Erosive gastritis, Armanni-Ebstein phenomenon and diabetic ketoacidosis.

Forensic Science, Medicine, and Pathology
Roger W Byard, Chong Zhou

Abstract

The Armanni-Ebstein phenomenon, which is found in the kidneys in diabetic ketoacidosis, has also been proposed as an independent diagnostic postmortem marker for hypothermia. A case is reported to demonstrate the possibility of a more complex inter-related etiology in certain instances. A 44-year-old man with a past history of hospital admission for hypothermia, alcoholism and insulin dependent diabetes mellitus was found dead at his home address. At autopsy there were prominent superficial erosive gastritis (Wischnewsky spots) in keeping with terminal hypothermia. In addition there was also marked cortical pallor of the kidneys due to subnuclear renal tubular epithelial vacuolization (Armanni-Ebstein phenomenon). Thus there was evidence for both hypothermia and Armanni-Ebstein phenomenon, suggesting a relationship. Subsequent biochemical testing of vitreous humor, however, demonstrated markedly elevated levels of glucose (36.5 mmol/l; N = 3.6-6.0 mmol/l), β-hydroxybutyrate (23.2 mmol/l; N < 0.3 mmol/l), and lactate (29.4 mmol/l; N = 0.2-2.0 mmol/l). Death was, therefore, due to diabetic ketoacidosis complicated by hypothermia. Diabetes mellitus has a known association with both hypothermia and Armanni-Ebstein phenomenon, thus,...Continue Reading

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Citations

Jul 10, 2012·International Journal of Legal Medicine·Cristian Palmiere, Patrice Mangin
Nov 2, 2012·Current Diabetes Reports·Devin W SteenkampMarie E McDonnell
Oct 5, 2010·Forensic Science, Medicine, and Pathology·Roger W Byard
May 16, 2012·Forensic Science, Medicine, and Pathology·Fiona BrightRoger W Byard
Jan 15, 2013·Forensic Science International : Synergy·Cristian PalmiereDominique Werner
Sep 30, 2010·Forensic Science International : Synergy·Chong Zhou, Roger W Byard
Mar 16, 2013·Journal of Forensic Sciences·Chong ZhouRoger W Byard
Nov 15, 2011·Journal of Forensic Sciences·Chong Zhou, Roger W Byard
Jan 25, 2019·The American Journal of Forensic Medicine and Pathology·Sinead McCarthyRexson Tse
Jan 3, 2020·The American Journal of Forensic Medicine and Pathology·Jack GarlandRexson Tse

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