Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 133–135 | Cite as

Lethal carbon monoxide toxicity in a concrete shower unit

  • Karen Heath
  • Roger W. ByardEmail author
Images in Forensics


A 47-year-old previously-well woman was found dead on the floor of a shower cubicle on a property in rural South Australia. The impression of the attending doctor and police was of collapse due to natural disease. Although there was significant stenosing coronary artery atherosclerosis found at autopsy, cherry pink discoloration of tissues prompted measurement of the blood carboxyhemoglobin level which was found to be 55%. The source of the gas was a poorly-maintained hot water heater that was mounted on the inside wall of the shower. Construction of the shower using an impermeable concrete rain water tank had caused gas accumulation when the water heater malfunctioned. Had lethal carbon monoxide exposure not been identified others using the same shower unit would also have been at risk.


Carbon monoxide Asphyxia Shower Gas water heater Malfunction 


Compliance with ethical standards

Ethical approval

This paper was approved by Forensic Science SA.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Dueñas-Laita A, Ruiz-Mambrilla M, Gandía F, et al. Epidemiology of acute carbon monoxide poisoning in a Spanish region. J Toxicol Clin Toxicol. 2001;39:53–7.CrossRefGoogle Scholar
  2. 2.
    Blumenthal I. Carbon monoxide poisoning. J R Soc Med. 2001;94:270–2.CrossRefGoogle Scholar
  3. 3.
    Walker E. Carbon monoxide poisoning is still an underrecognised problem. Br Med J. 1999;319:1082–3.CrossRefGoogle Scholar
  4. 4.
    Mohankumar TS, Kanchan T, Pinakini KS, et al. Gas geyser – a cause of fatal domestic carbon monoxide poisoning. J Forensic Legal Med. 2012;19:490–3.CrossRefGoogle Scholar
  5. 5.
    Byard RW. Issues in the classification and pathological diagnosis of asphyxia. Aust J Forensic Sci. 2011;43:27–38.CrossRefGoogle Scholar
  6. 6.
    Sedda AF, Rossi G. Death scene evaluation in a case of fatal accidental carbon monoxide toxicity. Forensic Sci Int. 2006;164:164–7.CrossRefGoogle Scholar
  7. 7.
    Nielsen H, Johannessen AC. Carbon monoxide poisoning due to lack of maintenance of a natural gas boiler. Ugeskr Laeger. 1994;156:322–3.PubMedGoogle Scholar
  8. 8.
    Jørgensen PH, Lings S. Carbon monoxide poisoning from a natural gas burner. Ugeskr Laeger. 1995;157:2452–3.PubMedGoogle Scholar
  9. 9.
    Dong LM, Zhao H, Zhang MC, He M. Poisoning by exhaust gas of the imperfect combustion of natural gas: 22 cases study. Fa Yi Xue Za Zhi. 2014;30:352–4.PubMedGoogle Scholar
  10. 10.
    Risser D, Bönsch A, Schneider B. Should coroners be able to recognize unintentional carbon monoxide-related deaths immediately at the death scene? J Forensic Sci. 1995;40:596–8.PubMedGoogle Scholar
  11. 11.
    Langlois NEI. Digital image analysis of fingernail colour in cadavers comparing carbon monoxide poisoning to controls. Forensic Sci Med Pathol. 2010;6:9–12.CrossRefGoogle Scholar
  12. 12.
    Thomsen JL, Kardel T. Intoxication at home due to carbon monoxide production from gas water heaters. Forensic Sci Int. 1988;36:69–72.CrossRefGoogle Scholar
  13. 13.
    Chong CK, Senan P, Kumar GV. Carbon monoxide poisoning from gas water heater installed and operated in the bathroom. Med J Malaysia. 1997;52:169–71.PubMedGoogle Scholar
  14. 14.
    Breindl D, Pollak S. A gas water heater as a means of suicide. Beitr Gerichtl Med. 1989;47:649–55.PubMedGoogle Scholar
  15. 15.
    Risser D, Schneider B. Carbon monoxide-related deaths from 1984 to 1993 in Vienna, Austria. J Forensic Sci. 1995;40:368–71.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Forensic Science SAAdelaideAustralia
  2. 2.School of MedicineUniversity of AdelaideAdelaideAustralia
  3. 3.School of Health SciencesThe University of AdelaideAdelaideAustralia

Personalised recommendations