A case of a previously healthy 48-year-old man murdered by exogenous insuli
n administration is reported. The patient was delivered unconscious to the
emergency unit. Initially, treatment with hyperbaric oxygen was commenced b
ecause decompression sickness was suspected. However, the treatment was abo
rted as the patient was found to be hypoglycaemic (nadir serum glucose 0.3
mmol/l) and treatment and diagnostics of hypoglycaemia commenced. Brain dam
age due to hypoglycaemia was severe, and the patient remained in a vegetati
ve state for 2 months before he died of multiorgan failure. Serum samples d
rawn at admittance were stored frozen, whereby it was possible to show retr
ospectively, that while the concentration of insulin in serum was high (75
mU/l, increasing further to over 240 mU/l in the next few hours) concentrat
ion of C-peptide was low (below detection limit of 0.1 nmol/l) at the hypog
lycaemic stage. It was concluded that the patient had received exogenous in
sulin somehow, and the police was informed. Circumstantial evidence obtaine
d during ensuing criminal investigation was considered by the court to prov
e the patient's wife (a nurse) guilty of murder. The availability of stored
frozen serum samples drawn at the early stage of hospitalization helped to
uncover the crime involved in our case. (C) 1999 Elsevier Science Ireland
Ltd. All rights reserved.