Author/Editor     Zorec-Karlovšek, M
Title     Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour - our experiences
Type     članek
Source     Forensic Sci Int
Vol. and No.     Letnik 146S
Publication year     2004
Volume     str. S19-23
Language     eng
Abstract     The final diagnosis of death in hypoglycaemic or diabetic coma should always be done as a synopsis of anamnestic response, morphology, biochemical (glucose, lactate, HBA1c, ketonic bodies, insulin, and C-peptide) and toxicological findings. High glucose levels in vitreous humour (more than 13 mmol/L, 234 mg/dL) or combined values of glucose and lactate in vitreous humour or in cerebrospinal fluid over threshold values of 23.7 mmol/L (427 mg/dL) and 23.4 mmol/L (422 mg/dL) respectively, can be an indicator of the pre-mortem hyperglycaemic state with fatal outcome. The determination of glycated haemoglobin, acetone and other ketone bodies improve the diagnostic values of the whole procedure. Diabetic ketoacidosis (blood aceton > 0.3 g/L) is more often the cause of death of diabetic patients than the non-ketotic hyperosmolal state. Hypoglycaemia is deemed fatal if the combined values are lower than 5.5 mmol/L (100 mg/dL) and can not be excluded if they are lower than 8.9 mmol/L (160 mg/dL). Two cases of detected hypoglycaemia are described further. A psychiatric patient with diabetes (Hba1c 8.4%) committed suicide with an insulin overdose. The combined values of glucose and lactate in vitreous humour and in cerebrospinal fluid were 3.3 and 4.1 mmol/1, respectively. In another case a low combined glucose and lactate value (8.7 mmol/L) in vitreous humour indicated, besides the high concentration of glibenclamide (0.9 mg/L) in the blood of a driver with a poorly controlled diabetic condition (Hba1c = 10.6%), a state of decreasing blood glucose in the time before the accident causing the driver to feel unwell and behave inappropriately.
Descriptors     HYPOGLYCEMIA
DIABETIC COMA
GLUCOSE
LACTATES
AUTOPSY
VITREOUS BODY
INSULIN
GLYBURIDE
OVERDOSE
KETONE BODIES
SUICIDE
ACCIDENTS, TRAFFIC
HEMOGLOBIN A, GLYCOSYLATED