Recognizing Poisoning
Poisoning may be accidental, suicidal, or homicidal, and the manner of death often depends on toxicological findings. Red flags suggesting poisoning at autopsy include: sudden unexplained death in a previously healthy individual, an unusual odor (almonds suggesting cyanide, garlic suggesting arsenic or organophosphates), severe gastrointestinal inflammation without infectious cause, multiple organ failure, and circumstantial evidence (suspicious substances found at the scene, financial motive, insurance policies). Common homicidal poisons historically include arsenic (tasteless, odorless, mimics natural illness), thallium (causes hair loss and neuropathy), cyanide (blocks cellular respiration), and antifreeze (ethylene glycol—sweet-tasting, metabolized to toxic oxalic acid causing kidney failure). Modern cases increasingly involve prescription medications administered in overdose quantities.