Medico-legal implications of toluene abuse and toxicity. Review of cases along with blood concentrations. (September 2018)

• Record Type: Journal Article
• Authors: Pelletti, Guido; Rossi, Francesca; Garagnani, Marco; Barone, Rossella; Roffi, Raffaella; Pelotti, Susi
• Is Part Of: Legal medicine. Volume 34(2018)
• Page Start: 48
• Page End: 57
• Publication Date: 2018-09
• Subjects: Forensic toxicology -- Forensic pathology -- Toluene exposure -- Toluene related deaths -- Driving impairment; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2018.08.008
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: A review of cases of toluene abuse and intoxication presented in the last 50 years is reported. Only cases with known blood concentration have been included. Toxicological results are reported and discussed in relation to the clinical presentation and/or the manner of death. The relevant forensic issues in the living and in the death subjects are discussed. Abstract: Toluene, a liquid aromatic hydrocarbon, is one of the most widely used industrial solvents, and is present in numerous paints, paint thinners, glues and other industrial and household products. It has become the most abused solvent in the world due to its rapid effects following inhalation. However, the numerous cases of fatal and non-fatal toluene-related intoxication reported in the literature have not yet been collected and discussed in the forensic setting. In this paper we aim to provide a review of the cases of toluene abuse and intoxication and the state of the art of the forensic toxicological analysis of toluene intoxications in the living and in the dead subject, from the early identification to the medico-legal interpretation of the toxicological result. We have identified a total of 45 papers regarding different aspects of toluene abuse, and divided them into three sections, namely sampling, storage and techniques of analysis, assessment in living subjects and post-mortem assessment. This article reports toluene concentrations in blood from 202 living subjects, 23 fatal toluene intoxications and 85 toluene related deaths. Toxicological results are discussed in relation to the clinical presentation (living subjects, including impaired drivers), and the manner of death according to the medical examiner reports (post-mortem examinations). Finally, we discuss the strengths and limitations of the review.