You\'re working at the medical examiner\'s office at San Mateo County Hospital. It has been a particularly light day, with only 1 homicide and a dead raccoon that you checked over for rabies. The reason didn\'t have rabies, and you\'re ready to go home. Just as you\'re flipping the switch, you get a call from your secretary. We\'ve got a dead kid up here that you\'ll want to look at right away. Might be foul play\". Thinking of your four-year old daughter ting for you at home, you grimace. \"OK, I\'m heading to the morgue. \"Performing autopsies on kids is the least favorite part of your job. But you are paid to solve medical mysteries and it looks like you\'ve got one here. In the morgue, you find the report from the hospital. Glancing over it, you notice a narrative of the girl\'s last hours and read it carefully: At 10AM, mother returns from the store to find girl vomiting, not feeling well, and sleepy. Mother put girl to bed. Ten minutes later, she noticed that the child\'s breathing became irregular and slow. She tried to wake her daughter but was not able to do so. The child became comatose. At noon, the girl was admitted to the hospital, with no heartbeat or spontaneous breathing. A police report states the following: The parents discovered that the girl had been dusting their chickens for miles using Pesens Insect Powder According to the label on the container, Peatens is an insecticide made of 10 g/kg Rotenone and 50 g/kg Sulfur appropriate for external use on dogs, cats. fowl, calves, horses, and goats for the treatment of lice, mites, and fleas. Summary of Autopsy Report: Immediate cause of death hypoxia (lack of oxygen). Tissue sections from kidneys, lungs, thymus, heart show generalized severe necrosis without evidence of inflammation, infection, or neoplasia. (massive cell death). Cellular stains: Diffuse severe mitochondrial damage throughout tissue sections. Special Molecular Analysis of tissues: ATP analysis of heart and kidneys: Reduced levels of ATP within mitochondria. ATP levels in cytoplasm within normal limits. Acetyl-CoA levels within nommal limits. NAD+ levels significantly decreased. NADH levels were significantly elevated. Answer the following questions: What could have been in the RespRog that killed the girl? How could a product normally harmless to humans and pets have killed the girl? What cellular process (processes was impaired? 4. Could NAD supplements or oxygen supplementation saved this girl? Why or Why
answer
1) Rotenone present in the pesticide \"pestene\" killed the girl.
2) The product pestene contains rotenone, which when used cautiously is ineffective on humans. But, since the child was too yound to understand the repercurssions of indiscriinate use. the child might hae ingested or inhaled large quantities of the pesticide, while dusting the chickens. The mean concentration of rotenone in the blood and tissue would have surpassed the prescribed tolerable levels.
3) Rotenone is a potent complex 1 inhibitor of mitochondrial respiratory chain. it impairs the conversion of NADPH to NAD+ and blocks the oxidation of NAD by substrates such as alpha-ketoglutarate, pyruvate and glutamate. it causes severe defects in liver and kidneys and disrubts the mitochondrial membrane permiability.
Therefore the major cellular processes affected are:
a) electron transport chain: (conversion of NADPH to NAD) by NADH dehydrogenase enzyme.
b) regulation of fatty acid synthesis in mitochondria
4) In the initial poisoning stages oxygen supplementation or proper ventilation at the earliest possible stage could have saved the girl. as the main reson for her death and organ failure was hypoxia.
By, the time the girl was brought to the hospital oxygen supplementation could not have save the girl, as, severe metabolic impairment and necrosis of multiple organs could not have been prevented by mere oxygen administration. The child was already comatose and had no spontaneous breathing.
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