Postmortem diagnosis of unsuspected diabetes mellitus.
Vitreous glucose, blood beta-hydroxybutyrate and glycated hemoglobin were systematically measured in a series of 500 medico-legal autopsies in order to characterize the glycemic control during the weeks preceding death and identify ketoacidosis as the cause of death in diagnosed and unsuspected diabetics. Unenhanced CT-scans, histology and toxicology were performed in all cases. 16 cases of diabetic ketoacidosis were identified based on the results of all investigations. Among those, 13 cases concerned individuals with pre-existing diagnoses of diabetes mellitus whereas 3 cases concerned individuals with undiagnosed diabetes. A recent cocaine use was observed in 2 cases. C-reactive protein, interleukin-6 and interleukin-10 were measured and proved to be increased in all cases of diabetic ketoacidosis, whereas markers of generalized, bacterial infection and sepsis were normal in most of these cases. The results of this study highlight the usefulness of systematically performing biochemistry to identify ketoacidosis in unsuspected diabetics. It also emphasizes the role of toxicology and biochemistry to support the diagnosis of diabetic ketoacidosis and delineate the pathophysiological mechanisms that may disrupt the metabolic balance and finally lead to death in diabetic individuals.
University Center of Legal Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland. cristian.palmiere@chuv.ch
Cristian
C
Palmiere
Daniel
D
Bardy
Patrice
P
Mangin
Dominique
D
Werner
D019840:2-Propanol / Q000032:analysis; D020155:3-Hydroxybutyric Acid / Q000032:analysis; D000096:Acetone / Q000032:analysis; D000209:Acute-Phase Proteins; D000293:Adolescent; D000328:Adult; D001569:Benzodiazepines / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D002352:Carrier Proteins / Q000097:blood; D003042:Cocaine / Q000652:urine; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D005260:Female; D049429:Forensic Pathology; D005947:Glucose / Q000032:analysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D009294:Narcotics / Q000652:urine; D011498:Protein Precursors / Q000097:blood; D014822:Vitreous Body / Q000737:chemistry; D000099231:Lipopolysaccharide-Binding Protein
D019840:2-Propanol; D020155:3-Hydroxybutyric Acid; D000096:Acetone; D000209:Acute-Phase Proteins; D001569:Benzodiazepines; D002097:C-Reactive Protein; D002116:Calcitonin; D002352:Carrier Proteins; D003042:Cocaine; D005947:Glucose; D006442:Glycated Hemoglobin; D016753:Interleukin-10; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D009294:Narcotics; D011498:Protein Precursors; D000099231:Lipopolysaccharide-Binding Protein