Postmortem Identification of Hyperglycemia using Vitreous Fluid Analysis

Objective: To investigate the role of vitreous glucose and lactate levels in determining post-mortem hyperglycemia. Methods: In this study, 150 autopsies for postmortem Identification of hyperglycemia using vitreous fluid analysis were also conducted in mortuary unit of DHQ Hospital Rawalpindi during Jan. 2020 to December 2020. The analysis was performed as soon as the body arrived in the mortuary. 0.2 ml of Vitreous fluid was obtained from the centre of eyes for each patient in a 1 mL syringe. Blood gas analyzer was used for potassium (K+), glucose and lactate measurement, by directly connecting the sample to the analyzer. The final autopsy studies were conducted 2 to 3 days after the first sample and vitreous fluid as obtained again for further biochemical analysis. Results: Mean age was 53 years with 70% comprising male population. We observed an initial steeper drop in vitreous glucose levels in early postmortem period time, however, in samples obtained after 2 to 3 days the glucose levels remained stable. In contrast, the lactate levels continued to rise with postmortem time as documented using vitreous potassium levels. In known diabetic patients we found glucose levels >10 mmol in all patients at first sample and therefore this value can be used as cutoff to labelled hyperglycemic state as the cause of death. Conclusion: Vitreous glucose can be used as a bedside technique to determine hyperglycemia as the cause of death and can provide a valuable information regarding cause of death before autopsy studies.