Forensic Science, Medicine, and Pathology

, Volume 10, Issue 3, pp 390–394 | Cite as

Forensic aspects of carbon monoxide poisoning by charcoal burning in Denmark, 2008–2012: an autopsy based study

  • Pia Rude Nielsen
  • Alexandra Gheorghe
  • Niels Lynnerup
Original Article


Carbon monoxide (CO) inhalation is a well-known method of committing suicide. There has been a drastic increase in suicide by inhalation of CO, produced from burning charcoal, in some parts of Asia, and a few studies have reported an increased number of these deaths in Europe. CO-related deaths caused by charcoal burning have, to our knowledge, not been recorded in the Danish population before. In this retrospective study we present all autopsied cases of CO poisoning caused by charcoal burning in the period 2008–2012. 19 autopsied cases were identified, comprising 11 suicides, 4 accidents, and 2 cases of maternal/paternal filicide-suicide. The mean age of decedents was 38.2 years and the majority of the decedents were men. In 16 cases carboxyhemoglobin levels were above 50 % and in 14 cases we found distinctive cherry red livor mortis. Various concentrations of ethanol and drugs were found in 9 cases. Data suggest that this method of death has increased significantly in Denmark. Therefore, it is highly relevant to draw attention to the subject, to increase awareness as well as prevent future escalation.


Carbon monoxide poisoning Suicide Maternal/paternal filicide-suicide Charcoal burning Disposable charcoal barbeques 



We wish to thank Asser Hedegaard Thomsen, MD, at the Department of Forensic Medicine Aarhus and Peter Thiis Knudsen, MD at the Department of Forensic Medicine Odense for their assistance in data collecting. The authors would also like to thank forensic toxicologist at the three Departments of Forensic Medicine in Denmark.


  1. 1.
    Goldstein M. Carbon monoxide poisoning. J Emerg Nurs. 2008;34:538–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. J Neurol Sci. 2007;262:122–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Labercke PJ, Bock H, Dittmann V, Hausmann R. Forensic and psychiatric aspects of joint suicide with carbon monoxide. Forensic Sci Med Pathol. 2011;7:341–3.CrossRefGoogle Scholar
  4. 4.
    Sarchiapone M, Mandelli L, Iosue M, Andrisano C, Roy A. Controlling access to suicide means. Int J Environ Res Public Health. 2011;8:4550–62.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Nordentoft M, Qin P, Helweg-Larsen K, Juel K. Restriction in means for suicide: an effective tool in preventing suicide. Suicide Life Threat Behav. 2007;37:688–97.PubMedCrossRefGoogle Scholar
  6. 6.
    Kreitman N. The coal gas story. United Kingdom suicide rates 1960–71. Br J Prev Soc Med. 1976;30:86–93.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Skilling GD, Sclare PD, Watt SJ, Fielding S. The effect of catalytic converter legislation on suicide rates in Grampian and Scotland, 1980–2003. Scott Med J. 2008;53(4):3–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Shelef M. Unanticipated benefits of automotive emission control: reduction in fatalities by motor vehicle exhaust gas. Sci Total Environ. 1994;146–147:93–101.PubMedCrossRefGoogle Scholar
  9. 9.
    Law CK, Yip PSF, Caine ED. The contribution of charcoal burning to the rise and decline of suicides in Hong Kong from 1997–2007. Soc Psychiatry Psychiatr Epidemiol. 2011;46:797–803.PubMedCrossRefGoogle Scholar
  10. 10.
    Lin JJ, Chang SS, Lu TH. The leading methods of suicide in Taiwan, 2002–2008. BMC Public Health. 2010;10:480.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Liu KY, Beautris A, Caine E, Chan K, Chao A, Conwell Y, et al. Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates. J Epidemiol Community Health. 2007;61:248–53.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Wu KC, Chen YY, Yip PS. Suicide methods in Asia: implications in suicide prevention. Int J Environ Res Public Health. 2012;9:1135–58.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Chung WS, Leung CM. Carbon monoxide poisoning as a new method of suicide in Hong Kong. Psychiatr Serv. 2001;52:836–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Pan YJ, Liao SC, Lee MB. Suicide by charcoal burning in Taiwan, 1995–2006. J Affect Disord. 2009;120:254–7.CrossRefGoogle Scholar
  15. 15.
    Chen YY, Bennewith O, Hawton K, Simkin S, Cooper J, Kapur N, Gunnell D. Suicide by burning barbecue charcoal in England. J Public Health (Oxf). 2013;35(2):223–7.CrossRefGoogle Scholar
  16. 16.
    Lyness JR, Crane J. Carbon monoxide poisoning from disposable charcoal barbeques. Am J Forensic Med Pathol. 2011;32:251–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Brooks-Lim EWL, Sadler DW. Suicide by burning barbeque charcoal: three case reports. Med Sci Law. 2009;49:301–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Hampson NB, Hauff NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26:665–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Bureau S, Vandenbergh L, Ueberberg A. Carbon monoxide poisoning. In: Saukko P, Knight B, editors. Knights forensic pathology. 3rd ed. London: Arnold; 2004. p. 563.Google Scholar
  20. 20.
    Yoshioka E, Hanley SJ, Kawanishi Y, Saijo Y. Epidemic of charcoal burning suicide in Japan. Br J Psychiatry. 2014;204:274–82.PubMedCrossRefGoogle Scholar
  21. 21.
    Lin C, Yen TH, Juang YY, Leong WC, Hung HM, Ku CH, et al. Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: a 10-year study in a general hospital in Taiwan. Gen Hosp Psychiatry. 2012;34:552–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Lee ACW, Ou Y, Lam SY, So KT, Kam CW. Non-accidental carbon monoxide poisoning from burning charcoal in attempted combined homicide-suicide. J Paediatr Child Health. 2002;38:465–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Pan YJ, Lee MB. Charcoal burning and maternal filicide-suicide trends in Taiwan: the impact of accessibility of lethal methods. J Formos Med Assoc. 2008;107:811–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Findlay GH. Carbon monoxide poisoning: optics and histology of skin and blood. Br J Dermatol. 1988;1:45–51.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Pia Rude Nielsen
    • 1
  • Alexandra Gheorghe
    • 1
  • Niels Lynnerup
    • 1
    • 2
  1. 1.Department of Forensic Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  2. 2.Laboratory of Biological Anthropology, Department of Forensic Medicine, Faculty of Health Sciences, The Panum InstituteUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations