BONSIGNORE A., MD* SBLANO S., PALMIERE C., La biochimica forense: stato dell’arte, prospettive future e presentazione di un caso di responsabilità professionale medica.

BONSIGNORE A. (*), SBLANO S. (**), PALMIERE C. (***)

La biochimica forense: stato dell’arte, prospettive future e presentazione di un caso di responsabilità professionale medica

(*) Sezione Dipartimentale di Medicina Legale, Università degli Studi di Genova, Via De Toni 12, 16132, Genova, Italia; (**) Sezione Dipartimentale di Medicina Legale, Università di Bari “Aldo Moro”, Piazza Giulio Cesare 1, 70124, Bari, Italia ; (***) University Center of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

Abstract :  Post-mortem biochemistry: state of the art, possible applications and illustration of a case of medical liability.

The aim of this work is to share with the scientific community the usefulness of post-mortem biochemistry as a complementary tool in forensic practice.

The authors illustrate a practical application of this discipline presenting a case in which biochemical analysis of blood and vitreous obtained from the body resulted as fundamental in order to reach the more complete understanding of the pathophysiological mechanisms that may be involved in the death process and, consequently, properly answer about Public Prosecutor’s questions concerning medical liability profiles.

Particularly, an autopsy case involving a 70 year-old-woman suffering from diabetes mellitus and impaired renal function who received metformin treatment is described.

Metformin is an oral anti-hyperglycemic agent used in the management of type 2 diabetes mellitus, and it is eliminated by the kidneys. Lactic acidosis from metformin overdose is a rare complication of metformin therapy and occurs infrequently with therapeutic use. Fatal cases, both accidental and intentional, are extremely rare in clinical practice.

In the presented case metformin concentrations in peripheral blood collected during hospitalization and femoral blood collected during autopsy were 42 µg/ml and 47.3 µg/ml respectively. Lactic acidosis (29.10 mmol/l) was objectified during hospitalization. Furthermore, post-mortem biochemistry allowed ketoacidosis to be diagnosed (blood β-hydroxybutyrate 10500 µmol/l). Death was attributed to lactic acidosis due to metformin intoxication. Increased plasma concentrations of the drug were attributed to severely impaired renal function. Accordingly, the forensic investigations led to the accused clinicians being considered guilty of manslaughter by the Public Prosecutor.

Keywords: Metformin-associated lactic acidosis, Fatal intoxication, Post-mortem Biochemistry, Medical Liability

 

Riassunto: Scopo del presente contributo è quello di condividere con la comunità scientifica l’utilità della biochimica post-mortem quale strumento di indagine nella pratica forense.

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