title: Lethal ventricular tachycardia triggered after femoral fracture repair in an obese man with insulin-resistant diabetes.
abstract: An obese man (height, 178 cm; weight, 160 kg; body mass index, 50.5 kg/m2) with a history of recurrent ventricular tachycardia (VT), cardiomyopathy, coronary sclerosis, and insulin-resistant diabetes suffered a right femur fracture in a vehicular accident. His fracture was repaired the following day, but shortly after surgery, his serum potassium (K+) level increased, presumably due to K+leakage from the injured muscles, leading to persistent VT and death. An autopsy revealed severe cardiac hypertrophy, moderate coronary sclerosis, and histological findings of myocardial hypercontraction, but not myoglobin-related renal failure, pulmonary thrombosis, lipid emboli, or inflammation. The hyperkalemia was not corrected by glucose-insulin infusion and led to the death of the patient due to the preexisting cardiomyopathy, coronary sclerosis, and a predisposition to VT. In addition to the autopsy, the analysis of the clinical course was indispensable for determining the cause of death as hyperkalemia-related VT.
authors.affiliation: Department of Forensic Medicine, Tokyo Medical University, 6-1-1 Shinjyuku, Shinjyuku-ku, Tokyo, 160-8402, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 NishiShinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Uramatsu
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Forensic Medicine, Tokyo Medical University, 6-1-1 Shinjyuku, Shinjyuku-ku, Tokyo, 160-8402, Japan. kenyoshi@tokyo-med.ac.jp.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Yoshida
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005264:Femoral Fractures / Q000601:surgery*; D006801:Humans; D006947:Hyperkalemia / Q000150:complications*; D008297:Male; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications; D017180:Tachycardia, Ventricular / Q000209:etiology*
keywords: Autopsy; High-energy trauma; Hyperkalemia; Insulin-resistant diabetes; Medical practice-associated death; Ventricular tachycardia