title: Determination of hypoglycaemia induced by insulin or its synthetic analogues post mortem.
abstract: The determination of human insulin or its synthetic analogues in post-mortem specimens represents a challenge for forensic toxicologists due to its proven instability in post-mortem blood. We present two cases of an insulin-induced hypoglycaemia. In the first case, ante-mortem material was available for the detection of an injection with human insulin. Human insulin was detected by immunopurification with magnetic beads and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses at a concentration of 5180 μU/ml. The molar ratio human insulin:C-peptide was 111. The second case describes a suicide by self-injection of Insulin lispro and determination of the drug after pre-extraction with methanol and immunopurification by LC-MS/MS at the injection site, in vitreous humour and organs. Apart from the well-known matrices--femoral blood and urine--the specimen vitreous humour and the injection site promise the best possibilities for a proof of insulin at autopsy. In addition to insulin analyses, the parameters C-peptide, proinsulin, glucose, lactate, and sulfonylureas should be measured in case of suspected fatal hypoglycaemia.
authors.affiliation: Institute of Forensic Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hess
authors.forename: B
authors.initials: B
authors.lastname: Madea
authors.forename: T
authors.initials: T
authors.lastname: Daldrup
authors.forename: F
authors.initials: F
authors.lastname: Musshoff
mesh_terms: D001344:Autopsy; D002853:Chromatography, Liquid; D017809:Fatal Outcome; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000473:pathology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000506:poisoning; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000506:poisoning; D008875:Middle Aged
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: LC-MS; hypoglycaemia; insulin; post mortem