Postmortem chemistry

Clinical chemistry results are often decisive in the clinical management of both hospitalized patients and out-patients to determine various aspects of their health. Postmortem changes make these analyses either impossible to carry out or their results otherwise difficult to interpret. Most of the problems are related to the lack of reference information regarding concentrations of different analytes in postmortem samples from subjects with well-characterized medical conditions immediately prior to death. Hence, at the Department of Forensic Medicine in Stockholm, a small portion of vitreous fluid has been collected consistently immediately upon arrival to the morgue or at the earliest possible convenience after arrival, and all samples have been subject to an immediate analysis with a blood gas instrument. Using this strategy, we have established reference levels for vitreous glucose, sodium and chloride that can be used to identify fatal hyperglycemia, and serious salt imbalances. We have also developed a model for time of death estimation using vitreous potassium levels: https://slbd.shinyapps.io/pmiPredictor/

We plan to evaluate the postmortem applicability of select clinical chemistry analyses which can be performed as bedside (POC) tests. These studies aim at identifying such tests that can provide rapid information about serious medical conditions before the autopsy is completed. This can improve the decision-making for the pathologists in the postmortem casework.