{"title":"对 29 例胰岛素过量致死病例的回顾性研究","authors":"Yuhao Yuan , Zhonghao Yu , Fang Tong, Shuquan Zhao, Yiling Li, Qing Shi, Yiwu Zhou","doi":"10.1016/j.forsciint.2024.112126","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases.</p></div><div><h3>Methods</h3><p>Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis.</p></div><div><h3>Results</h3><p>Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning.</p></div><div><h3>Conclusion</h3><p>Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation.</p></div>","PeriodicalId":12341,"journal":{"name":"Forensic science international","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A retrospective study of 29 fatal cases of insulin overdose\",\"authors\":\"Yuhao Yuan , Zhonghao Yu , Fang Tong, Shuquan Zhao, Yiling Li, Qing Shi, Yiwu Zhou\",\"doi\":\"10.1016/j.forsciint.2024.112126\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases.</p></div><div><h3>Methods</h3><p>Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis.</p></div><div><h3>Results</h3><p>Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning.</p></div><div><h3>Conclusion</h3><p>Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation.</p></div>\",\"PeriodicalId\":12341,\"journal\":{\"name\":\"Forensic science international\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Forensic science international\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S037907382400207X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, LEGAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Forensic science international","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S037907382400207X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, LEGAL","Score":null,"Total":0}
引用次数: 0
摘要
目的总结国内外近期发生的胰岛素过量致死中毒案例,从而为胰岛素过量致死案例的法医鉴定提供有价值的见解。方法对2000年以来发表的有关胰岛素过量致死的文献进行系统检索和筛选。结果在29例胰岛素中毒死亡病例中,自杀和他杀分别占55.2%和41.4%。34.5%的受害者或肇事者与医疗行业有关,27.6%患有糖尿病,24.1%患有抑郁症等精神疾病。静脉注射比皮下注射更容易导致死亡。在某些病例中,对注射部位的胰岛素和质胺进行免疫组化染色的结果呈阳性。死后血液中胰岛素与 C 肽的平均摩尔比为 13.76 ± 5.167,表明对胰岛素中毒具有重要的诊断价值。结论对胰岛素过量致死病例的评估应全面,包括病例调查、现场检查、病历审查、尸检结果、病理检查和实验室检测,同时考虑尸体状况和死亡尸检的时间。使用质谱仪检测胰岛素证明很有价值,尤其是在尸体保存不善的情况下。
A retrospective study of 29 fatal cases of insulin overdose
Purpose
To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases.
Methods
Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis.
Results
Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning.
Conclusion
Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation.
期刊介绍:
Forensic Science International is the flagship journal in the prestigious Forensic Science International family, publishing the most innovative, cutting-edge, and influential contributions across the forensic sciences. Fields include: forensic pathology and histochemistry, chemistry, biochemistry and toxicology, biology, serology, odontology, psychiatry, anthropology, digital forensics, the physical sciences, firearms, and document examination, as well as investigations of value to public health in its broadest sense, and the important marginal area where science and medicine interact with the law.
The journal publishes:
Case Reports
Commentaries
Letters to the Editor
Original Research Papers (Regular Papers)
Rapid Communications
Review Articles
Technical Notes.