Deadside analysis

Clinical chemistry results are often decisive in the clinical management of both hospitalized patients and in out-patient care for decisions regarding management and treatment measures. Postmortem changes make some of these analyses either impossible to carry out or make the results difficult to interpret. Hence, there is a need for postmortem reference intervals for a large number of analyses which could assist in identifying severe medical conditions. At the department of forensic medicine in Stockholm, we have collected vitreous fluid upon arrival of deceased to the morgue and analyzed the samples 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 with regular instrumentation, but also as rapid tests, hence the designation deadside analysis. We will take advantage of the access to the internal organs, allowing for analysis of homogenates of tissues where possible pathologies exist. This strategy will add diagnostic information that can be available for the pathologist´s decision-making during the autopsy and provide guidance in the postmortem casework.

PI: Henrik Druid, henrik.druid@ki.se