atrial-natriuretic-factor and Hypothermia

Despite the progress made during the past several decades in forensic pathology, the possibilities for the postmortem diagnosis of hypothermia remains relatively limited. Aside from histology and immunohistochemistry, numerous authors have investigated the postmortem biochemistry of hypothermia fatalities. Several biochemical markers (e.g., glucose, electrolytes, hormones, ketone bodies, and neurotransmitters) and various biological samples (e.g., blood, urine, heart, liver, skeletal muscle as well as pericardial and cerebrospinal fluids) have been proposed as potentially useful markers to improve the insufficient diagnostic efficacy of macroscopic and microscopic findings. The aim of this article is to review the medicolegal literature covering the postmortem biochemical investigations that are associated with hypothermia cases as well as report our own research results on this topic where possible.

Topics: 2-Propanol; Atrial Natriuretic Factor; Biomarkers; Blood Urea Nitrogen; C-Reactive Protein; Catecholamines; Chromogranin A; Creatine Kinase, MB Form; Creatinine; Electrolytes; Erythropoietin; Forensic Pathology; Glucose; Humans; Hypothermia; Ketone Bodies; Myoglobin; Natriuretic Peptide, Brain; Neopterin; Nerve Growth Factors; Pituitary Hormones; Postmortem Changes; S100 Calcium Binding Protein beta Subunit; S100 Proteins; Serotonin; Troponin I; Troponin T; Uric Acid; Vitreous Body

The present study investigated the molecular pathology of atrial and brain natriuretic peptides (ANP and BNP) in the myocardium to evaluate terminal cardiac function in routine forensic casework with particular regard to fatal drug intoxication (n = 18; sedative-hypnotics, n = 10; methamphetamine, n = 8), hypothermia (cold exposure, n = 13), and hyperthermia (heatstroke, n = 10), compared with that in acute ischemic heart disease (AIHD, n = 35) and congestive heart disease (CHD, n = 11) as controls (total n = 87; within 48 h postmortem). Quantitative analyses of myocardial ANP and BNP messenger RNA demonstrated that their expressions in bilateral atrial and ventricular walls were high in methamphetamine intoxication and hypothermia, comparable to those in AIHD and CHD, but were low in sedative-hypnotic intoxication and hyperthermia. In pericardial fluid, both ANP and BNP levels were increased in hypothermia, while CHD cases had an elevated BNP level, and ANP level showed a tendency to increase in hyperthermia; however, immunohistochemistry showed no evident differences in myocardial ANP and BNP among the causes of death. These findings suggest terminal high cardiac strain in methamphetamine intoxication, decreased cardiac strain in sedative-hypnotic intoxication and hyperthermia (heatstroke), and persistent congestion in hypothermia (cold exposure).

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Autopsy; Cause of Death; Female; Gene Expression; Heart Atria; Heart Failure; Heart Ventricles; Heat Stroke; Humans; Hypnotics and Sedatives; Hypothermia; Illicit Drugs; Male; Methamphetamine; Middle Aged; Myocardial Ischemia; Myocardium; Natriuretic Peptide, Brain; Pathology, Molecular; Pericardial Effusion; Poisoning; Postmortem Changes; Prescription Drug Misuse; RNA-Directed DNA Polymerase; RNA, Messenger

Topics: Accidents, Home; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Atropine; Bradycardia; Cardiac Pacing, Artificial; Cardiotonic Agents; Cold Temperature; Diuresis; Dopamine; Electric Countershock; Electrocardiography; Female; Humans; Hypothermia; Rewarming; Unconsciousness; Vasoconstriction