Importance of storing emergency serum samples for uncovering murder with insulin

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.