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

Heß, Cornelius; Mußhoff, Frank; Madea, Burkhard

doi:10.1007/s00414-010-0509-6

Cited by 59 publications

(50 citation statements)

References 82 publications

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“…This results in further mobilisation of liver glycogen and the release of glucose into blood circulation as a counterbalancing phenomenon. Considering the difficulty in interpreting postmortem blood glucose levels, other biological fluids, such as vitreous humor and cerebrospinal fluid, have been proposed in order to estimate the antemortem blood glucose concentrations [1,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Glucose Metabolismmentioning

confidence: 99%

“…The number of substances that may be used for diagnostic purposes in forensic routine has increased significantly, though some studies have put back into question the usefulness of other molecules that are no longer systematically used. Postmortem determinations of a wide variety of substances are now technically possible in many biological fluids, including blood, vitreous humor, urine, cerebrospinal, pericardial and synovial fluids [2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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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: Glucose Metabolismmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postmortem chemistry update part I

2011

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“…In many cases, the forensic pathologist may not be able to demonstrate unequivocal biochemical or histological proof for hyperglycaemia or hypoglycaemia [1]. The present part of the review continues source [2] and describes chromatographic methods for the determination of human and synthetic insulins, C-peptide, proinsulin and ketone bodies in specialized (forensic) laboratories.…”

Section: Introductionmentioning

confidence: 97%

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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“…Thus, vitreous glucose concentration (individually considered) has been proposed to be the most reliable marker to estimate antemortem blood glucose levels. However, in a review of the literature concerning glucose metabolism disorders and postmortem biochemistry, Hess et al [14] reasserted the postmortem biochemical evaluation of glucose metabolism based on the combination of glucose and lactate concentrations, especially when the analyses are performed in the vitreous humor.…”

Section: Introductionmentioning

confidence: 99%

Is the formula of Traub still up to date in antemortem blood glucose level estimation?

et al. 2012

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According to the hypothesis of Traub, also known as the 'formula of Traub', postmortem values of glucose and lactate found in the cerebrospinal fluid or vitreous humor are considered indicators of antemortem blood glucose levels. However, because the lactate concentration increases in the vitreous and cerebrospinal fluid after death, some authors postulated that using the sum value to estimate antemortem blood glucose levels could lead to an overestimation of the cases of glucose metabolic disorders with fatal outcomes, such as diabetic ketoacidosis. The aim of our study, performed on 470 consecutive forensic cases, was to ascertain the advantages of the sum value to estimate antemortem blood glucose concentrations and, consequently, to rule out fatal diabetic ketoacidosis as the cause of death. Other biochemical parameters, such as blood 3-beta-hydroxybutyrate, acetoacetate, acetone, glycated haemoglobin and urine glucose levels, were also determined. In addition, postmortem native CT scan, autopsy, histology, neuropathology and toxicology were performed to confirm diabetic ketoacidosis as the cause of death.According to our results, the sum value does not add any further information for the estimation of antemortem blood glucose concentration. The vitreous glucose concentration appears to be the most reliable marker to estimate antemortem hyperglycaemia and, along with the determination of other biochemical markers (such as blood acetone and 3-betahydroxybutyrate, urine glucose and glycated haemoglobin), to confirm diabetic ketoacidosis as the cause of death.

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

Cited by 59 publications

References 82 publications

Postmortem chemistry update part I

Postmortem chemistry update part I

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

Is the formula of Traub still up to date in antemortem blood glucose level estimation?

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