Interpretation of postmortem vitreous concentrations of sodium and chloride.
Vitreous fluid can be used to analyze sodium and chloride levels in deceased persons, but it remains unclear to what extent such results can be used to diagnose antemortem sodium or chloride imbalances. In this study we present vitreous sodium and chloride levels from more than 3000 cases. We show that vitreous sodium and chloride levels both decrease with approximately 2.2mmol/L per day after death. Since potassium is a well-established marker for postmortem interval (PMI) and easily can be analyzed along with sodium and chloride, we have correlated sodium and chloride levels with the potassium levels and present postmortem reference ranges relative the potassium levels. We found that virtually all cases outside the reference range show signs of antemortem hypo- or hypernatremia. Vitreous sodium or chloride levels can be the only means to diagnose cases of water or salt intoxication, beer potomania or dehydration. We further show that postmortem vitreous sodium and chloride strongly correlate and in practice can be used interchangeably if analysis of one of the ions fails. It has been suggested that vitreous sodium and chloride levels can be used to diagnose drowning or to distinguish saltwater from freshwater drowning. Our results show that in cases of freshwater drowning, vitreous sodium levels are decreased, but that this mainly is an effect of postmortem diffusion between the eye and surrounding water rather than due to the drowning process, since the decrease in sodium levels correlates with immersion time.
Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, SE-171 77 Stockholm, Sweden. Electronic address: brita.zilg@gmail.com.
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Zilg
Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, SE-171 77 Stockholm, Sweden.
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Alkass
Department of Medicine and Health, Linköping University, University Hospital, SE-581 85 Linköping, Sweden.
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Berg
Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, SE-171 77 Stockholm, Sweden.
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Druid
D002712:Chlorides / Q000032:analysis*; D003681:Dehydration / Q000175:diagnosis; D004332:Drowning / Q000175:diagnosis; D049429:Forensic Pathology; D005618:Fresh Water; D006801:Humans; D006955:Hypernatremia / Q000209:etiology; D007010:Hyponatremia / Q000209:etiology; D011180:Postmortem Changes; D012016:Reference Values; D000068357:Saline Waters; D012964:Sodium / Q000032:analysis*; D014822:Vitreous Body / Q000737:chemistry*; D014869:Water Intoxication / Q000175:diagnosis
D002712:Chlorides; D012964:Sodium
Chloride; Hypernatremia; Hyponatremia; Postmortem; Sodium; Vitreous