Elevated postmortem ethanol concentrations in an insulin-dependent diabetic

Area of Science:

• Forensic Pathology
• Toxicology
• Endocrinology

Background:

• A 54-year-old female with insulin-dependent diabetes mellitus was discovered deceased in her residence.
• The scene showed no signs of violence, but the body exhibited decomposition and a pool of blood near the head.

Observation:

• Autopsy revealed autolytic changes, with no immediate cause of death apparent.
• Toxicology screening was negative for common illicit drugs and opiates.
• Elevated alcohol (ethanol) and isopropanol levels were detected in postmortem samples, alongside acetone.

Findings:

• The official cause of death was determined to be metabolic acidosis secondary to diabetes mellitus.
• Postmortem bacterial production of ethanol was considered a potential explanation for the observed ethanol concentrations.

Implications:

• This case highlights the importance of considering postmortem changes in interpreting toxicology data.
• Accurate determination of cause of death in diabetic patients requires careful integration of clinical history, autopsy findings, and toxicology.
• Understanding postmortem ethanol production is crucial in forensic investigations involving decomposition.