Biochemical markers of fatal hypothermia

Biochemical

markers

of

fatal

hypothermia

Cristian

Palmiere

*

,

Daniel

Bardy

,

Igor

Letovanec

,

Patrice

Mangin

,

Marc

Augsburger

,

Francesco

Ventura

,

Katia

Iglesias

,

Dominique

Werner

a

UniversityCenterofLegalMedicine,UniversityofLausanne,RueduBugnon21,1011Lausanne,Switzerland

b

LaboratoryofClinicalChemistry,LausanneUniversityHospital,1011Lausanne,Switzerland

c

UniversityInstituteofPathology,LausanneUniversityHospital,1011Lausanne,Switzerland

d_{DepartmentofLegalMedicine,UniversityofGenova,ViadeToni12,16132Genova,Italy}

e_{InstituteofSocialandPreventiveMedicine,LausanneUniversityHospital,RueduBugnon17,1004Lausanne,Switzerland}

1. Introduction

Thepostmortemdiagnosisofhypothermiaremainsdifficultto

ascertaintoday, despite progressmade duringthe past several

decadesinthe realmof forensic pathology [1,2]. Thefollowing

autopsy findingshave been proposedas indicative of death by

hypothermia: frost erythema in certain body areas (extensor

surfacesandlargejointssuchastheouterhiparea,elbows,knees

and, less often, on the flanks and face), bright red lividity,

hemorrhagicspotsofthegastricand,lessfrequently,duodenaland

jejunal mucosa, pancreatic hemorrhages, synovial membrane

hemorrhages,bloodydiscolorationofsynovialfluid,signsofacute

pancreatitisandhemorrhagesintothelargemusclesofthebody,

especially the iliopsoas muscle [3–10]. Histological findings,

includingfattydegenerationoftherenaltubularepitheliumcells,

cardiac myocytes and hepatocytes, as wellas vacuolization of

pancreatic,hepatic, renal, adrenal and anterior pituitary gland

cells, have alsobeen observedin association withhypothermia

fatalities [11–19].

Additionally, increasesordecreases in theimmunopositivity

rate for some markers in thehypothalamus, anterior pituitary

gland, adrenal medulla, midbrain periaqueductal gray matter,

renaltubularepithelialcellsandglomerularpodocyteshavebeen

notedinthese cases [20–25].

External and internal observations, both macroscopic and

microscopic, can be of diagnostic significance when found

concurrently,thoughtheyprovenon-specificasexclusivefindings

inthemselves.Frosterythemaandgastrichemorrhages

(Wisch-newskyspots),for instance,have beenproposed asspecificfor

hypothermia when appearing concomitantly. Furthermore, a

strong correlation with such macroscopic findings has been

describedforthefattydegenerationoftherenaltubularepithelium

cells [8]. Nonetheless, the diagnosis of death by hypothermia

remainsamedleyofobservationsincludingasignificanthistoryof

exposuretocold,non-specificpathologicalfindingswhenpresent

andtheabsenceofothercausesofdeathbasedonallpostmortem

findings.

Beyond histology and immunohistochemistry, postmortem

biochemical investigations in relationto hypothermia fatalities

have been carried out over the years. The first reports were

publishedbyMant[26,27]and focusedon vitreousmagnesium

valuesin aseriesofhypothermiafatalitiesandacontrolgroup.

Thereafter, numerous researchers have shown interest in the

postmortembiochemistryrelatedtohypothermiafatalitieswith

Keywords:

Hypothermia; Postmortembiochemistry; Biochemicalmarkers; Ketonebodies; Blood ABSTRACT

Theaimofthisstudywastoinvestigatetheusefulnessofpostmortembiochemicalinvestigationsinthe diagnosisoffatalhypothermia.10casesoffatal hypothermiaand30controlcaseswereselected.Aseries ofbiochemicalparameters,suchasglucose,acetone,3-beta-hydroxybutyrate,isopropylalcohol,free fattyacids,adrenaline,growthhormone,adrenocorticotropichormone,thyroid-stimulatinghormone, cortisol,calcium,magnesium,C-reactiveprotein, procalcitoninaswellasmarkersofrenalandcardiac functionsweremeasuredinblood,postmortemserumfromfemoralblood,urine,vitreousand pericardial fluid.Theresultssuggestedthatdeathsduetohypothermia,especiallyinfree-ethanolcases, arecharacterizedbyincreasedketonelevelsinbloodandother biologicalfluids,increasedadrenaline concentrationsinurine,increasedcortisollevelsinpostmortemserumfromfemoralbloodandincreased freecortisol valuesinurine.Increasedordecreasedlevelsofotherbiologicalparametersareeitherthe resultofterminalmetabolicchangesortheexpressionofpreexisting diseasesandmayprovide informationtoelucidatethedeathprocessonacase-by-casebasis.

* Correspondingauthor.Tel.:+410213144961;fax:+410213147090; mobile:+41795566989.

E-mailaddress:cristian.palmiere@chuv.ch(C.Palmiere).

1

Published in Forensic Science International 226, issues 1-3, 54–61, 2013

which should be used for any reference to this work