Increased Adrenaline to Noradrenaline Ratio Is a Superior Indicator of Antemortem Hypothermia Compared with Separate Catecholamine Concentrations

Pakanen, B M Lasse; Kortelainen, Marja-Leena; Särkioja, Terttu; Porvari, Katja

doi:10.1111/j.1556-4029.2011.01805.x

Cited by 30 publications

(30 citation statements)

References 25 publications

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“…Error bars represent 95 % confidence interval. ***p<0.001 compared with hypothermia as main cause of death (COD); ¤p<0.05 compared with cardiovascular disease (CVD) deaths adrenaline (73.7 %) or ANR (68.9 %) [3], but the specificity of ANR was somewhat better (78.1 %). Most studies on hypothermia indicators have not provided these calculations exclusively for hypothermia deaths, making it difficult to compare the diagnostic accuracy of different indicators.…”

Section: Discussionmentioning

confidence: 98%

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Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

et al. 2014

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Severe cold stress has been shown to cause changes in the expression and secretion of thrombomodulin (TM), an endothelial protein regulating haemostasis and inflammation. To further evaluate TM as a cold stress indicator, relative TM mRNA and TM protein levels in the myocardium and the concentrations of TM in serum and urine were analysed in different causes of death (hypothermia main cause, n = 80; hypothermia contributory cause, n = 26; cardiovascular disease (CVD) main cause, n = 94; trauma main cause, n = 45; other main cause, n = 25). Urinary catecholamine concentrations and myocardial heat shock factor 1 (HSF1) transcript levels were also studied. The TM mRNA and the TM protein levels in myocardium and urine were significantly lower in hypothermia deaths than those in the controls. Post-mortem interval did not correlate with urinary TM concentration. The sensitivity and specificity of urinary TM assay to detect hypothermia deaths were 70.8 and 70.3 %, respectively. Catecholamine concentrations in urine correlated significantly with TM concentration in urine and TM mRNA levels in all groups excluding CVD deaths. There were no differences in the HSF1 transcript levels and no correlation to TM levels. These findings provide further evidence that cold stress and hypothermia affect TM expression and secretion and that they are possibly linked to catecholamine action. Thus, measuring post-mortem TM levels may provide additional support to diagnosing hypothermia in medico-legal examination. The results may also provide additional knowledge for the treatment of hypothermic patients and the use of hypothermia for medical purposes.

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Section: Discussionmentioning

confidence: 98%

“…The adrenaline to noradrenaline ratio in urine has been shown to be a decent marker, with high (>0. 19) values referring to hypothermia [3], but there is an indisputable need for a better one.…”

Section: Introductionmentioning

confidence: 99%

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

et al. 2014

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“…On the other hand, catecholamine stability in postmortem blood samples remains an issue of controversy, since they may diffuse from sympathetic nerve ending and adrenal glands into the blood [30].…”

Section: Discussionmentioning

confidence: 99%

A case of suicide by self-injection of adrenaline

Palmière

Bévalot

Malicier³

et al. 2015

Forensic Sci Med Pathol

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Adrenaline (epinephrine) auto-injectors provide life-saving pre-hospital treatment for individuals experiencing anaphylaxis in a community setting. Errors in handling adrenaline auto-injectors, particularly by children and healthcare professionals, have been reported. Reports of adrenaline overdoses are limited in the medical literature. In most of these cases, accidental adrenaline administration results from medical error. Exogenous administration of catecholamine is responsible for cardiovascular and metabolic responses, which may cause supraventricular tachycardia, ventricular dysrhythmias and myocardial ischemia. The authors present a unique autopsy case involving a 34 year-old woman who intentionally self-injected adrenaline using an adrenaline auto-injector as part of a suicide plan. Catecholamines and metanephrines were measured in peripheral and cardiac blood as well as urine and vitreous humor. Based on the results of all postmortem investigations, the cause of death was determined to be cardiac dysrhythmia and cardiac arrest following adrenaline self-injection.

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“…Pakanen et al [6] analyzed urine catecholamine levels in 358 autopsy cases, including 145 cases with hypothermia as the main cause of death. They found that adrenaline was a better marker of hypothermia death than noradrenaline, as already demonstrated by Hirvonen and Huttunen [49].…”

Section: Catecholaminesmentioning

confidence: 99%

“…This makes the postmortem diagnosis of hypothermia relatively arduous in forensic death investigations [6].…”

Section: Introductionmentioning

confidence: 99%

Postmortem biochemical investigations in hypothermia fatalities

Palmière

Mangin

2012

Int J Legal Med

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Despite the progress made during the past several decades in forensic pathology, the possibilities for the postmortem diagnosis of hypothermia remains relatively limited. Aside from histology and immunohistochemistry, numerous authors have investigated the postmortem biochemistry of hypothermia fatalities. Several biochemical markers (e.g., glucose, electrolytes, hormones, ketone bodies, and neurotransmitters) and various biological samples (e.g., blood, urine, heart, liver, skeletal muscle as well as pericardial and cerebrospinal fluids) have been proposed as potentially useful markers to improve the insufficient diagnostic efficacy of macroscopic and microscopic findings. The aim of this article is to review the medicolegal literature covering the postmortem biochemical investigations that are associated with hypothermia cases as well as report our own research results on this topic where possible.

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Increased Adrenaline to Noradrenaline Ratio Is a Superior Indicator of Antemortem Hypothermia Compared with Separate Catecholamine Concentrations

Cited by 30 publications

References 25 publications

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

A case of suicide by self-injection of adrenaline

Postmortem biochemical investigations in hypothermia fatalities

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