Loading...
Adult hypoglycaemia; a narrative review on forensic aspects
Marks, Vincent Gama, Rousseau
Marks, Vincent
Gama, Rousseau
Authors
Editors
Other contributors
Affiliation
Epub Date
Issue Date
2021-04-30
Submitted date
Files
Alternative
Abstract
Forensic hypoglycaemia describes interactions between hypoglycaemia and the law. Hypoglycaemia, or more correctly the neuroglycopenia and associated temporary brain malfunction, may result in a state of automatism during which sufferers are absolved, in law, from responsibility for what would otherwise be a criminal offence. Courts consider hypoglycaemia beyond the experience of the layman and consequently require an expert to explain what it is and how it affects behaviour. Experts on hypoglycaemia are few reflecting the rarity with which hypoglycaemia occurs in all except patients with diabetes treated with hypoglycaemic agents. Experts on hypoglycaemia are drawn from a number of disciplines, toxicology, pharmacology, internal medicine, forensic pathology, endocrinology and clinical biochemistry of which the last three are the most important in the forensic context. Death from hypoglycaemia may be due either to natural underlying causes or from the hypoglycaemia. Hypoglycaemia is produced by accidental or malicious administration of hypoglycaemic agents of which insulin is the commonest. The purported victim may be alive or dead when first brought to medical attention. In the former, investigation is essentially the same as for any case of spontaneous hypoglycaemia. Investigation of suspected death from hypoglycaemia requires collaboration between a forensic pathologist and either a toxicologist or clinical biochemist. The post mortem measurement of blood glucose is of little or no value in the investigation of hypoglycaemia whereas detection and quantification of the pancreatic hormones insulin, C-peptide and proinsulin, preferably by liquid chromatography/mass-spectrometry (LC-MS), is essential. Vitreous humour is most useful fluid for analysis as all three hormones remain measurable for several days after death from insulin poisoning unlike in serum from peripheral blood. Biochemical and immunohistological analysis of tissue surrounding a suspected injection site, if identified, is also valuable.
Citation
Marks, V. and Gama, R. (2021) Adult hypoglycaemia; a narrative review on forensic aspects. Journal of Laboratory and Precision Medicine, 6: 11.
Publisher
Research Unit
PubMed ID
PubMed Central ID
Embedded videos
Additional Links
Type
Journal article
Language
en
Description
© 2021. Published by AME Publishing Company. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://jlpm.amegroups.com/article/view/5995/html
Series/Report no.
ISSN
2519-9005
EISSN
2519-9005