Lethal ventricular tachycardia triggered after femoral fracture repair in an obese man with insulin-resistant diabetes

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• 作者：Hideyuki Maeda ; Masashi Uramatsu…
• 关键词：Autopsy ; Hyperkalemia ; Insulin ; resistant diabetes ; Medical practice ; associated death ; Ventricular tachycardia ; High ; energy trauma
• 刊名：International Journal of Legal Medicine
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：130
• 期：6
• 页码：1587-1591
• 全文大小：651 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Forensic Medicine
  Medical Law
  Medicine/Public Health, general
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1437-1596
• 卷排序：130

文摘

An obese man (height, 178 cm; weight, 160 kg; body mass index, 50.5 kg/m2) with a history of recurrent ventricular tachycardia (VT), cardiomyopathy, coronary sclerosis, and insulin-resistant diabetes suffered a right femur fracture in a vehicular accident. His fracture was repaired the following day, but shortly after surgery, his serum potassium (K+) level increased, presumably due to K+ leakage from the injured muscles, leading to persistent VT and death. An autopsy revealed severe cardiac hypertrophy, moderate coronary sclerosis, and histological findings of myocardial hypercontraction, but not myoglobin-related renal failure, pulmonary thrombosis, lipid emboli, or inflammation. The hyperkalemia was not corrected by glucose-insulin infusion and led to the death of the patient due to the preexisting cardiomyopathy, coronary sclerosis, and a predisposition to VT. In addition to the autopsy, the analysis of the clinical course was indispensable for determining the cause of death as hyperkalemia-related VT.