Postmortem Analysis of Vitreous Humor For Detection of Antemortem Disorders in Glucose Metabolism. An Old Method Revisited

Holstein, Andreas; Titze, Ulf; Heß, Cornelius

doi:10.1055/a-0752-0028

Cited by 4 publications

(5 citation statements)

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“…This confirms the usefulness of this material in postmortem chemical analysis and the possibility of its use if blood cannot be collected or at the initial stage of decomposition of the corpse. This is in line with previous reports on the usefulness of VH in postmortem diagnosis [2,13,16,28,33,34,[36][37][38][39][40].…”

Section: Discussionsupporting

confidence: 93%

Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions

Nowak

Zawadzki

2020

Diagnostics

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Diabetes mellitus is classified as the epidemic of the 21st century. Due to the fact that acute carbohydrate metabolism disorders usually do not indicate morphological change, postmortem diagnosis is required to perform biochemical tests. The authors decided to evaluate the usefulness of determining glucose, lactate, acetone, β-hydroxybutyric acid (BHB), and 1,5-anhydroglucitol (1,5-AG) in postmortem blood/serum, urine, and vitreous humor (VH). Biological material was collected during autopsies. The study group consisted of 50 diabetics, while the control group consisted of 50 non-diabetics, who died a sudden death, with negative test results for the presence of ethyl alcohol and were not resuscitated before death. Statistical analysis was performed using the IBM SPSS Statistics 25 software package. The most statistically significant difference between the two groups was observed for mean 1,5-AG concentration. The authors found many correlations between the concentration of the examined markers in different materials, mainly between blood/serum and VH. The most suitable short-term glycemic marker in postmortem diagnosis is 1,5-AG. Diagnosis may be supported with determinations of acetone and BHB. For medicolegal assessment, the interpretation of the biochemical test results should comprise information on circumstances of death, medical history, results of other toxicological and histopathological tests, and autopsy report.

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Section: Discussionsupporting

confidence: 93%

Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions

Nowak

Zawadzki

2020

Diagnostics

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“…It was emphasized that glucose level estimations must be made as soon as possible after death to have its high diagnostic validity to determine ante-mortem hyperglycemia otherwise the glycolysis will distort it (Hamilton-Paterson & Johnson, 1940). According to the latest research data, blood glucose level alone does not have high diagnostic value (C. Hess, Stockhausen, Kernbach-Wighton, & Madea, 2015;Holstein et al, 2018). In post-mortem analysis not only blood, but also vitreous fluid and cerebrospinal fluid are often used for glucose concentration examination.…”

Section: Discussionmentioning

confidence: 99%

“…Also, glucose concentration fluctuates in different parts of the body. It is higher in the right side of the heart due to glycogenolysis in the liver after death (Holstein et al, 2018). As we can see, the processes occurring in the human body before and after death can affect the main biochemical markers for diagnosing glucose metabolism disorders.…”

Section: Introductionmentioning

confidence: 95%

“…One glucose molecule is metabolized into two lactate molecules during the pathway of anaerobic glycolysis after death. The decrease of glycaemia in the first hour after death is approximately 13mg/dl whereas lactic acid level in blood increase 10 -15mg/dl/h during the next 10 hours after the death (Holstein, Titze, & Hess, 2018). Moreover, due to neurohormones, such as adrenaline, noradrenaline and dopamine, produced during agonal reactions and/or cardiopulmonary resuscitation previous to death, the liver converts glycogen into glucose and large amounts of glucose are released into the bloodstream (Palmiere & Mangin, 2012).…”

Section: Introductionmentioning

confidence: 99%

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The Post-Mortem Evaluation of Glucose Concentration in Blood and Its Diagnostical Value

Lukočiūtė

Ginčienė²,

Chmieliauskas

et al. 2019

CBUP

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Introduction: Hyperglycemia is a consequence of uncontrolled diabetes and over a long period of time can lead to serious violations of the various systems of the body. In daily clinical practice, glucose level in blood and glycated hemoglobin are major and frequently used worldwide laboratory findings for the diagnosis of glucose metabolism disorders. In forensic medicine, the diagnostic value of post-mortem blood glucose levels is questionable because of its significant and rapid variation after death. Our research was aimed to analyse glucose concentration in blood after death and to estimate its diagnostic value. Methods: Data analysis of the State Forensic Medicine Service (SFMS) of Vilnius region of sudden death cases was performed. 238 autopsy findings were analysed. A retrospective analysis was performed using the R commander program. Results: The analysis included 238 individuals, 161 (67.6%) were men and 77 (32.4%) women. Mean age was 52.28 ± 15.45 yeras. Mean alcohol level in blood was 2.257 ± 1.482 g/L. Mean post-mortem glucose concentration in blood was 6.716 ± 5.800 mmol/l. The lowest glucose concentration was 0.600 mmol/l and the highest - 33.300 mmol/l. There were no significant glycemia level difference between men and women (p = 0.279). In 6 cases, glucose concentrations were compared before and after death. The difference in blood glucose was insignificant (p = 0.90). There was no strong correlation between ethyl alcohol and glucose concentration (r = 0.037, p = 0.667). There was a weak correlation between age and blood glucose concentration (r = 0.03, p = 0.639). Conclusions: According to SFMS autopsy data, post-mortem glucose levels remain within the normal values. Evaluation of glucose after death remains a valuable diagnostic criterion for sudden death due to hyperglycaemia, when the hyperglycaemic episode is first and fatal to the subject.

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“…Vitreous glucose is preferentially used in postmortem biochemistry, as serum glucose decreases to a far greater extent after death due to autolysis and/or microbial metabolism. Moreover, vitreous humor is well protected from contamination due to its isolated location in the eye cavity [6][7][8]. To our knowledge, there is no internationally established range for the normal value of glucose in vitreous humor, but several researchers have investigated when vitreous glucose is considered elevated, and a cut-off value of between 10 and 13 mmol/L is reported [5,6].…”

Section: Diabetic Ketoacidosismentioning

confidence: 99%

Sudden death due to diabetic ketoacidosis following power failure of an insulin pump: Autopsy and pump data

Kjærulff

Astrup

2019

Journal of Forensic and Legal Medicine

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Purpose. To report a case in which autopsy findings and data from an insulin pump illustrate the course up to the death of a 31-year-old man with a history of type 1 diabetes mellitus who was found dead in his apartment with his insulin pump disassembled and placed in another room. Methods. Autopsy findings including histological, toxicological and biochemical examination are presented. Postmortem download of data from the insulin pump gave the history of the pump, which included blood glucose, insulin bolus, carbohydrate intake and the time course in the days to death, and the pump settings were recorded. For this case report, police reports on the death as well as hospital records were also reviewed. Results. At the patch for the insulin pump, nothing abnormal was found. Biochemical analysis showed glucose of 35 mmol/L in vitreous humor fluid indicating antemortem hyperglycemia, and ketone bodies in the blood of 11.0 mmol/L indicating ketoacidosis. Acute pulmonary hemostasis, chronic fat accumulation in the liver and acute fat accumulation in the kidneys were histological detected. There were no signs of late diabetic complications such as nephropathy or cardiovascular disease in the tissues. Insulin pump data showed that after three alarms, a power failure of the pump occurred leading to discontinuing insulin delivery, and about 48 hours before the deceased was found dead, his body was depleted of insulin. Conclusion.The cause of death is believed to be diabetic ketoacidosis due to completely lack of insulin because of power failure of the insulin pump, which therefore has been a decisive factor in the cascade of events that led to death. The case is, to our knowledge, the first to illustrate a death caused by diabetic ketoacidosis which is supported by autopsy findings and by data of an insulin pump up to the time of power failure. It is a strong example of usefulness of postmortem download of data from insulin pumps to help determine the cause of death among diabetics. Forensic pathologists should therefore review data and history of the pump systematically.

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Postmortem Analysis of Vitreous Humor For Detection of Antemortem Disorders in Glucose Metabolism. An Old Method Revisited

Cited by 4 publications

References 31 publications

Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions

Postmortem Determination of Short-Term Markers of Hyperglycemia for the Purposes of Medicolegal Opinions

The Post-Mortem Evaluation of Glucose Concentration in Blood and Its Diagnostical Value

Sudden death due to diabetic ketoacidosis following power failure of an insulin pump: Autopsy and pump data

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