Forensic medical examination in the case of suspicion of inappropriate provision of toxicological care (a case from practice)

As an example of practical observation, the basic principles of the forensic medical assessment of the therapeutic and diagnostic processes are demonstrated in the case of suspicion of improper provision of toxicological care in the case of ethylene glycol poisoning. This study highlighted the factors hindering the provision of toxicological care and its forensic assessment.

Factors such as the lack of information from eyewitnesses or the patient himself about the oral intake of a liquid with potentially toxic properties and the possibility of reliably establishing the presence of ethylene glycol in the body only by chemical and toxicological examination can hinder toxicological care and its forensic assessment. Toxicological care, including antidote therapy with ethanol, can and should be used only if there is reliable information or if there is a sufficient possibility of assuming poisoning with ethylene glycol. Owing to the instability of hemodynamic parameters, which are inevitable with oral poisoning with ethylene glycol, the risk of natural complications during the transportation of the patient is obviously higher than when he is left in a specialized hospital with high-tech equipment and round-the-clock supervision.

Cases of ethylene glycol poisoning, in which treatment does not bring improvements to the patient or at least stability of dynamics, do not automatically indicate that the medical care provided was inappropriate (incorrect). In acute oral poisoning with ethylene glycol, even proper medical care does not guarantee the prevention of a fatal outcome.