title: Possible postmortem serum markers for differentiation between fresh-, saltwater drowning and acute cardiac death: a preliminary investigation.
abstract: The aim of the present study was to investigate the differences in postmortem blood biochemistry between fresh-, saltwater drowning and acute myocardial infarction/ischemia (AMI) (n=11, n=15 and n=23, respectively; postmortem interval <48 h). Left and right cardiac blood samples were examined for the serum markers: sodium (Na), chloride (Cl), magnesium (Mg), blood urea nitrogen (BUN), creatinine (Cr), pulmonary surfactant-associated protein A (SP-A) and cardiac troponin T (cTn-T). The most efficient markers were the left-right cardiac BUN ratio for determination of drowning (hemodilution) and the left heart blood Mg level for differentiation between fresh- and saltwater aspiration. A characteristic feature of saltwater drowning was a low left-right BUN ratio and a marked elevation in the serum Cl, Mg and Ca levels of the left heart blood. Serum cTn-T level was usually low in drownings, showing a difference from most cases of AMI. Freshwater drowning showed a significant elevation of serum SP-A, although there was considerable overlapping with saltwater drowning and AMI. These findings suggested the usefulness of serum markers in the investigation of death from drownings.
authors.affiliation: Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan. baolizhu@med.osaka-cu.ac.jp
authors.forename: Bao-Li
authors.initials: BL
authors.lastname: Zhu
authors.forename: Kaori
authors.initials: K
authors.lastname: Ishida
authors.forename: Mari
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Li
authors.initials: L
authors.lastname: Quan
authors.forename: Shigeki
authors.initials: S
authors.lastname: Oritani
authors.forename: Kohei
authors.initials: K
authors.lastname: Tsuda
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Kamikodai
authors.forename: Masaki Q
authors.initials: MQ
authors.lastname: Fujita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maeda
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000097:blood; D003937:Diagnosis, Differential; D004332:Drowning / Q000097:blood* / Q000175:diagnosis; D005260:Female; D005618:Fresh Water; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D037662:Pulmonary Surfactant-Associated Protein A / Q000097:blood; D012623:Seawater; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D002712:Chlorides; D037662:Pulmonary Surfactant-Associated Protein A; D020107:Troponin T; D008274:Magnesium; D002118:Calcium