Is the formula of Traub still up to date in antemortem blood glucose level estimation?
According to the hypothesis of Traub, also known as the 'formula of Traub', postmortem values of glucose and lactate found in the cerebrospinal fluid or vitreous humor are considered indicators of antemortem blood glucose levels. However, because the lactate concentration increases in the vitreous and cerebrospinal fluid after death, some authors postulated that using the sum value to estimate antemortem blood glucose levels could lead to an overestimation of the cases of glucose metabolic disorders with fatal outcomes, such as diabetic ketoacidosis. The aim of our study, performed on 470 consecutive forensic cases, was to ascertain the advantages of the sum value to estimate antemortem blood glucose concentrations and, consequently, to rule out fatal diabetic ketoacidosis as the cause of death. Other biochemical parameters, such as blood 3-beta-hydroxybutyrate, acetoacetate, acetone, glycated haemoglobin and urine glucose levels, were also determined. In addition, postmortem native CT scan, autopsy, histology, neuropathology and toxicology were performed to confirm diabetic ketoacidosis as the cause of death. According to our results, the sum value does not add any further information for the estimation of antemortem blood glucose concentration. The vitreous glucose concentration appears to be the most reliable marker to estimate antemortem hyperglycaemia and, along with the determination of other biochemical markers (such as blood acetone and 3-beta-hydroxybutyrate, urine glucose and glycated haemoglobin), to confirm diabetic ketoacidosis as the cause of death.
University Centre of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Rue Michel-Servet 1, 1211, Genève 4, Switzerland. cristian.palmiere@chuv.ch
Cristian
C
Palmiere
Frank
F
Sporkert
Paul
P
Vaucher
Dominique
D
Werner
Daniel
D
Bardy
François
F
Rey
Christelle
C
Lardi
Christophe
C
Brunel
Marc
M
Augsburger
Patrice
P
Mangin
D020155:3-Hydroxybutyric Acid / Q000097:blood; D000090:Acetoacetates / Q000097:blood; D000096:Acetone / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D005260:Female; D049429:Forensic Pathology; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D055641:Mathematical Concepts; D008875:Middle Aged; D011180:Postmortem Changes; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014822:Vitreous Body / Q000378:metabolism*
D020155:3-Hydroxybutyric Acid; D000090:Acetoacetates; D000096:Acetone; D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin; D019344:Lactic Acid