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Vanhaebost J, Palmiere C, Scarpelli MP, Bou Abdallah F, Capron A, Schmit G. Postmortem diagnosis of hyponatremia: case report and literature review. Int J Legal Med 2017; 132:173-179. [PMID: 28503702 DOI: 10.1007/s00414-017-1601-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 01/06/2023]
Abstract
Hyponatremia is defined as a plasma sodium concentration less than 135 or 130 mEq/L (or mmol/L) and may be responsible for life threatening symptoms that can be observed in a variety of medical conditions. Cases of fatal hyponatremia have been reported in both clinical and forensic literature in situations of water intoxication due to psychogenic polydipsia, amphetamine derivative drug intake, high-endurance exercise, iatrogenic causes, and exceptional cases of child abuse by forced water intoxication. Vitreous sodium levels have been determined to be relatively stable during the early postmortem period and similar to levels found in normal serum of living subjects. Nevertheless, there are relatively few cases of fatal hyponatremia described in literature that underwent exhaustive postmortem biochemical investigations. A case of fatal water intoxication in a psychiatric patient who underwent medicolegal investigations, including postmortem biochemistry, was chosen as a starting point to a literature review of deaths by hyponatremia that may be encountered in the forensic setting.
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Affiliation(s)
- Jessica Vanhaebost
- Service d'Anatomie Pathologique et Médecine Légale, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.
| | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Fabiola Bou Abdallah
- University Paris-Descartes, Laboratory of Medical Ethics and Forensic Medicine, Paris, France
| | - Arnaud Capron
- Clinical Chemistry Department, Cliniques Universitaires St Luc, Brussels, Belgium.,Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, UCL, Brussels, Belgium
| | - Gregory Schmit
- Service d'Anatomie Pathologique et Médecine Légale, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Affiliation(s)
- Xiulu Ruan
- 1 Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Jin J Luo
- 2 Temple University School of Medicine, Philadelphia, PA, USA
| | - Alan D Kaye
- 1 Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA, USA
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Radojevic N, Bjelogrlic B, Aleksic V, Rancic N, Samardzic M, Petkovic S, Savic S. Forensic aspects of water intoxication: four case reports and review of relevant literature. Forensic Sci Int 2012; 220:1-5. [PMID: 22306188 DOI: 10.1016/j.forsciint.2012.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 11/29/2022]
Abstract
Water intoxication (WI) is a rare condition that originates from over-consumption of water, with a potentially fatal outcome. Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI. We present four case reports of WI. Two of them are unusual pediatric clinical cases using medical documentation and police case files, one of which is related to child abuse, and the other to a psychiatric disorder. The other two cases are fatal adult cases submitted to autopsy from a psychiatric hospital. Also, we present a diagnostic algorithm for polydipsia and polyuria before death. WI is usually seen in patients with psychiatric disorders, victims of child abuse or torture, drug abusers or it can be iatrogenically induced.
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Affiliation(s)
- Nemanja Radojevic
- Department of Forensic Medicine, Clinical Centre of Montenegro, Podgorica, Montenegro.
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Palmiere C, Mangin P. Postmortem chemistry update part I. Int J Legal Med 2011; 126:187-98. [PMID: 21947676 DOI: 10.1007/s00414-011-0625-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/09/2011] [Indexed: 11/30/2022]
Abstract
Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.
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Affiliation(s)
- Cristian Palmiere
- University Centre of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
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Dinis-Oliveira RJ, Carvalho F, Duarte JA, Remião F, Marques A, Santos A, Magalhães T. Collection of biological samples in forensic toxicology. Toxicol Mech Methods 2010; 20:363-414. [PMID: 20615091 DOI: 10.3109/15376516.2010.497976] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Forensic toxicology is the study and practice of the application of toxicology to the purposes of the law. The relevance of any finding is determined, in the first instance, by the nature and integrity of the specimen(s) submitted for analysis. This means that there are several specific challenges to select and collect specimens for ante-mortem and post-mortem toxicology investigation. Post-mortem specimens may be numerous and can endow some special difficulties compared to clinical specimens, namely those resulting from autolytic and putrefactive changes. Storage stability is also an important issue to be considered during the pre-analytic phase, since its consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample. The knowledge on degradation mechanisms and methods to increase storage stability may enable the forensic toxicologist to circumvent possible difficulties. Therefore, advantages and limitations of specimen preservation procedures are thoroughfully discussed in this review. Presently, harmonized protocols for sampling in suspected intoxications would have obvious utility. In the present article an overview is given on sampling procedures for routinely collected specimens as well as on alternative specimens that may provide additional information on the route and timing of exposure to a specific xenobiotic. Last, but not least, a discussion on possible bias that can influence the interpretation of toxicological results is provided. This comprehensive review article is intented as a significant help for forensic toxicologists to accomplish their frequently overwhelming mission.
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Affiliation(s)
- R J Dinis-Oliveira
- Institute of Legal Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
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6
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Hypotone Hyperhydratation. Rechtsmedizin (Berl) 2010. [DOI: 10.1007/s00194-010-0681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hayashi T, Ishida Y, Miyashita T, Kiyokawa H, Kimura A, Kondo T. Fatal water intoxication in a schizophrenic patient--an autopsy case. ACTA ACUST UNITED AC 2005; 12:157-9. [PMID: 15914312 DOI: 10.1016/j.jcfm.2005.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of fatal water intoxication due to polydipsia. A 69-year-old schizophrenic male was found dead at his room of the hospital in which he had been admitted. Medico-legal autopsy was carried out to determine the cause of his death. The autopsy revealed no severe trauma leading him to the death. Internally, it was noticed that the stomach was vigorously expanded, including fluid contents. Intracardiac blood, being dark-red in color, seemed to be diluted. The both lungs ballooned aqueously, showing apparently edema. However, there was neither macroscopic nor histopathological lesion, being responsible for his death. Postmortem biochemical analyses revealed severe hyponatremia of 92 mEq/ml. In cases with short postmortem interval, serum sodium level almost similarly reflected antemortem level. According to his psychiatric doctor, he had been diagnosed as water intoxication due to polydipsia. Moreover, at 2 h before the discovery of his body, he had been found to drink much running water. It was concluded the cause of his death as fatal water intoxication.
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Affiliation(s)
- Takahito Hayashi
- Department of Forensic Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
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Abstract
Water intoxication during pregnancy is an uncommon event, usually associated with iatrogenic fluid overload, the prolonged administration of high doses of oxytocin or psychiatric disorder. This case report describes water intoxication presenting as the sudden onset of grand mal convulsions in the immediate postpartum period, after a normal delivery in a healthy parturient. The most likely explanation was an excessive voluntary ingestion of large quantities of water and hypotonic fluids during labour.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Australia
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Affiliation(s)
- D J Farrell
- Department of Histopathology, Torbay Hospital, Lawes Bridge, Torquay, Devon, TQ2 7AA, UK;
| | - L Bower
- Department of Clinical Chemistry, Torbay Hospital
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Hédouin V, Révuelta E, Bécart A, Tournel G, Deveaux M, Gosset D. A case of fatal salt water intoxication following an exorcism session. Forensic Sci Int 1999; 99:1-4. [PMID: 10069018 DOI: 10.1016/s0379-0738(98)00179-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In response to a recent article published in this review, we present in this paper, an unusual case of fatal salt water intoxication. In this case, we point out three special features, the type of water ingested, the physiopathologic consequences of the ingestion and the very strange context of occurrence. This complex case allows us to point out complications due to salt poisoning and others caused by water intoxication.
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Affiliation(s)
- V Hédouin
- Service de Médecine Légale et Pénitentiaire, CHRU de Lille, Hôpital Salengro, France
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