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
References
Nov 18, 1978·British Medical Journal·E A Gale, R B Tattersall
Nov 1, 1987·Diabetes Care·J M GuerinJ M Segrestaa
Jul 1, 1988·Diabetes·A R ScottR B Tattersall
Aug 10, 1994·Forensic Science International : Synergy·K F Kock, V Vestergaard
Apr 22, 1999·Postgraduate Medical Journal·Y OzawaT Saruta
Apr 6, 2004·Forensic Science International : Synergy·J PreussB Madea
May 26, 2007·The American Journal of Forensic Medicine and Pathology·Roger W Byard, Michael Tsokos
Jan 20, 2010·Forensic Science, Medicine, and Pathology·Chong ZhouRoger W Byard
Feb 13, 2010·Forensic Science, Medicine, and Pathology·Elisabeth E Turk
Jul 7, 2011·Journal of Forensic Sciences·Neil B Hampson
Dec 1, 2006·Forensic Science, Medicine, and Pathology·Jørgen L ThomsenPeter D Ottosen
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
Aug 6, 2013·Journal of Forensic and Legal Medicine·Fiona BrightRoger W Byard
May 8, 2014·PloS One·Wulin TianGuanghong Xie
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
Dec 17, 2016·Journal of Forensic Sciences·Chong ZhouRoger W Byard
Feb 6, 2018·The American Journal of Forensic Medicine and Pathology·Rexson TseSimon Stables
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