RESUMO
Because of the lack of characteristic morphological findings post mortem diagnosis of diabetes mellitus and identification of diabetic coma can be complicated. 1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, competes with glucose for renal reabsorption. Therefore low serum concentrations of 1,5-AG, reflect hyperglycemic excursions over the prior 1-2 weeks in diabetic patients. Next to clinical applications determination of 1,5-AG can also be used in forensic analysis. To investigate the elimination of 1,5-AG, a liquid chromatographic-mass spectrometric method for the determination of 1,5-AG and creatinine in urine was developed and validated according to international guidelines. To evaluate ante mortem concentrations of 1,5-AG spot urine samples of 30 healthy subjects, 46 type 1 and 46 type 2 diabetic patients were analyzed. 1,5-AG urine concentrations of diabetic patients were significantly (p<0.001) lower (mean: 1.54µg/ml, n=92) compared to concentrations of healthy subjects (mean: 4.76µg/ml, n=30) which led to the idea that 1,5-AG urine concentrations post mortem might help in the interpretation of a diabetic coma post mortem. Urine of 47 deceased non-diabetics, 37 deceased diabetic and 9 cases of diabetic coma were measured. Comparison of blood and urine 1,5-AG concentrations in clinic samples (linear, R2=0.13) and forensic samples (linear, R2=0.02) showed no correlation. Urinary levels of 1,5-AG in deceased diabetic (mean 6.9µg/ml) and in non-diabetic patients (mean 6.3µg/ml) did not show a significant difference (p=0.752). However, urinary 1,5-AG concentrations in deceased due to diabetic coma (mean: 1.7µg/ml) were significantly lower than in non-diabetic (mean: 6.3µg/ml, p=0.039) and lower than in diabetic cases (mean: 4.7µg/ml, p=0.058). The determination of a reliable cut-off for the differentiation of diabetic to diabetic coma cases was not possible. Normalization of urinary 1,5-AG concentrations with the respective creatinine concentrations did not show any gain of information. In clinical (serum) and forensic blood samples a significant difference between all groups could be detected (p<0.05). Comparison of blood and urine 1,5-AG concentrations in clinical samples (linear, R2=0.13) and forensic samples (linear, R2=0.02) showed no correlation.
Assuntos
Desoxiglucose/urina , Diabetes Mellitus/urina , Coma Diabético/urina , Biomarcadores/sangue , Biomarcadores/urina , Cromatografia Líquida , Creatinina/sangue , Desoxiglucose/sangue , Diabetes Mellitus/sangue , Coma Diabético/sangue , Medicina Legal , Humanos , Espectrometria de Massas , Mudanças Depois da MorteAssuntos
Diabetes Mellitus Tipo 1/urina , Ácidos Dicarboxílicos/urina , Corpos Cetônicos/urina , Equilíbrio Ácido-Base , Caproatos/urina , Caprilatos/urina , Criança , Pré-Escolar , Cromatografia Gasosa , Diabetes Mellitus Tipo 1/tratamento farmacológico , Coma Diabético/urina , Feminino , Humanos , Insulina/uso terapêutico , Masculino , Espectrometria de Massas , Estado Pré-Diabético/urinaAssuntos
Captopril/uso terapêutico , Cetoacidose Diabética/diagnóstico , Corpos Cetônicos/urina , Coma Diabético/diagnóstico , Coma Diabético/urina , Cetoacidose Diabética/urina , Erros de Diagnóstico , Guias como Assunto , Humanos , Reprodutibilidade dos Testes , Urinálise/métodos , Urinálise/normasAssuntos
Coma Diabético/urina , Concentração Osmolar , Idoso , Coma Diabético/mortalidade , Feminino , HumanosRESUMO
These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California Medical Center, San Francisco. Taken from transcriptions, they are prepared by Drs. Martin J. Cline and Hibbard E. Williams, Assistant Professors of Medicine, under the direction of Dr. Lloyd H. Smith, Jr., Professor of Medicine and Chairman of the Department of Medicine.