Daniel Hussey¹, Sarah Parsons^1,2

¹Victorian Institute of Forensic Medicine, South Bank, Melbourne; ²Department of Forensic Medicine Monash University

Sepsis is an overreaction of the immune system to infection associated with significant morbidity and mortality in both adults and children. Clinical diagnosis of sepsis requires evidence of infection and organ dysfunction. Postmortem diagnosis can be difficult due to many factors including putrefaction, bacterial translocation and lack of circumstantial information. Biomarkers commonly utilised for the diagnosis of sepsis include procalcitonin and C-reactive protein (CRP). There is a paucity of studies on the efficacy of these markers in diagnosing sepsis in children postmortem.  This study examined the utility of these markers in diagnosing sepsis at autopsy in children.  All cases of death in a child <15 years that underwent an internal examination at VIFM over a 9-year period were examined. Data extracted included microbiology and virology results, demographic, CRP, procalcitonin and cause of death. CRP and procalcitonin value postmortem were of limited utility in certain circumstances. 

Felicity Barnes^1
1Victorian Institute of Forensic Medicine

Since the first documented insulin murder in 1957, insulin overdose has been reported in homicides, suicides and accidental deaths¹. Given the non-specific autopsy findings associated with insulin overdose, toxicology has the potential to play a significant role in the investigation of such cases. The analysis and interpretation of insulin and C-peptide levels in the forensic post-mortem setting is fraught with difficulties². In this study, a retrospective analysis will be performed of all closed Victorian Coronial cases between 2012 and 2022 where insulin and C-peptide testing was completed. This investigation aims to determine the utility, as well as the strengths and weaknesses of post-mortem insulin and C-peptide testing at the Victorian Institute of Forensic Medicine.

References:

1. Marks V, Richmond C (2008) Kenneth Barlow: the first documented case of murder by insulin. J R Soc Med. 101(1), 19-21

2. Manetti, AC, Visi, G, Spina, F, De Matteis, A, Del Duca, F, Turillazzi, E, & Maiese, A (2022). Insulin and Oral Hypoglycemic Drug Overdose in Post-Mortem Investigations: A Literature Review. Biomedicines, 10(11), 2823

Jagbir Grewal¹, Victoria Kueppers¹

¹Department Of Forensic Pathology, PathWest Laboratory Medicine WA

Fat embolism syndrome (FES) is a rare but potentially fatal condition that most commonly arises following orthopaedic trauma, though it can also occur after surgical manipulation of adipose tissue. This report details the case of a 63-year-old female patient with multiple significant comorbidities, including ischaemic heart disease, type 2 diabetes mellitus, hypertension, marked obesity, obstructive sleep apnoea, asthma, and a substantial history of smoking.

The patient underwent elective abdominal incisional hernia repair but failed to return to her baseline functional status postoperatively. Instead, her condition progressively deteriorated despite intensive care unit (ICU) management. Multiple investigations were undertaken across different medical specialties while considering various diagnoses, none of which could be confirmed. Ultimately, her clinical course culminated in multi-organ failure, necessitating palliative care.

During the post-mortem examination, distinctive fatty aggregates were apparent within large vascular spaces of multiple organs, including the liver which appeared necrotic. The presence of fat was confirmed on histological assessment, including Oil Red-O special staining. This case highlights FES as a potentially fatal complication of surgery, to be considered in obese patients where fat displacement may have occurred during surgery.