In a suspected diabetic coma death, which vitreous parameter is most RELIABLE for establishing ante-mortem hyperglycaemia, given that postmortem blood glucose is invariably unreliable?

• A Vitreous glucose >200 mg/dL
• B Vitreous acetone > serum acetone
• C Vitreous insulin concentration >50 µIU/mL
• D Vitreous beta-hydroxybutyrate >2 mmol/L combined with vitreous glucose >200 mg/dL ✓

Explanation

Vitreous glucose is protected from bacterial glycolysis longer than blood glucose, making vitreous glucose >200 mg/dL suggestive of ante-mortem hyperglycaemia. However, vitreous beta-hydroxybutyrate >2 mmol/L combined with elevated vitreous glucose provides stronger evidence for diabetic ketoacidosis (DKA) as the cause of death, since ketone bodies also accumulate reliably in vitreous. Vitreous insulin is rapidly degraded postmortem. Blood glucose falls within hours of death due to glycolysis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.