A forensic pathologist notes the following vitreous biochemistry values from a decomposed body: Na+ 116 mEq/L, K+ 22 mEq/L, Cl- 90 mEq/L. The vitreous sodium:potassium ratio is approximately 5.3. What does a vitreous potassium of 22 mEq/L most likely suggest?

• A Death within the last 24 hours
• B Antemortem hyperkalemia as the cause of death
• C Marked decomposition invalidating TSD estimation by vitreous K+ ✓
• D Ante-mortem renal failure causing potassium accumulation

Explanation

Vitreous potassium exceeding approximately 15 mEq/L and values as high as 22 mEq/L indicate advanced postmortem change; standard regression equations for TSD using vitreous K+ are calibrated for values below approximately 10–12 mEq/L. Extreme values reflect decomposition-related potassium liberation rather than a reliable linear increase, making TSD estimation unreliable. Antemortem hyperkalemia is possible but cannot be inferred from postmortem vitreous values alone; reference ranges established postmortem cannot diagnose antemortem electrolyte disorders.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.