Insulin injection sites: morphology and immunohistochemistry

Lutz, Rainer; Pedal, I; Wetzel, Cornelia; Mattern, Rainer

doi:10.1016/s0379-0738(97)00153-9

Cited by 29 publications

(13 citation statements)

References 12 publications

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“…The scarce subcutaneous fatty tissue did not allow for histological examination in this case. In both cases, the blood morphine levels were of the same magnitude as the concentrations reported in published fatal cases, although at the lower end of the distribution range for case 1 [3,6,10,19,20]. With a blood alcohol concentration of 0.18 g/dL, however, this case fits the curve of combination intoxications presented by Ruttenber et al [17].…”

Section: Discussionsupporting

confidence: 75%

“…However, the elevated codeine concentration in the heart blood in case 1 is somewhat puzzling. It might be explained by a postmortem redistribution [7,[9][10][11]24], although this phenomenon should also be expected for morphine and 6-acetyl-morphine. A separate intake at an earlier date or a chronic abuse constitute other possible explanations.…”

Section: Discussionmentioning

confidence: 94%

“…Collection of tissue specimens from injection marks and of control tissue samples has been recommended to establish the injection site [27], but we have failed to find any reports where analysis of such material has been used for this purpose except for insulin poisonings, where the objective has been to restricted to qualitative detection of exogenous insulin [28,29]. Although Goldenberger et al [7] presented tissue concentrations of morphine, 6-acetylmorphine and heroin in tissue from one injection mark, they did not comment on this further and the appearance of the injection site, as to extent and age of the bleeding, was not reported.…”

Section: Discussionmentioning

confidence: 99%

“…The extensive variation in concentrations found in deaths attributed to heroin intoxication may be explained by differences in samples used (e.g. central vs peripheral blood) [7,[9][10][11], differences in tolerance [5,12,13] and the time interval between injection and death [5,6,11,[14][15][16]. The simple fact that an intentional overdose, when injected, may exceed the fatal dose severalfold will also contribute to the wide interindividual variation in postmortem blood concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Fatal injections of heroin. Interpretation of toxicological findings in multiple specimens

Druid

Holmgren

1998

International Journal of Legal Medicine

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We report two fatalities due to injection of heroin. The first case was witnessed but during the early phase of the police investigation the question was raised whether the injection was self-administered. Multiple samples were collected from different sites and analysed in order to establish drug distribution and to determine the site of injection. Fresh injection marks were found in both antecubital fossae but histological examination failed to settle which one was the last. However, toxicological analysis of the tissues at the injection sites indicated that the injection in the right arm was the last one. This was consistent with the suspicion that the victim was given the injection by another person although probably in agreement with the deceased. In the second case, a similar toxicological procedure was used. This fatality was not witnessed, however ample evidence indicated that it was an isolated event in a former intravenous heroin addict and there was only one fresh injection mark. Even in this case, the concentration of morphine was much higher in the tissue sample from the injection mark than in any of the blood samples.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fatal injections of heroin. Interpretation of toxicological findings in multiple specimens

Druid

Holmgren

1998

International Journal of Legal Medicine

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“…Incomplete, difficult-to-interpret results were obtained. In addition, a successful attempt of immunohistochemical (IHC) detection of insulin in samples taken from the injection sites was made (Figure 4) [21,22]. The results of the tests carried out in the abovementioned clinical laboratories confirmed our previous experience with the low usefulness of insulin determinations in the autopsy hemolyzed blood specimens (article in press).…”

Section: Homicide-suicidesupporting

confidence: 63%

Insulin in Forensic Medicine and Toxicology

Skowronek¹

2019

Ultimate Guide to Insulin

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Today insulin is used not only in medicine in the treatment of diabetes but also in sport as a doping agent and for criminal purposes. Suicides and homicides with insulin maybe are not so common, but are seen in the routine medicolegal and toxicological-clinical practice. Despite the often quite clear circumstances of death and a well-established mechanism of action of insulin and its analogs, it is difficult to analytically confirm its excessive exogenous administration in postmortem biological material. There are no uniform international standards of conduct in such cases, both at the stage of the material sampling during autopsy and forensic laboratory analysis and the final interpretation of the obtained results. The aim of the study is to present the current state of basic knowledge about nonmedical use of insulin, with particular emphasis on the possibility of postmortem diagnosis. The study also highlighted the little known clinical problem of insulin abuse for recreational purposes.

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Murder by insulin: suspected, purported and proven—a review

Marks

2009

Drug Testing and Analysis

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Murder by insulin-whether attempted, suspected or proven-is rare. Only 66 cases worldwide could be found for this review. A conviction was secured in 31 cases and additional weapon was employed in 11. Differentiation of attempted homicide from Munchausen syndrome by proxy in the young and from 'mercy killing' in the elderly was not attempted. Most perpetrators were close relatives and most victims were alive when discovered and responded to treatment. Hypoglycaemia is the first clue to homicidal insulin use in living subjects and requires the demonstration of a plasma insulin concentration of generally more than 1000 pmol/L and undetectable plasma C-peptide concentration to establish the diagnosis. Serum glucose measurements are valueless in victims found dead. The presence near the body of insulin vials, syringes or needles, loose talk by the suspected perpetrator or their ready access to insulin may be the only clue. The demonstration of insulin in tissue around an injection site by immunohistopathology or by measuring it in an extract clinches the diagnosis. Immunoassays suitable for clinical use to detect and measure insulin and C-peptide are subject to random errors and cannot be relied upon unless special precautions including separation by gel filtration or HPLC are undertaken prior to analysis. They do not detect or measure accurately a new generation of synthetic insulin analogues. Mass spectrometry will be required to do this and to validate clinical immunoassays, upon which convictions have always had to rely in the past.

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Insulin injection sites: morphology and immunohistochemistry

Cited by 29 publications

References 12 publications

Fatal injections of heroin. Interpretation of toxicological findings in multiple specimens

Fatal injections of heroin. Interpretation of toxicological findings in multiple specimens

Insulin in Forensic Medicine and Toxicology

Murder by insulin: suspected, purported and proven—a review

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