A forensic pathologist finds vitreous glucose concentration of 0 mg/dL and elevated vitreous lactate in a body retrieved 24 hours after death. The most likely antemortem clinical context is:

• A Terminal hypoglycaemia or rapid agonal glucose consumption ✓
• B Hyperglycaemic hyperosmolar state prior to death
• C Prolonged starvation lasting more than 3 days before death
• D Diabetic ketoacidosis

Explanation

Vitreous glucose declines postmortem due to glycolytic consumption by local cells. A finding of zero vitreous glucose at 24 hours with elevated lactate suggests that antemortem glucose was already very low (hypoglycaemia) and/or rapid agonal consumption occurred. In contrast, diabetic ketoacidosis and hyperglycaemic states tend to leave elevated vitreous glucose readings. Prolonged starvation reduces serum glucose but not to absolute zero. Paired vitreous glucose with lactate therefore provides a surrogate marker for antemortem hypoglycaemia.

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.