The Determination of Insulin Overdose in Postmortem Investigations (original) (raw)

Insulin in Forensic Medicine and Toxicology

Ultimate Guide to Insulin, 2019

Today insulin is used not only in medicine in the treatment of diabetes but also in sport as a doping agent and for criminal purposes. Suicides and homicides with insulin maybe are not so common, but are seen in the routine medicolegal and toxicological-clinical practice. Despite the often quite clear circumstances of death and a well-established mechanism of action of insulin and its analogs, it is difficult to analytically confirm its excessive exogenous administration in postmortem biological material. There are no uniform international standards of conduct in such cases, both at the stage of the material sampling during autopsy and forensic laboratory analysis and the final interpretation of the obtained results. The aim of the study is to present the current state of basic knowledge about nonmedical use of insulin, with particular emphasis on the possibility of postmortem diagnosis. The study also highlighted the little known clinical problem of insulin abuse for recreational purposes.

Usefulness of postmortem biochemistry in forensic pathology: Illustrative case reports

Legal Medicine, 2012

The aim of this work is to present some practical, postmortem biochemistry applications to illustrate the usefulness of this discipline and reassert the importance of carrying out biochemical investigations as an integral part of the autopsy process. Five case reports are presented pertaining to diabetic ketoacidosis in an adult who was not known to suffer from diabetes and in presence of multiple psychotropic substances; fatal flecainide intoxication in a poor metabolizer also presenting an impaired renal function; diabetic ketoacidosis showing severe postmortem changes; primary aldosteronism presented with intracranial hemorrhage and hypothermia showing severe postmortem changes. The cases herein presented can be considered representative examples of the importance of postmortem biochemistry investigations, which may provide significant information useful in determining the cause of death in routine forensic casework or contribute to understanding the pathophysiological mechanisms involved in the death process.

The Use of Postmortem Forensic Toxicology Today. An Alert for the Pathologist.

Tricyclic antidepressant drugs concentrations in blood and other biological fluids and tissues, do not remain constant in the body in the interval between death and the collection of samples. Blood drug concentrations change significantly during the postmortem period. Because amitriptyline and the other tricyclic antidepressants are highly tissue bound, tissue release in the postmortem period gives rise to elevated blood levels. Postmortem Drug diffusion from solid organs into the blood is mainly a matter of passive diffusion as described by Fick’s first law of diffusion, which states that the rate of diffusion is proportional to the concentration gradient across the diffusion barrier. This postmortem redistribution can result in increase in postmortem blood amitriptyline concentrations to roughly 2-8 times the perimortem levels. Unless postmortem concentration changes, several factors, can render blood and tissue samples useless for the determination of antidepressant here drug concentrations. The data of the two cases presented here illustrates the need for a thorough examination of death scene, reviewing the deceased’s history and detailed examination of the body. The potential of false determination of the cause and manner of death in cases with tricyclic antidepressants is an existing factor while considering only the postmortem concentrations of the drugs in the blood and tissues.

The value of toxicology in determining cause of death. A study of 400 autopsy cases

Studies in Health Sciences, Curitiba, 2023

The interest of a forensic autopsy is the search for the cause of death. However, sometimes doubt suspicion persists about association with toxic substances. In this perspective, it's important to ask whether such toxicological analyses following a forensic autopsy are important in determining the cause of death. On the other hand, ask yourself, which toxins are most frequently encountered. The question then being is to compare the results of toxicological analyses with the conclusions established during the forensic autopsy. We have tried to show that, during the search for the cause of death, toxicological analyses are essential to assess the participation of xenobiotics in the fatal process. Materials and methods: This is a retrospective study, descriptive study on the analysis of toxicological results compared with conclusions from forensic autopsies (N=400), performed on requisition from the judicial authority of the competent territory, in the forensic medicine department (thanatology unit) of the university hospital of Sidi Bel Abbés (Algeria) during the period from January 01,2017 to December 31,2019. The sampling is carried out on different body fluids to determine how the person died. We had at our disposal blood (cardiac and peripheral), urine, gastric contents. Results: we obtained on our sample of 400, 274 males for 126 females with a sex ratio of 2.17. The minimum age was 0 days. The maximum age was 93 years, with a mean of 38 years and a standard deviation of 23 years. The natural form of death represented 41%, the unatural form (suicidal, criminal, accidental) represented 37% and the undetermined form represented 23%. According to the direct causes of death, acute cardiorespiratory distress represents the majority, i.e. 78.5%. Cardiopulmonary diseases represent the majority (28%), followed by death of traumatic origin (23.3%), death of asphyxic origin (12%) and having remained undetermined (19%). Requests for toxicological analysis of autopsies, including the establishment of the cause of death requiring the results of toxicological analysis represent (45%). Of all the results received (N=42), we found that the results that came back positive represent 43%, of which the molecules with neuropsychotropic effects represent the majority of 50%, then alcohol (20%) and cannabis (10%). Conclusion: In current forensic practice, the performance and analysis of samples for toxicological purposes appears to be an essential step, in order to better understand the circumstances of unatural deaths, and to clarify some situations for which the cause of death does not appear obvious. The evaluation of the nature of the substances most frequently encountered in search for causes of death can be evaluated over time according to the modes of prescription.

Site Dependence of Drug Concentrations in Postmortem Blood--A Case Study

Journal of Analytical Toxicology, 1987

A 25-year-old female died from a suicidal overdose of Imlpramlne, acetaminophen, codeine, dlphenhydramine, and ethanol. Blood samples from ten segregated arterial and venous sites, twenty-four tissue samples, cerebrospinal fluid, vitreous humor, and bile were analyzed. Imipramine and desipramine, which were highly concentrated in the liver and lungs, each showed marked site dependent differences in blood concentrations. The highest concentrations were in pulmonary venous blood and the lowest in peripheral venous blood. Imipramine concentrations in the ten blood samples differed by as much as 760% (range 2.1 to 16.0 mg/L). Blood desipramlne concentrations ranged from 1.4 to 10.6 mg/L. In contrast, blood concentrations of acetaminophen differed by less than 20% (55 to 65 mg/L) and blood ethanol concentrations ranged from 151 to 175 mg/100 mL. Blood concentrations of diphenhydramine ranged from 0.34 to 2.07 mg/L and codeine from 0.33 to 0.89 mg/L. The data illustrates that a marked site dependent variability in postmortem blood concentrations exists for some drugs but not others.