Navigation/Menü: Links auf weitere Seiten dieser Website
Objekt-Metadaten
| Zur postmortalen Diagnose von Störungen des Kohlenhydratstoffwechsels Schibel, Natalia |
| Main title | Zur postmortalen Diagnose von Störungen des Kohlenhydratstoffwechsels |
| Title variations | A study about the postmortem diagnosis of disorders of the carbohydrate metabolism |
| Author(s) | Schibel, Natalia
Place of birth: Swetlyje Gory/Moskau Russland |
| 1. Referee | Prof. Dr. Dr. h. c. F. Pragst |
| Further Referee(s) | Priv.-Doz. Dr. med. M. Pirlich Priv.-Doz. Dr. F. Mußhoff |
| Keywords | Coma diabeticum Insulinintoxication Hypoglycemia antidiabetics |
| Classification (DDC) | 610 Medical sciences; Medicine |
| Summary | Acute complications of diabetes mellitus like diabetic ketoacidosis and hyperosmolar coma, as well as hypoglycemia can lead to death if not adequately treated. The later detection of the lethal glycometabolic imbalance is complicated by postmortem changes of the biochemical parameters. In this study an approach to the postmortem diagnosis position was compiled by based on the evaluation of the literature and on own investigations. In the own investigations, the autopsy protocols, as well as the toxicological expertises of 74 cases with a hyperglycemic derangement, 19 cases with a not confirmed suspicion on a diabetic coma and 10 cases with a hypolycemia were included which were autopsied in the Institute of Legal Medicine of the Charite Berlin. The morphological organ changes and the biochemical parameters were shown in detail. Glucose and lactate were measured in liquor and in vitreous humor and the sum concentration of both was calculated according to Traub. The average of this sum value in liquor in of the diabetic coma cases was 617,9 mg/dl, and in the vitreous humor 568,7 mg/dl. Therefore, they were well above the limits of 362 mg/dl and 415 mg/dl described in literature. In the group of the death with not confirmed suspicion of a diabetic coma the average of this concentration sum was 216 mg/dl in liquor and 220,3 mg/dl in vitreous humor an therefore clearly under the limit value. All hypoglycemia cases were caused by an external insulin administration. The measured insulin concentration in blood ranged between <2 and 229 µIE/ml. In one case 13990 µIE/ml were measured in the tissues of the injection area. Between 1991 and 2003 merely glibenclamid was detected in only two cases by a HPLC-DAD-screening for oral antidiabetics in the Institute of Legal Medicine of the Charite. The concentrations were in both cases in the therapeutic range. Morphological organ changes were found in 79 cases. Pancreas fibrosis and atrophy in 66% as well as glomerulosclerosis in 27% of the cases proved to bi diabetes-specific symptoms. General arteriosclerosis existed in 77% of the cases. In 71% a brain edema was ascertained, this can point to a diabetic coma. Stomach mucous membrane erosions in 24% and a lung edema in 26% of the investigated cases were found as unspecific coma complications. |
| Documents |
FUDISS_derivate_000000003395
If your browser can't open the file, please download the file first and then open it
|
| FU Department | Department of Medicine - Charité - University Medicine Berlin |
| Year of publication | 2007 |
| Document type | Doctoral thesis |
| Media type/Format | Text |
| Language | German |
| Terms of use/Rights | Nutzungsbedingungen |
| Date of defense | 2008-02-22 |
| Created at | 2007-11-30 : 12:00:00 |
| Last changed | 2010-02-19 : 10:24:49 |
| Old Darwin URL | http://www.diss.fu-berlin.de/2007/816/ |
| Static URL | http://www.diss.fu-berlin.de/diss/receive/FUDISS_thesis_000000003395 |
| NBN | urn:nbn:de:kobv:188-fudissthesis000000003395-9 |
| Statistics | |
