ISSN: 0022-1198
CODEN: JFSCA
Page Count: 4

Postmortem Diagnosis of Unsuspected Diabetes Mellitus Established by Determination of Decedent's Hemoglobin A1c Level
Robinson, CA
Division of Laboratory Medicine, University of Alabama at Birmingham, AL

Khuu, HM
Division of Laboratory Medicine, University of Alabama at Birmingham, AL

Konrad, RJ
Division of Laboratory Medicine, University of Alabama at Birmingham, AL

Brissie, RM
Division of Laboratory Medicine, University of Alabama at Birmingham, AL

(Received 30 June 1998; accepted 22 September 1998)

Abstract

Although approximately 15.7 million Americans have diabetes mellitus, with the vast majority having type 2 diabetes, it is estimated that as many as 5.4 million are undiagnosed. The present case illustrates that undiagnosed diabetes can be a factor in otherwise unexplained deaths. A 39-year-old white male with no significant past medical history other than alcohol abuse was found deceased at his residence. The manner of death appeared to be natural, but no anatomic cause was found. Toxicological analysis revealed a blood ethanol level of 0.02 g/dL and was negative for drugs of abuse. Analysis of the vitreous fluid revealed a glucose level of 502 mg/dL. The blood glucose level was 499 mg/dL, and the hemoglobin A1c (HbA1c) level was 10.6%. Only trace urine ketones were detected, suggesting that the death was the result of hyperglycemic hyperosmolar non-ketosis (HHNK) from unsuspected diabetes. The postmortem HbA1c value serves as a definitive indicator of prolonged hyperglycemia. In order to aid the interpretation of the clinical data, this case is discussed in conjunction with a similar case of a known diabetic patient.

Keywords:
forensic science, hemoglobin A1c, diabetes

Paper ID: JFS14524J
DOI: 10.1520/JFS14524J
ASTM International is a member of CrossRef.