On the diagnosis of hypoglycemia in car drivers--including a review of the literature

Hypoglycaemia: insulin and conflicts with the law

ypoglycaemia can bring patients into contact with the law in a variety of ways. It can be used as a defence against almost any criminal charge especially those involved with driving or with violence. It has also been used as an offensive weapon. Allegations of murder by insulin are easy to make but difficult to substantiate as methods of analysis that are appropriate for clinical use are not necessarily adequate for forensic purposes.

Sudden adult death

In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.