This blog will discuss anything related to the practice of forensic pathology. Topics will including recent articles in the medical literature, interesting cases in the news, TV forensics, and the general day to day things I have to deal with as a forensic pathologist. If there is something you want to know or have an idea for a topic, drop me a line. I am going to try and spend some time on histopathology with the hope of getting fellows ready for the boards!
Friday, April 22, 2011
What's the diagnosis April 22, 2011
Let's do something a bit different and give you all a break from the histo. What am I going to so with these vitreous electrolytes??
Na 130 mmol/L
Cl 110 mmol/L
VUN 30
Cr 2.0 mg/dl
Glucose 580 mg/dl
Ketones negative
This is my first time participating. As a new pathology resident I'm just beginning to learn about these things. I am interested in the fields of Forensics and Neuropath and was so excited to come across your blog!
Do you need the potassium level as a frame of reference?
Littlebrownbird, welcome and thanks for the comment!
Potassium is not helpful. It increases rapidly after death and it's virtually impossible to find any meaning in it's value (unless it is very very low). Our lab doesn't even report K levels.
Zzeva, the PMI is about 24 hours. If you look at the values, you'll see the ketones are negative!
As for HbA1C, it can be done postmortem, but I've never seen it done, nor can I think of a circumstance when it would be helpful. I don't really care about how well his glucose was controlled, it doesn't affect the cause or the manner or death. Clinically, it's interesting, and if he were alive and I were an internist, then I would be interested, but not so much at autopsy.
The answer: these values are a good example of what you'll see with non-ketotic hyperosmolar diabetic coma, which is how this case was signed out.
I use vit chemistry quite a bit. I always order vit electrolytes on people with no medical history who die suddenly and on obese people. I will tell you, I frequently get a positive result. Over the past few years I've been doing this, I have been amazed at how common undiagnosed diabetes is!
Hello,
ReplyDeleteThis is my first time participating. As a new pathology resident I'm just beginning to learn about these things. I am interested in the fields of Forensics and Neuropath and was so excited to come across your blog!
Do you need the potassium level as a frame of reference?
When did you sample this(how long have been after the death)?
ReplyDeleteAnyway, How about HbA1C?
and an aketotic form?
Littlebrownbird, welcome and thanks for the comment!
ReplyDeletePotassium is not helpful. It increases rapidly after death and it's virtually impossible to find any meaning in it's value (unless it is very very low). Our lab doesn't even report K levels.
Zzeva, the PMI is about 24 hours. If you look at the values, you'll see the ketones are negative!
ReplyDeleteAs for HbA1C, it can be done postmortem, but I've never seen it done, nor can I think of a circumstance when it would be helpful. I don't really care about how well his glucose was controlled, it doesn't affect the cause or the manner or death. Clinically, it's interesting, and if he were alive and I were an internist, then I would be interested, but not so much at autopsy.
The answer: these values are a good example of what you'll see with non-ketotic hyperosmolar diabetic coma, which is how this case was signed out.
ReplyDeleteI use vit chemistry quite a bit. I always order vit electrolytes on people with no medical history who die suddenly and on obese people. I will tell you, I frequently get a positive result. Over the past few years I've been doing this, I have been amazed at how common undiagnosed diabetes is!