Detection of diabetic metabolism disorders post‐mortem – forensic case reports on cause of death hyperglycaemia

Heß, Cornelius; Wöllner, Kirsten; Mußhoff, Frank; Madea, Burkhard

doi:10.1002/dta.1479

Cited by 18 publications

(20 citation statements)

References 27 publications

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“…According to Cornelius Hess et al glucose concentration in vitreous fluid correlate with glycaemia previous to death ( Cornelius Hess, Musshoff, & Madea, 2011;. Moreover, estimation of HbA1c, fructosamine, or anhydroglucitol may provide useful data on the long-term glycemic control for individuals with diabetes (C. Hess et al, 2013;Lepik, Tõnisson, Kuudeberg, & Väli, 2018;Walta, Keltanen, Lindroos, & Sajantila, 2016). Though it has been thought that the glucose concentration in blood doesn't have high diagnostic validity because of its broad variation after death there are some studies that suggest post-mortal blood glucose analysis can be a useful diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

“…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 (Association, 2018). In forensic medicine, the diagnostic value of post-mortem blood glucose levels is questionable because of its significant and rapid variation after death (C. Hess, Wöllner, Musshoff, & Madea, 2013). First of all, blood glucose metabolization proceeds in cells for a while after the termination of cardiovascular and respiratory organ systems.…”

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lukočiūtė

Ginčienė²,

Chmieliauskas

et al. 2019

CBUP

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“…In forensic setting, high urine glucose levels can be indicative of diabetic coma. But as urine glucose level only weakly correlates with VH glucose concentrations, low levels of glucose in urine does not exclude high vitreous glucose concentrations [10].…”

Section: Urine Sticksmentioning

confidence: 99%

“…glycated hemoglobin, HbA1c) to assess antemortem (AM) hyperglycemia and ketoacidosis. These conditions may not be easily detected by other methods in the autopsy [10,11]. Vitreous humor (VH) is often preferred as a sample material over blood as it is less affected by putrefaction and biochemical PM changes e.g.…”

Section: Introductionmentioning

confidence: 98%

The usefulness of point-of-care (POC) tests in screening elevated glucose and ketone body levels postmortem

Walta

Keltanen

Lindroos

et al. 2016

Forensic Science International

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The aim was to evaluate the performance of point-of-care (POC) tests in detecting glucose and ketone bodies in postmortem (PM) samples and to assess the usefulness of POC tests in sample screening for more precise analyses. Glucose and ketone body, β-hydroxybutyrate (BHB), were measured from vitreous humor (VH) in 52 autopsy cases with a POC blood glucose monitoring device (BGMD). In addition glucose and ketone bodies, acetone (Ac) and acetoacetate (AcAc), were measured from urine samples in another set of 59 cases with semi-quantitative stick tests. The results were compared to the concentration in VH measured with validated methods (values ≥ 7mmol/l indicate possible hyperglycemia and total ketone body levels ≥ 3mmol/l ketoacidosis). The sensitivity for glucose with the BGMD was 1.0 and specificity 0.94 when the threshold value for the meter to predict elevated glucose was set to ≥ 10mmol/l. The correlation between the BGMD and the validated method was strong (R(2)=0.89). For detecting ketoacidosis, the BGMD had a sensitivity of 1.0 and specificity of 0.73, when the threshold value was set to 2.5mmol/l. The urine stick test presented a sensitivity of 0.89 and specificity of 0.90 for detecting elevated VH glucose concentration. The sensitivity and specificity for the stick test to detect cases with possible ketoacidosis were 0.84 and 0.68, respectively. According to the results, BGMD can be reliably applied for sample screening, although more samples need to be analyzed for delineating the correct threshold values. In the case of glucose, the urine stick tests could be indicative in detecting cases with VH glucose ≥ 10mmol/l. For predicting possible ketoacidosis with elevated VH total ketone bodies, the stick test is not reliable as the test presented both false-positive and -negative results.

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“…Practically, any trace of glucose in the vitreous fluid is likely an indication of antermortem hyperglycemia [20]. For urine PM glucose measurements, specifying cutoff values for evaluating AM glucose balance from PM urine samples is challenging, and the urine glucose measurement should primarily be used to confirm vitreous findings [21][22][23].…”

Section: Glucose Analysismentioning

confidence: 99%

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

et al. 2018

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Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau's database between years 2011-2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

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Detection of diabetic metabolism disorders post‐mortem – forensic case reports on cause of death hyperglycaemia

Cited by 18 publications

References 27 publications

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

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

The usefulness of point-of-care (POC) tests in screening elevated glucose and ketone body levels postmortem

Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

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