|
Parameter
|
Obvious Suicide
|
Occult Suicide
|
|
suicide note
|
present
|
absent
|
|
sulfonylurea medicine bottle
|
present
|
hidden
|
Who to suspect of occult sulfonylurea ingestion:
(1) health care professional
(2) someone with access to a sulfonylurea
(3) no obvious anatomic cause of death found at autopsy
(4) nondiabetic with a sulfonylurea identified in the serum or urine
Methods of confirming sulfonylurea ingestion:
(1) finding undissolved tablets or pills in the stomach or GI tract
(2) measuring serum sulfonylurea concentrations
Quantitation of the serum sulfonylurea concentration can help distinguish normal usage from the overdose, but cannot identify the reason for the overdose.
False negative analysis:
(1) Post-mortem glucose measurements are unreliable because of post-mortem glycolysis may falsely elevate blood glucose measurements.
(2) Prolonged interval between ingestion and death (which may occur if the person was comatose for several days).
Differential diagnosis for an overdose of a sulfonylurea:
(1) homicide by sulfonylurea
(2) accidental overdose
