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Serum atrial natriuretic peptide (ANP) as an objective indicator for the diagnosis of neurogenic shock: animal experiment and human case report

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Abstract

In forensic medicine, the diagnosis of death due to neurogenic shock is considered to be an aporia, as lacking objective indicators and presenting atypical symptoms in autopsy. Medico-legal disputes and complaints occasionally result from this ambiguity. To explore potential objective indicators of neurogenic shock, we set up a model of neurogenic shock by applying an external mechanical force on the carotid sinus baroreceptor in rabbits. The serum atrial natriuretic peptide (ANP) level was measured by radioimmunoassay in the control group (n = 8), survival group (n = 15) and death group (n = 5) both before and after the insult. The serum ANP level showed a significant increase after the insult in the death group compared with the serum obtained before the insult (P = 0.006), while the serum ANP level after the insult in the survival group and control group was not statistically significant compared with the serum obtained before the insult (P = 0.332 and P = 0.492, respectively). To verify the repeatability of the model and the postmortem behavior of serum ANP, five healthy adult rabbits underwent the same procedure as the experimental group. The mortality rate was consistent with the former experiment (20 %). There were no significant changes in serum ANP level in vitro and in vivo (within 48 and 24 h, respectively). But there was a significant decrease in serum ANP level at 48 h postmortem in vivo (P = 0.001). A female patient who expired due to neurogenic shock during a hysteroscopy was reported. Neither fatal primary disease nor evidence for mechanical injuries or intoxication was found according to the autopsy. The serum ANP level was assayed as a supplementary indicator and was found to be three-fold higher than the normal maximum limit. Combined with the animal experiment, this case highlights that serum ANP has the potential to be an objective indicator for the diagnosis of death due to neurogenic shock.

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Acknowledgments

This research received no specific grant from any funding agency. The authors have no conflicts of interests to declare.

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Authors and Affiliations

  1. Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, 400016, People’s Republic of China

    Min-Zhu Zhao, Yong-Guo Li, Peng Zhang, Jin-Cheng Xiong, Xuan Xiao & Jian-Bo Li

  2. Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400016, People’s Republic of China

    Min-Zhu Zhao, Yong-Guo Li, Peng Zhang, Jin-Cheng Xiong, Xuan Xiao & Jian-Bo Li

  3. School of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, People’s Republic of China

    Shi-Sheng Zhu

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  1. Min-Zhu Zhao
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Correspondence to Jian-Bo Li.

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The procedures were reviewed and approved by the Experimental Animal Care and Use Committee of Chong Qing Medical University. Written informed consent was obtained from the patient’s family.

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Zhao, MZ., Li, YG., Zhang, P. et al. Serum atrial natriuretic peptide (ANP) as an objective indicator for the diagnosis of neurogenic shock: animal experiment and human case report. Int J Legal Med 131, 473–478 (2017). https://doi.org/10.1007/s00414-016-1455-8

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  • DOI: https://doi.org/10.1007/s00414-016-1455-8

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