Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

Autor: Alpo Vuorio, Antti Sajantila, Tanja Laukkala, Ilkka Junttila, Bruce Budowle
Přispěvatelé: Medicum, Department of Forensic Medicine, Forensic Medicine, University of Helsinki, PaleOmics Laboratory
Rok vydání: 2018
Předmět:
Blood Glucose
Fatal flight accident
medicine.medical_treatment
Autopsy
Coronary Artery Disease
Ketone Bodies
01 natural sciences
MELLITUS
chemistry.chemical_compound
0302 clinical medicine
Glucose measurement
Pilot incapacitation
Medicine
Postmortem Diagnosis
Diabetes
319 Forensic science and other medical sciences
Middle Aged
INSULIN
3. Good health
medicine.anatomical_structure
POISONING DEATHS
Adult
medicine.medical_specialty
Diabetic ketoacidosis
Hypoglycemia
VITREOUS-HUMOR
Pathology and Forensic Medicine
03 medical and health sciences
POSTMORTEM DIAGNOSIS
Diabetes mellitus
Diabetic ketoacidose
Diabetes Mellitus
Humans
Hypoglycemic Agents
CORONARY-HEART-DISEASE
030216 legal & forensic medicine
LC-MS/MS
Aged
Glycated Hemoglobin
Accident investigation
business.industry
Insulin
010401 analytical chemistry
medicine.disease
United States
0104 chemical sciences
Vitreous Body
Coronary arteries
Pilots
Glucose
Accidents
Aviation
chemistry
Hyperglycemia
Emergency medicine
Glycated hemoglobin
business
Zdroj: International Journal of Legal Medicine. 132:1713-1718
ISSN: 1437-1596
0937-9827
DOI: 10.1007/s00414-018-1879-4
Popis: Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau's database between years 2011-2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (similar to 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.
Databáze: OpenAIRE
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