Suicidal insulin overdose managed by excision of insulin injection site.

Campbell, Ian W; Ratcliffe, J G

doi:10.1136/bmj.285.6339.408

Cited by 40 publications

(23 citation statements)

References 2 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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“…In one case of an insulin intoxication, Winston et al [68] measured vitreous insulin in a concentration of 31 μU/ml but there are no reference data or validated methods for VF and cerebrospinal fluid. If an injection site exists, the excision of the surrounding dermal area should be taken into consideration [69,70] and a forensic toxicologic analysis of insulin in the injection site can be done.…”

Section: Insulin In Other Matricesmentioning

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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“…In a case reported by Campbell and Ratcliffe (1982), a 24-yearold man injected 200IU soluble insulin and 200IU of protamine zinc insulin subcutaneously, along with ingestion of 6 pints (3.5L) of lager. He presented 45 minutes later conscious and sweating, with no focal neurology and an initial blood sugar of 1.4 mmol/L.…”

Section: Management Of the Patient With Hypoglycaemiamentioning

confidence: 98%

Features, Prevention and Management of Acute Overdose Due to Antidiabetic Drugs

Moore

Wood

1993

Drug Safety

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Hypoglycaemic medication forms a disparate group of therapeutic compounds including insulin, the sulphonylureas and biguanides. They are all designed to prevent hyperglycaemia and in general are well tolerated. Careful prescribing practice and patient education by the physician can do much to reduce the risk of adverse effects from diabetic therapy. However, the presentation of adverse effects, together with accidental and non-accidental overdose, is a frequent clinical problem. Furthermore, the possible impairment of hypoglycaemic awareness in patients prescribed human insulin has added complexity to diabetic management. The cardinal features of insulin overdose are hypoglycaemia and hypokalaemia. The sulphonylureas predominantly cause hypoglycaemia, while the biguanides may precipitate lactataemia and acidosis. Recognition of hypoglycaemia is therefore crucial in avoidance of toxicity. Intravenous dextrose is the mainstay of therapy following gut decontamination (for the oral agents). The efficacy of glucagon is dependent on hepatic glycogen stores and should therefore be used with caution. Diazoxide is not recommended. More recently, octreotide has been shown to be effective in sulphonylurea overdose. Patients should be admitted and monitored with serial blood sugar measurements for a minimum of 1 to 2 days as clinically warranted.

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Suicidal insulin overdose managed by excision of insulin injection site.

Cited by 40 publications

References 2 publications

Postmortem chemistry update part I

Postmortem chemistry update part I

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

Features, Prevention and Management of Acute Overdose Due to Antidiabetic Drugs

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