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Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

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Abstract

In continuation to part I, a literature review is presented concerning biochemical problems of forensic post mortem cases of unclear hyperglycaemia or hypoglycaemia. Clinical parameters for this purpose were recently reviewed. Particular attention was paid to the detection of diabetic ketoacidosis, of hyperosmolar coma, insulinoma, insulin-induced or oral diabetic-induced hypoglycaemia. The second part of the review discusses the analytes ketone bodies, synthetic insulins, human insulin, C-peptide, proinsulin and insulin antibodies. Special interest is given to post mortem matrices for those analytes to reference concentrations, stability data, analytic interferences and analytical procedures which should be used in toxicological laboratories willing to detect diabetic metabolism disorders after death.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany

    Frank Musshoff, Cornelius Hess & Burkhard Madea

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  1. Frank Musshoff
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  2. Cornelius Hess
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  3. Burkhard Madea
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Correspondence to Cornelius Hess.

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Both Frank Musshoff and Cornelius Hess contributed equally to this work.

Electronic supplementary material

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Part 2 Online resource 1

Reference ranges of ketone bodies in blood and collectives of deaths due to diabetic ketoacidosis post-mortem (Mv mean value) (DOC 66.5 kb)

Part 2 Online resource 2

Three chromatograms of (1) free acetone, (2) sum of acetone + acetoacetate and (3) sum of acetone + acetoacetate + β-OHB (DOC 56 kb)

Part 2 Online resource 3

Primary structures of human insulin (a) and its synthetic analogues insulin lispro (Humalog®, b), insulin aspart (Novomix®, c), insulin glargine (Lantus®, d), insulin glulisine (Apidra®, e) and insulin detemir (Levemir®, f) (DOC 100 kb)

Part 2 Online resource 4

Onset of action, peak of action and duration of action of regular and synthetic insulins sold on the market [22, 136, 136] (DOC 15 kb)

Part 2 Online resource 5

Levels of insulin, proinsulin, C-peptide, insulin antibodies and sulfonylureas to differentiate between insulinoma and insulin/sulphonylurea intoxication (DOC 28 kb)

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Musshoff, F., Hess, C. & Madea, B. Disorders of glucose metabolism: post mortem analyses in forensic cases–part II. Int J Legal Med 125, 171–180 (2011). https://doi.org/10.1007/s00414-010-0510-0

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