Accidental Insulin Overdose

Batalis, Nick I.; Prahlow, Joseph A.

doi:10.1520/jfs2004059

Cited by 27 publications

(20 citation statements)

References 19 publications

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“…An elevated postmortem serum insulin level, along with a suppressed C peptide level, is virtually diagnostic of an exogenous insulin administration. If an injection site is detected on the body, the excision of the surrounding dermal area should be taken into consideration: toxicological analysis and immunohistochemical demonstration of insulin in the tissues at the injection site should always be performed [73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91].…”

Section: Insulin and C Peptidementioning

confidence: 99%

Postmortem chemistry update part I

2011

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Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.

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Section: Insulin and C Peptidementioning

confidence: 99%

Postmortem chemistry update part I

2011

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“…I/C in a living person is thought to reliably distinguish between hypoglycaemia due to exogenous insulin (I/C>1 meaning high insulin, low Cpeptide which is under the detection limit most of the time [36]) and hypoglycaemia due to an insulinoma or a sulfonylurea overdose [37]. The suppression of C-peptide level is due to a negative feedback system that stops the cleavage of the proinsulin molecule after the detection of the active insulin molecule in bloodstream [38]. Hypoglycaemia caused by oral substances is biochemically indistinguishable from hypoglycaemia caused by an insulinoma.…”

Section: Relevancementioning

confidence: 99%

“…Hypoglycaemia caused by oral substances is biochemically indistinguishable from hypoglycaemia caused by an insulinoma. In both cases, C-peptide levels and insulin levels are increased, the ratio of insulin to C-peptide is <1 (mean value 0.16 [37,39]) and their concentration is 31.66± 17.25 μU/ml [38] (human insulin), 3.44±1.45 μg/l and 7.85±3.21 μg/l (C-peptide) and 15.7±2.3 pmol/l (proinsulin) [39,40]. The diagnosis of insulin-secreting tumours relies mainly on biochemical profile because of their often small size.…”

Section: Relevancementioning

confidence: 99%

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

2010

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In continuation to part I, a literature review is presented concerning biochemical problems of forensic post mortem cases of unclear hyperglycaemia or hypoglycaemia. Clinical parameters for this purpose were recently reviewed. Particular attention was paid to the detection of diabetic ketoacidosis, of hyperosmolar coma, insulinoma, insulin-induced or oral diabetic-induced hypoglycaemia. The second part of the review discusses the analytes ketone bodies, synthetic insulins, human insulin, C-peptide, proinsulin and insulin antibodies. Special interest is given to post mortem matrices for those analytes to reference concentrations, stability data, analytic interferences and analytical procedures which should be used in toxicological laboratories willing to detect diabetic metabolism disorders after death.

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“…When deaths appears to be related to diabetes mellitus [469][470][471], in addition to testing the vitreous for glucose, further relevant information may be obtained by testing the vitreous for the ketone beta-hydroxbutyrate [472] and by measuring blood HbA1c levels (with elevated levels indicating the presence of diabetes mellitus [473][474][475]), as well as analysing for insulin and c-peptide [476,477]. Others have advocated measuring lactate to assist in the establishment of the presence of antemortem hyperglycemia [478].…”

Section: Toxic and Metabolic Causes Of Sudden Deathmentioning

confidence: 99%

Sudden adult death

Langlois

2009

Forensic Sci Med Pathol

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In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.

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Accidental Insulin Overdose

Cited by 27 publications

References 19 publications

Postmortem chemistry update part I

Postmortem chemistry update part I

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

Sudden adult death

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