Post-mortem urinary myoglobin levels with reference to the causes of death☆
Abstract
To evaluate pathophysiological significance of post-mortem urinary myoglobin levels in determining the cause of death, we investigated 210 forensic autopsy cases, partially in comparison with serum levels. Post-mortem serum myoglobin levels were extraordinary high in most cases possibly due to post-mortem change. Urinary myoglobin levels did not correlate with the serum levels, showing possible post-mortem elevation in cases of a prolonged post-mortem period over 48
h. A high (>1000
ng/ml), moderate (100–1000
ng/ml), slight (50–100
ng/ml) and not significant (<50
ng/ml) elevation of urinary myoglobin were observed in 26, 43, 31 and 110 cases, respectively. Half the highly elevated cases were those with a survival time over 24
h. In cases of minor muscle injury such as head trauma, elevation of urinary myoglobin level was closely related to longer survival. In acute/subacute deaths with a post-mortem interval within 48
h, a significant difference was observed in relation to the blood carboxyhemoglobin (COHb) levels of fire victims: myoglobinuria over 100
ng/ml was more frequently and markedly observed in cases with COHb below 60% than over 60%, suggesting muscle damage in fatal burns. Similar elevation was observed in heat stroke victims, and also in some cases of acute and subacute death from polytrauma, asphyxiation, drowning, electricity and spontaneous cerebral bleeding, but not in myocardial infarction. Thus, it was suggested that high post-mortem urinary myoglobin levels in acute and subacute death cases may be a possible indicator of antemortem massive skeletal muscle damage as well as exertional muscle hyperactivity or convulsive disorders associated with hypoxia.
Keywords: Forensic pathology, Myoglobinuria, Burn, Muscle injury, Hypoxia, Post-mortem change
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☆ Presented in part at the 75th Annual Meeting of the German Society for Legal Medicine, Zurich, 1996 and the 15th Triennial Meeting of the International Association of Forensic Sciences, Los Angeles, 1999.
PII: S0379-0738(00)00326-1
© 2001 Elsevier Science Ireland Ltd. All rights reserved.
