RU2131700C1 - Method for diagnosing hyperglycemia coma in postmortem period - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining glucose quantity in vitreous body of the cadaver eye. The value being higher than 17 mmole/l, hyperglycemic coma in postmortem period is to be diagnosed. EFFECT: enhanced accuracy of diagnosis.

Description

 The invention relates to forensic science and biochemistry and can be used to establish the cause of death.

In forensic and pathological practice, there is a known method for diagnosing hyperglycemic coma in the post-mortal period by determining glucose in the blood of a corpse:
"Biochemical studies of cadaveric blood in the pathological and forensic diagnostics", guidelines, Moscow, 1977 and 1978

 Kachina N. N., “Determination of glucose in liquid blood and in a dry spot during forensic medical examinations” - materials of the III All-Russian Congress of Forensic Physicians, Saratov, 1992, p. 239-243.

The disadvantages of this method:
1. The lack of a range of temporary stability - the interval during which the biomedical parameter retains its functional specificity and uniqueness.

 The quantitative determination of glucose in the study of blood or blood serum in the post-mortal period does not reflect its true content at the time of death. After the onset of death, a steady decrease in the indicator is observed, up to the complete absence of glucose by the end of 2-3 days / Kachina N.N. "Posthumous assessment of glycemia in terms of glucose and glycosylated hemoglobin of blood" - forensic medical examination, 1991, N 4, p. 7-10 /.

 2. No noise immunity - parameter resistance as a result of the influence of factors of the external and internal environment.

 The decrease in blood glucose in the post-mortal period depends on the rate of metabolic processes in the blood cells, mainly in red blood cells, which, in turn, depends on the rate of cooling of the corpse, its storage conditions (low or high ambient temperature).

 3. The recommended method for examining cadaveric blood (from the femoral vein) is limited in connection with the above post-mortal period to 1 day. Most often, the autopsy, and therefore the collection of objects, and their investigation are carried out at a later date (2-3 days).

 4. Such a parameter as uniqueness is not always respected. The determination of glycemia by the level of glucose in cadaveric blood presents significant difficulties, since a wave-like character of the glucose content in the blood of living persons during the day is noted. Many factors influence the blood glucose level during life (food intake, its qualitative composition, stressful situations, physical activity, etc.). The features of the course of the agonal period, depending on the cause of death, also affect the level of glycemia. All of these factors can dramatically change the indicator both upward and downward.

 The invention is aimed at solving the problem, improving the accuracy and reliability of diagnosis.

 To solve this problem, the vitreous body of the eye is taken instead of blood as the object of study, since the glucose content in the vitreous does not depend on the duration of the post-mortal period.

 The method is as follows: the vitreous body of the eye of a corpse in a volume of 0.5 - 1.0 ml is taken with a disposable syringe. The puncture is carried out at the outer corner of the eye. The vitreous humor is centrifuged for 20 minutes in plastic tubes at 8,000 rpm in a TsLN-2 centrifuge. Quantitative determination of glucose in the vitreous fluid of the eye is carried out by the standard unified glucose oxidase method / Valakhovsky I.S. in the book. "Laboratory research methods in the clinic", ed. Menshikova V.V., 1987, p. 230 - 234 /.

 With a glucose content above 17 mmol / l, hyperglycemic coma is determined.

 Examples of specific performance.

 The glucose content was determined in the blood and vitreous body of 17 corpses of patients with diabetes mellitus. The post-mortal period ranged from 16 to 110 hours.

 In 5 corpses, the cause of death was a complication of the underlying disease - hyperglycemic coma. The glucose content in the vitreous in this group of patients averaged 36.08 ± 7.60 mmol / L (from 17.6 to 53.0 mmol / L).

 The rest died as a result of other causes of death (chronic coronary heart disease, burn disease, general hypothermia, hypertension, bronchial asthma, acute alcohol poisoning). The glucose content in the vitreous in this group averaged 2.43 ± 0.66 mmol / L (from 0.0 to 7.1 mmol / L).

 45 samples of the vitreous from corpses with various types of violent and non-violent death (control group) with a post-mortal period of 12 to 56 hours were also examined. The glucose content in the vitreous in this group was 0.39 ± 0.07 mmol / L (from 0.0 to 2.1 mmol / L). The blood serum glucose from the femoral vein in these corpses was within the normal range for cadaveric blood of 2.44 ± 0.34 mmol / L (from 0.0 to 10.0 mmol / L).

 Example 1. The deceased K., husband., 22 years old, the cause of death is diabetes mellitus, hyperglycemic coma.

 Death at home. During his life, he was registered about the disease.

 The post-mortal period is 16 hours.

 Serum glucose is 55.7 mmol / L.

 The glucose content in the vitreous is 38.3 mmol / L.

 Due to the short post-agonal period, a typically high blood glucose level is observed. In the vitreous body there is a sharp increase in glucose.

 The immediate cause of death is hyperglycemic coma.

 Example 2. Deceased S., husband., 60 years old, cause of death - diabetes mellitus, hyperglycemic coma.

 He was delivered from home to the hospital by the GSSP team in a state of hyperglycemic coma after an epileptic seizure. Death after 1.5 days. All the time was in a coma. The level of blood glucose during treatment in a hospital ranged from 12.5 to 22.6 mmol / L.

 Post-mortal period of 60 hours.

 Serum glucose is 0.0 mmol / L.

 Vitreous glucose 17.6 mmoll / L.

 Diagnosis was carried out according to clinical data. The absence of glucose in the blood is associated with a long post-mortal period and storage conditions of the corpse before the study. However, a high glucose level is observed in the vitreous.

 The immediate cause of death is hyperglycemic coma.

 Example 3. The deceased F., husband .. 51 years old, - the cause of death - general hypothermia of the body.

 GSCP brigade delivered to the intensive care unit in an unconscious state. It was discovered at the entrance of a residential building. He died without regaining consciousness after 2 days. During his life he suffered from diabetes.

 The post-mortal period is 43 hours.

 Serum glucose 0.7 mmol / L.

 Vitreous glucose is 2.4 mmol / L.

 In this example, a decrease in serum glucose is associated with post-mortal glucose utilization and corresponds to the normal glucose level in cadaveric blood. In the vitreous body, the glucose content is slightly increased in comparison with the "control" group.

 Hyperglycemic coma was not found.

 Example 4. Died A., female 70 years old, the cause of death is chronic coronary heart disease.

 She was taken to the hospital by the GSSP brigade from the scene of the fire with a diagnosis of carbon monoxide poisoning. I was treated for 4 days. Concomitant diseases: hypertension, diabetes mellitus, chronic coronary heart disease, arrhythmia.

 Death occurred suddenly during a meal (at dinner) as a result of a stop in blood circulation.

 The post-mortal period is 46 hours.

 Serum glucose is 23.2 mmol / L.

 Vitreous glucose is 7.1 mmol / L.

 It should be noted that the intravital level of glucose in the blood of the patient during treatment in the hospital ranged from 8.0 to 13.8 mmol / L.

 It should be noted that clinical tests are performed in whole blood. However, due to the thickening of blood in the post-mortal period, studies in cadaveric blood are carried out not in whole blood, but in blood serum. The glucose content in blood serum has a larger digital indicator than in whole blood.

 In this example, sharply increased serum glucose levels are associated primarily with food intake. Therefore, there is also an increased glucose content in the vitreous fluid compared with the "control" group, but below 17 mmol / L.

 Despite the high glucose content in biofluids, hyperglycemic coma is ruled out by clinical and forensic data.

 Positive effect.

 The studied parameter (glucose content in the vitreous body of the eye) remains valid for a long post-mortal period.

 When death as a result of hyperglycemic coma, a significantly increased glucose content in the vitreous body is noted, different from the glucose level in patients with diabetes mellitus with other causes of death (t = 4.411 p <0.001) and the control group (t = 4.966 p <0.001).

 The concentration of glucose in the vitreous body in a concentration exceeding 17 mmol / l is a specific marker indicating death due to hyperglycemic coma.

 The simplicity and low cost of determining glucose in the vitreous body allows for screening studies of suddenly died for the presence of hyperglycemic status.

Claims (1)

 A method for diagnosing hyperglycemic coma in the post-mortal period by examining the biological material of a corpse, characterized in that the quantity of glucose is determined in the vitreous body of the eye and, when it is higher than 17 mmol / l, hyperglycemic coma is diagnosed.