Armanni–Ebstein Lesions in Terminal Hyperglycemia |
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| Authors: | Chong Zhou MBBS Andrea J Yool PhD Roger W Byard MD |
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| Affiliation: | 1. The University of Adelaide Medical School, Adelaide, SA, Australia;2. Forensic Science SA, Adelaide, SA, Australia;3. School of Medicine, University of Adelaide, Adelaide, SA, Australia |
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| Abstract: | Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose. |
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| Keywords: | forensic science Armanni– Ebstein phenomenon glycogen nephrosis diabetes mellitus hyperglycemia renal tubular vacuolization |
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