario is definitely not “normal,” so temp would be lost more rapidly. Could be 2 or 3 or 4 degrees per hour if there is wind or cold rain for example. Let’s say the ME found the core temp was 40 with an ambient temp of 30. This means the body is still cooling since it has not yet reached ambient temperature. Let’s also say that in his experience he believes (educated guess at best) the body would lose about 3 degrees per hour under the circumstances he sees at the scene. If so, subtracting the measured corpse temperature (40 degrees) from the normal body temperature (98) and dividing by the rate of loss (3 degrees/hour) would yield the estimated TOD.

The math: 98-40 = 58; 58/3 = 19 hours.

Based on these calculations, your ME might conclude that the death occurred approximately 19 hours earlier, give or take a couple of hours.

Of course the major flaw here is that the actual rate of temperature loss might vary from his estimate so, despite the math, his assessment remains a best guess. He would likely suggest a broad range—maybe saying the TOD was between 16 and 24 hours earlier. That’s really the best he could do.

So your corpse could be partially or completely frozen and the time of death could be difficult to determine. Except for one more trick: stomach contents.

Let’s say the corpse is frozen so that temp, rigor, and lividity are of no help yet it was known that the victim had eaten a certain food at a certain time prior to his disappearance. It takes the stomach 2-3 or so hours to empty after a meal so if the ME found the undigested meal in the victim’s stomach and knew the time of this final meal from witnesses, he could then more accurately place the time of death as within 2-3 hours after that meal. Let’s say he had lunch around noon, went skiing, and was then found dead 24 hours later. If the ME found that last meal still in his stomach he might suggest that the TOD was between 1 and 4 p.m. the day before. This might be your best bet for narrowing down the TOD.

 
 

Q and A: Can My Female Character Cause Her Pregnancy To Become A “Stone Baby” By Shear Will?

Q: I am writing a story about a woman who, through sheer force of will, doesn’t allow her body to complete childbirth. The baby dies and becomes a lithopedia. My questions are:

Will there be bleeding in spite of the labor stopping? What happens to the placenta? Will the body absorb it or will it harden like some kind cocoon? Will the mother lactate? Will it cause the mother pain to carry the stone baby? Will the woman have periods? Is it plausible that the mother’s body will experience contractions years later? Or pains caused by the stone baby that she could believe are contractions? How long does it take the fetus to calcify into the lithopedia?

Nicole Nelson-Hicks, Nashville, TN

A: First of all, there is no way she could stop her pregnancy, labor, or delivery by simple force of will. The body will do what the body does and it will eject the fetus either as a stillbirth or a live child. There is no way to stop this.

Secondly, lithopedia (stone babies—singular lithopedion) tend to occur in abdominal pregnancies as opposed to intrauterine pregnancies, even though it is possible for the fetus to remain within the uterus. Conception actually takes place in the fallopian tube as the egg descends and the sperm rises – at least in most cases. A tubal pregnancy can result where the fetus grows within the fallopian tube and rarely the fertilized egg will escape the end of the fallopian tube and settle within the abdomen. Sometimes the blood supply is established and the child can grow within the abdomen. Rarely to term but it can grow. It would take 12 or so weeks for the fetus to reach a size that would be easily visible.

x-ray

In this situation sometimes the tissues of the dead fetus are not absorbed by the body but rather become walled off with fibrous tissue and this can often then calcify which is where the term stone baby comes from.

Lithopedion

Often the woman will have no knowledge of this whatsoever and women have lived late in life, and indeed very late in life, and not know this has occurred. It is often found on an abdominal x-ray that is taken for some other reason. But she could feel the discomfort or have some sensation of a mass or fullness in her abdomen and it could be discovered as a result of that.

If the pregnancy were outside the uterus and in the abdomen, as is most likely in these exceedingly rare circumstances, she would not lactate because those hormones don’t appear until very late in the pregnancy. She would most likely have normal periods, and could even become pregnant again since the uterus, ovaries, and fallopian tubes would be normal and would continue to function normally.

However, if the fetus remained within the uterus, this could interfere with future pregnancies, though not always. It would be very similar to a woman who had large fibroids, which are muscular masses that develop with in the muscular wall of the uterus and often cause pain and abnormal bleeding. Sometimes normal pregnancies occur despite these and that could be the case here.

It is possible that she could experience discomfort many years later with the fetus being located in either the uterus or the abdomen so that part of your story would work quite well.

In summary, this is an exceedingly rare circumstance and it is nothing that she could force to happen. Most likely it would be with an abdominal pregnancy but it could be an intrauterine pregnancy—though this would be even more rare. If an abdominal pregnancy, she could easily go through life normally and have other children and be completely unaware or she can develop symptoms later as I described above. If the pregnancy were intrauterine, she would likely have more symptoms and more likely be aware that something wasn’t right. But in either circumstance it would be possible for her to have normal periods and even become pregnant again.

 
2 Comments

Posted by on January 28, 2014 in Medical Issues, Q&A

 

Life Imitating Art? Murder or Accident?

It’s been said that art imitates life and that often life imitates art? Is the death of “spy” Gareth Williams a murder or a tragic case of autoerotic asphyxia? Is it a true mystery anticipated by an author’s question?

 

460x

 

The Story:

http://bigstory.ap.org/article/police-spy-bag-probably-died-accident

The Question:

http://writersforensicsblog.wordpress.com/2011/09/18/q-and-a-can-a-murder-be-staged-to-look-like-an-accidental-death-from-autoerotic-asphyxia/

Two other posts on autoerotic asphyxia:

http://writersforensicsblog.wordpress.com/2009/06/02/autoerotic-asphyxia-a-very-bizarre-case/

http://writersforensicsblog.wordpress.com/2009/06/05/autoerotic-asphyxia-redux-david-carradine/

 

 
 
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