Postmortem Chemical Changes in Pathological Conditionsa

Diseases or conditions

Body fluids analyzed

Interpretation

Acidosis and alkalosis Dehydration

Diabetes mellitus Endocrine disorders

Hepatic coma

Hyperglycemia

Hypoglycemia

Inborn errors of metabolismc Liver diseases (See also "Hepatic coma")

Low-salt pattern

Serum Vitreous

Vitreous

Serum and other body fluids

Cerebrospinal fluid

Serum, cerebrospinal fluid, and vitreous Blood Serum

Vitreous

Postmortem change unrelated to clinical disease Vitreous (decomposition pattern) Uremia Vitreous

Postmortem measurements of pH values probably not reliable. For ketoacidosis, see "Diabetes mellitus."

High sodium (>155 meq/L) and chloride (>135 meq/L) values with moderate increase (above 40 mg/dL) of urea nitrogen concentration.

High glucose (>200 mg/dL or >11.1 mmol/L) and ketone concentrations in diabetic ketoacidosis.

The concentration of many pituitary, adrenal cortical, and some other hormones reflects the antemortem values. Epinephrine and insulin are unstable.

Glutamine concentrations increased.

See "Diabetes mellitus."

No reliable way to diagnose hypoglycemia.

Abnormal metabolites are found.

Aminotransferases and other enzyme activities increase erratically after death and cannot be used for diagnosis. The albumin-globulin ratio can be estimated reliably.

Low sodium, chloride, and potassium concentrations common in fatty change or cirrhosis of the liver.

Low sodium and chloride concentrations but high potassium values (>20 mEq/L).

Marked increase of urea nitrogen and creatinine concentrations with sodium and chloride values near the normal range. (See also "Dehydration.")

b In alphabetical order.

Examples are maple syrup urine disease, methylmalonic acidemia, medium chain acyl-CoA dehydrogenase deficiency.

blocks (6). See also under "Immunohistochemistry" in Chapter 14 and below under "Polymerase chain reaction."

POLYMERASE CHAIN REACTION (PCR) This method has become a particularly powerful tool to study gene expression (7,8), viral antigen (9-11), as well as deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and proteins in other settings (2).

ATOMIC ABSORPTION SPECTROSCOPY This method, together with inductively coupled plasma emission spectros-copy and inductively coupled plasma mass spectroscopy has been used to analyze iron, copper, and other essential elements in fresh and formalin-fixed autopsy tissues (12).

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