Abstract
Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.
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References
Coe JI (1993) Postmortem chemistry update. Emphasis on forensic application. Am J Forensic Med Pathol 14(2):91–117
Arroyo A, Valero J, Marrón T, Vidal C, Hontecillas B, Bernal J (1998) Pericardial fluid postmortem: comparative study of natural and violent deaths. Am J Forensic Med Pathol 19(3):266–268
Madea B, Kreuser C, Banaschak S (2001) Postmortem biochemical examination of synovial fluid—a preliminary study. Forensic Sci Int 118(1):29–35
Gagajewski A, Murakami MM, Kloss J, Edstrom M, Hillyer M, Peterson GF, Amatuzio J, Apple FS (2004) Measurement of chemical analytes in vitreous humor: stability and precision studies. J Forensic Sci 49(2):371–374
Arroyo A, Rosel P, Marrón T (2005) Cerebrospinal fluid: postmortem biochemical study. J Clin Forensic Med 12(3):153–156
Mulla A, Massey KL, Kalra J (2005) Vitreous humor biochemical constituents: evaluation of between-eye differences. Am J Forensic Med Pathol 26(2):146–149
Madea B, Musshoff F (2007) Postmortem chemistry. Forensic Sci Int 165(2–3):165–171
Uemura K, Shintani-Ishida K, Saka K, Nakajima M, Ikegaya H, Kikuchi Y, Yoshida K (2008) Biochemical blood markers and sampling sites in forensic autopsy. J Forensic Leg Med 15(5):312–317
Thierauf A, Musshoff F, Madea B (2009) Postmortem biochemical investigations of vitreous humor. Forensic Sci Int 192(1–3):78–82
Luna A (2009) Is postmortem biochemistry really useful? Why is it not widely used in forensic pathology? Leg Med (Tokyo) 11(Suppl 1):S27–S30
Maeda H, Zhu BL, Ishikawa T, Quan L, Michiue T (2009) Significance of postmortem biochemistry in determining the cause of death. Leg Med (Tokyo) 11(Suppl 1):S46–S49
Hess C, Musshoff F, Madea B (2011) Disorders of glucose metabolism—post mortem analyses in forensic cases: part I. Int J Legal Med 125(2):163–170
Musshoff F, Hess C, Madea B (2011) Disorders of glucose metabolism—post mortem analyses in forensic cases—part II. Int J Legal Med 125(2):171–180
Maeda H, Ishikawa T, Michiue T (2011) Forensic biochemistry for functional investigation of death: concept and practical application. Leg Med (Tokyo) 13(2):55–67
Boulagnon C, Garnotel R, Fornes P, Gillery P (2011) Postmortem biochemistry of vitreous humor and glucose metabolism: an update. Clin Chem Lab Med 49(8):1265–1270
Hamilton-Paterson JL, Johnson EWM (1940) Postmortem glycolysis. J Pathol Bacteriol 50:473–482
Tonge JI, Wannan JS (1949) The postmortem blood sugar. Med J Aust 1:439–447
Naumann HN (1949) Diabetes and uremia diagnosed at autopsy by testing cerebrospinal fluid and urine. Arch Pathol (Chic) 47(1):70–77
Naumann HN (1959) Postmortem chemistry of the vitreous body in man. Arch Ophthalmol 62:356–363
Fekete JF, Kerenyi NA (1965) Postmortem blood sugar and blood urea nitrogen determinations. Can Med Assoc J 92:970–973
Leahy MS, Farber ER (1967) Postmortem chemistry of human vitreous humor. J Forensic Sci 12(2):214–222
Coe JI (1969) Postmortem chemistries on human vitreous humor. Am J Clin Pathol 51(6):741–750
Coe JI (1972) Use of chemical determinations on vitreous humor in forensic pathology. J Forensic Sci 17(4):541–546
Coe JI (1973) Some further thoughts and observations on postmortem chemistries. Forensic Sci Gazette 5:2–6
Coe JI (1974) Postmortem chemistry: practical considerations and a review of the literature. J Forensic Sci 19(1):13–32
Swift PG, Worthy E, Emery JL (1974) Biochemical state of the vitreous humor of infants at necropsy. Arch Dis Child 49(9):680–685
Coe JI (1977) Postmortem chemistry of blood, cerebrospinal fluid, and vitreous humor. In: Tedeschi CG, Eckert WG, Tedeschi LG (eds) Forensic medicine, vol 2. Saunders, Philadelphia, pp 1030–1060
Coe JI (1977) Postmortem chemistry of blood, cerebrospinal fluid, and vitreous humor. Leg Med Annu 1976:55–92
Daae LN, Teige B, Svaar H (1978) Determination of glucose in human vitreous humor. Various analytical methods give different results. Z Rechsmed 80(4):287–291
Traub F (1969) Methode zur Erkennung von tödlichen Zuckerstoffwechselstörungen an der Leiche. Zbl Allg Path 112:390–399
Sippel H, Möttönen M (1982) Combined glucose and lactate values in vitreous humor for postmortem diagnosis of diabetes mellitus. Forensic Sci Int 19(3):217–222
Kernbach G, Püschel K, Brinkmann B (1986) Biochemical measurements of glucose metabolism in relation to cause of death and postmortem effects. Z Rechtsmed 96(3):199–213
Péclet C, Picotte P, Jobin F (1994) The use of vitreous humor levels of glucose, lactic acid and blood levels of acetone to establish antemortem hyperglycemia in diabetics. Forensic Sci Int 65(1):1–6
De Letter EA, Piette MH (1998) Can routinely combined analysis of glucose and lactate in vitreous humor be useful in current forensic practice? Am J Forensic Med Pathol 19(4):335–342
Brinkmann B, Fechner G, Karger B, DuChesne A (1998) Ketoacidosis and lactic acidosis—frequent causes of death in chronic alcoholics? Int J Legal Med 111(3):115–119
Osuna E, García-Víllora A, Pérez-Cárceles MD, Conejero J, Abenza JM, Martínez P, Luna A (2001) Glucose and lactate in vitreous humor compared with the determination of fructosamine for the postmortem diagnosis of diabetes mellitus. Am J Forensic Med Pathol 22(3):244–249
Karlovsek MZ (1995) Postmortem diagnosis of diabetes mellitus and diabetic coma: a comparison of HbA1, glucose, lactate and combined glucose and lactate values in vitreous humor and in cerebrospinal fluid. In: Jacob B, Bonte W (Eds), Advances in Forensic Sciences: Forensic Criminalistic 2, Vol. 4, Verlag Dr Köstner, Berlin, 1995, 38–48
Karlovsek MZ (2004) Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humor—our experiences. Forensic Sci Int 2(146 Suppl):S19–S23
Zilg B, Alkass K, Berg S, Druid H (2009) Postmortem identification of hyperglycemia. Forensic Sci Int 185(1–3):89–95
Osuna E, García-Víllora A, Pérez-Cárceles M, Conejero J, Maria Abenza J, Martínez P, Luna A (1999) Vitreous humor fructosamine concentrations in the autopsy diagnosis of diabetes mellitus. Int J Legal Med 112(5):275–279
Vivero G, Vivero-Salmerón G, Pérez Cárceles MD, Bedate A, Luna A, Osuna E (2008) Combined determination of glucose and fructosamine in vitreous humor as a postmortem tool to identify antemortem hyperglycemia. Rev Diabet Stud 5(4):220–224
Goullé JP, Lacroix C, Bouige D (2002) Gylcated haemoglobin: a useful postmortem reference marker in determining diabetes. Forensic Sci Int 128(1–2):44–49
Mitchell GA, Kassovska-Bratinova S, Boukaftane Y, Robert MF, Wang SP, Ashmarina L, Lambert M, Lapierre P, Potier E (1995) Medical aspects of ketone body metabolism. Clin Invest Med 18(3):193–216
Laffel L (1999) Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev 15(6):412–426
Laffel L (2000) Sick-day management in type 1 diabetes. Endocrinol Metab Clin North Am 29(4):707–723
Pounder DJ, Stevenson RJ, Taylor KK (1998) Alcoholic ketoacidosis at autopsy. J Forensic Sci 43:812–816
Osuna E, Vivero G, Conejero J, Abenza JM, Martínez P, Luna A, Pérez-Cárceles MD (2005) Postmortem vitreous humor beta-hydroxybutyrate: its utility for the postmortem interpretation of diabetes mellitus. Forensic Sci Int 153(2–3):189–195
Kanetake J, Kanawaku Y, Mimasaka S, Sakai J, Hashiyada M, Nata M, Funayama M (2005) The relationship of a high level of serum beta-hydroxybutyrate to cause of death. Leg Med (Tokyo) 7(3):169–174
Felby S, Nielsen E, Thomsen JL (2008) The postmortem distribution of ketone bodies between blood, vitreous humor, spinal fluid and urine. Forensic Sci Med Pathol 4(2):100–107
Bailey DN (1990) Detection of isopropanol in acetonemic patients not exposed to isopropanol. J Toxicol Clin Toxicol 28(4):459–466
Davis PL, Dal Cortivo LA, Maturo J (1984) Endogenous isopropanol: forensic and biochemical implications. J Anal Toxicol 8(5):209–212
Teresiński G, Buszewicz G, Madro R (2009) Acetonaemia as an initial criterion of evaluation of a probable cause of sudden death. Leg Med (Tokyo) 11(1):18–24
Jones AE, Summers RL (2000) Detection of isopropyl alcohol in a patient with diabetic ketoacidosis. J Emerg Med 19(2):165–168
Jenkins AJ, Merrick TC, Oblock JM (2008) Evaluation of isopropanol concentrations in the presence of acetone in postmortem biological fluids. J Anal Toxicol 32(8):719–720
Molina DK (2010) A characterization of sources of isopropanol detected on postmortem toxicologic analyses. J Forensic Sci 55(4):998–1002
Duffens K, Marx JA (1987) Alcoholic ketoacidosis—a review. J Emerg Med 5(5):399–406
Wrenn KD, Slovis CM, Minion GE, Rutkowski R (1991) The syndrome of alcoholic ketoacidosis. Am J Med 91(2):119–128
Adams SL (1990) Alcoholic ketoacidosis. Emerg Med Clin North Am 8(4):749–760
Caspar CB, Risti B, Iten PX, Jost R, Russi EW, Speich (1993) Alcoholic ketoacidosis. Schweiz Med Wochenschr 123(41):1929–1934
Hooper RJ (1994) Alcoholic ketoacidosis: the late presentation of acidosis in an alcoholic. Ann Clin Biochem 31(Pt 6):579–582
Sibaï K, Eggimann P (2005) Alcoholic ketoacidosis: not rare cause of metabolic acidosis. Rev Med Suisse 1(32):2106, 2108–10, 2112–5.
McGuire LC, Cruickshank AM, Munro PT (2005) Alcoholic ketoacidosis. Emerg Med J 23(6):417–420
Denmark LN (1993) The investigation of beta-hydroxybutyrate as a marker for sudden death due to hypoglycemia in alcoholics. Forensic Sci Int 62(3):225–232
Thomsen JL, Felby S, Theilade P, Nielsen E (1995) Alcoholic ketoacidosis as a cause of death in forensic cases. Forensic Sci Int 75(2–3):163–171
Iten PX, Meier M (2000) Beta-hydroxybutyric acid—an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers. J Forensic Sci 45(3):624–632
Elliott S, Smith C, Cassidy D (2010) The postmortem relationship between beta-hydroxybutyrate (BHB), acetone and ethanol in ketoacidosis. Forensic Sci Int 198(1):53–57
Teresiński G, Buszewicz G, Madro R (2005) Biochemical background of ethanol-induced cold susceptibility. Leg Med (Tokyo) 7(1):15–23
Teresiński G, Buszewicz G, Madro R (2002) The influence of ethanol on the level of ketone bodies in hypothermia. Forensic Sci Int 127(1–2):88–96
Winston DC (2000) Suicide via insulin overdose in nondiabetics: the New Mexico experience. Am J Forensic Med Pathol 21(3):237–240
Finkbeiner WE, Ursell PC, Davis RL (2004) Autopsy pathology. A manual and atlas. Churchill Livingstone, Philadelphia
Niswender KD (2011) Basal insulin: physiology, pharmacology, and clinical implication. Postgrad Med 123(4):17–26
Niswender KD (2011) Basal insulin: beyond glycemia. Postgrad Med 123(4):27–37
Sturner WQ, Putnam RS (1972) Suicidal insulin poisoning with nine day survival: recovery in bile at autopsy by radioimmunoassay. J Forensic Sci 17(4):514–521
Lindquist O, Rammer L (1975) Insulin in postmortem blood. Z Rechtsmed 75(4):275–277
Bauman WA, Yalow RS (1981) Insulin as a lethal weapon. J Forensic Sci 26(3):594–598
Campbell IW, Ratcliffe JG (1982) Suicidal insulin overdose managed by excision of insulin injection site. Br Med J (Clin Res Ed) 285(6339):408–409
Hood I, Mirchandani H, Monforte J, Stacer W (1986) Immunohistochemical demonstration of homicidal insulin injection site. Arch Pathol Lab Med 110(10):973–974
Haibach H, Dix JD, Shah JH (1987) Homicide by insulin administration. J Forensic Sci 32(1):208–216
Patel F (1992) Fatal self-induced hyperinsulinemia: a delayed postmortem analytical detection. Med Sci Law 32:151–159
Beastall GH, Gibson IH, Martin J (1995) Successful suicide by insulin injection in a non-diabetic. Med Sci Law 35(1):79–85
Patel F (1995) Successful suicide by insulin injection in a non-diabetic. Med Sci Law 35(2):181–182
Kernbach-Wighton G, Püschel K (1998) On the phenomenology of lethal applications of insulin. Forensic Sci Int 93(1):61–73
Wehner F, Mittmeyer HJ, Wehner HD, Schieffer MC (1998) Insulin or morphine injection? Immunohistochemical contribution to the elucidation of a case. Forensic Sci Int 95(3):241–246
Marks V, Teale JD (1999) Hypoglycemia: factitious and felonious. Endocrinol Metab Clin North Am 28(3):579–601
Marks V (1999) Murder by insulin. Med Leg J 67(Pt 4):147–163
Marks V (2009) Murder by insulin: suspected, purported and proven. A review. Drug Test Anal 1(4):162–176
Banaschak S, Bajanowski T, Brinkmann B (2000) Suicide of a diabetic by inducing hyperglycemic coma. Int J Legal Med 113(3):162–163
Iwase H, Kobayashi M, Nakajima M, Takatori T (2001) The ratio of insulin to C-peptide can be used to make a forensic diagnosis of exogenous insulin overdosage. Forensic Sci Int 115(1–2):123–127
Batalis NI, Prahlow JA (2004) Accidental insulin overdose. J Forensic Sci 49(5):1117–1120
Nikolić S, Atanasijević T, Popović V (2006) A suicide by insulin injection—case report. Srp Arh Celok Lek 134(9–10):444–447
Rao NG, Menezes RG, Nagesh KR, Kamath GS (2006) Suicide by combined insulin and glipizide overdose in a non-insulin dependent diabetes mellitus physician: a case report. Med Sci Law 46(3):263–269
More DS, Arroyo MC (1985) Biochemical changes of the synovial fluid with regard to the cause of death. 1: Calcium, inorganic phosphorus, glucose, urea nitrogen, uric acid, proteins, and albumin. J Forensic Sci 30(2):541–546
Zhu BL, Ishida K, Quan L, Taniguchi M, Oritani S, Li DR, Fujita MQ, Maeda H (2002) Postmortem serum uric acid and creatinine levels in relation to the causes of death. Forensic Sci Int 125(1):59–66
Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Quan L, Maeda H (2005) Evaluation of postmortem urea nitrogen, creatinine and uric acid levels in pericardial fluid in forensic autopsy. Leg Med (Tokyo) 7(5):287–292
Zhu BL, Ishikawa T, Michiue T, Tanaka S, Zhao D, Li DR, Quan L, Oritani S, Maeda H (2007) Differences in postmortem urea nitrogen, creatinine and uric acid levels between blood and pericardial fluid in acute death. Leg Med (Tokyo) 9(3):115–122
Maeda H, Zhu BL, Bessho Y, Ishikawa T, Quan L, Michiue T, Zhao D, Li DR, Komatsu A (2008) Postmortem serum nitrogen compounds and C-reactive protein levels with special regard to investigation of fatal hyperthermia. Forensic Sci Med Pathol 4(3):175–180
Byramji A, Cains G, Gilbert JD, Byard RW (2008) Hyponatremia at autopsy: an analysis of etiologic mechanisms and their possible significance. Forensic Sci Med Pathol 4(3):149–152
Ingham AI, Byard RW (2009) The potential significance of elevated vitreous sodium levels at autopsy. J Forensic Leg Med 16(8):437–440
DiMaio VJ, DiMaio D (2001) Forensic pathology. 2nd Ed
Whitehead FJ, Couper RT, Moore L, Bourne AJ, Byard RW (1996) Dehydration deaths in infants and young children. Am J Forensic Med Pathol 17(1):73–78
Ross MP, Spiller HA (1999) Fatal ingestion of sodium hypochlorite bleach with associated hypernatremia and hyperchloremic metabolic acidosis. Vet Hum Toxicol 41(2):82–86
Byard RW (2002) Incapacitation or death of a socially isolated parent or carer could result in the death of dependent children. J Paediatr Child Health 38(4):417–418
Madea B, Lachenmeier DW (2005) Postmortem diagnosis of hypertonic dehydration. Forensic Sci Int 155(1):1–6
Chen X, Huang G (1995) Autopsy case report of a rare acute iatrogenic water intoxication with a review of the literature. Forensic Sci Int 76(1):27–34
Arieff AI, Kronlund BA (1999) Fatal child abuse by forced water intoxication. Pediatrics 103(6 Pt 1):1292–1295
Garigan TP, Ristedt DE (1999) Death from hyponatremia as a result of acute water intoxication in an Army basic trainee. Mil Med 164(3):234–238
Gardner JW (2002) Death by water intoxication. Mil Med 167(5):432–434
Gutmann FD, Gardner JW (2002) Fatal water intoxication of an Army trainee during urine drug testing. 167(5):435–437
Farrell DJ, Bower L (2003) Fatal water intoxication. J Clin Pathol 56(10):803–804
Hayashi T, Ishida Y, Miyashita T, Kiyokawa H, Kimura A, Kondo T (2005) Fatal water intoxication in a schizophrenic patient—an autopsy case. J Clin Forensic Med 12(3):157–159
Kalantar-Zadeh K, Nguyen MK, Chang R, Kurtz I (2006) Fatal hyponatremia in a young woman after ecstasy ingestion. Nat Clin Pract Nephrol 2(5):283–288
Vucicevic Z, Degoricija V, Alfirevic Z, Vukicevic-Badouin D (2007) Fatal hyponatremia and other metabolic disturbances associated with psychotropic drug polypharmacy. Int J Clin Pharmacol Ther 45(5):289–292
Musham CK, Jarathi A, Pedraza G (2010) A rare case of fatal hyponatremia due to a combination of psychotropic polypharmacy and hypothyroidism. Prim Care Companion J Clin Psychiatry 12(4)
Zhu BL, Ishikawa T, Quan L, Li DR, Zhao D, Michiue T, Maeda H (2005) Evaluation of postmortem serum calcium and magnesium levels in relation to the causes of death in forensic autopsy. Forensic Sci Int 155(1):18–23
Li DR, Quan L, Zhu BL, Ishikawa T, Michiue T, Zhao D, Yoshida C, Chen JH, Wang Q, Komatsu A, Azuma Y, Maeda H (2009) Evaluation of postmortem calcium and magnesium levels in the pericardial fluid with regard to the cause of death in medicolegal autopsy. Forensic Sci Int 11(Suppl 1):S276–S278
Azparren JE, de la Rosa I, Sancho M (1994) Biventricular measurement of blood strontium in real cases of drowning. Forensic Sci Int 69(2):139–148
Azparren JE, Vallejo G, Reyes E, Herranz A, Sancho M (1998) Study of the diagnostic value of strontium, chloride, haemoglobin and diatoms in immersion cases. Forensic Sci Int 91(2):123–132
Azparren JE, Ortega A, Bueno H, Andreu M (2000) Blood strontium concentration related to the length of the agonal period in seawater drowning cases. Forensic Sci Int 108(1):51–60
Azparren JE, Fernandez-Rodriguez A, Vallejo G (2003) Diagnosing death by drowning in fresh water using blood strontium as an indicator. Forensic Sci Int 137(1):55–59
Azparren JE, Cubero C, Perucha E, Martínez P, Vallejo G (2007) Comparison between lung weight and blood strontium in bodies found in seawater. Forensic Sci Int 168(2):128–132
Azparren JE, Perucha E, Martínez P, Muñoz R, Vallejo G (2007) Factors affecting strontium absorption in drawings. Forensic Sci Int 168(2–3):138–142
Pérez-Cárceles MD, Sibón A, Gil del Castillo ML, Vizcaya MA, Osuna E, Casas T, Romero JL, Luna A (2008) Strontium levels in different causes of death: diagnostic efficacy in drowning. Biol Trace Elem Res 126(1–3):27–37
Papadodima SA, Athanaselis SA, Skliros E, Spiliopoulou CA (2009) Forensic investigation of submersion deaths. Int J Clin Pract 64(1):75–83
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The authors are grateful to the anonymous reviewers, whose constructive and useful comments improved the quality of the article.
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Palmiere, C., Mangin, P. Postmortem chemistry update part I. Int J Legal Med 126, 187–198 (2012). https://doi.org/10.1007/s00414-011-0625-y
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DOI: https://doi.org/10.1007/s00414-011-0625-y