DOT/FAA/AM-00/22

Dennis V. Canfield

Arvind K. Chaturvedi

Henry K. Boren

Stephen J. H. Véronneau

Vicky L. White

Civil Aeromedical Institute

Federal Aviation Administration

Oklahoma City, Oklahoma 73125

June 2000

Final Report

This document is available to the public

through the National Technical Information

Service, Springfield, Virginia 22161.

Abnormal Glucose Levels

Found in Transportation

Accidents Office of Aviation Medicine

Washington, D.C. 20591

U.S. Department

of Transportation

Federal Aviation

Administration
NOTICE

This document is disseminated under the sponsorship of

the U.S. Department of Transportation in the interest of

information exchange. The United States Government

assumes no liability for the contents thereof.
i

Technical Report Documentation Page

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.

DOT/FAA/AM-00/22

4. Title and Subtitle 5. Report Date

Abnormal Glucose Levels Found in Transportation Accidents June 2000

6. Performing Organization Code

7. Author(s) 8. Performing Organization Report No.

Canfield, D.V., Chaturvedi, A.K, Boren, H.K., Véronneau, S.J.H.,

and White, V.L.

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS)

FAA Civil Aeromedical Institute

P.O. Box 25082 11. Contract or Grant No.

Oklahoma City, Oklahoma 73125

12. Sponsoring Agency name and Address 13. Type of Report and Period Covered

Office of Aviation Medicine

Federal Aviation Administration

800 Independence Ave., S.W.

Washington, D.C. 20591 14. Sponsoring Agency Code

15. Supplemental Notes

This work was accomplished under the approved task AM-B-98-TOX-202.

16. Abstract

Purpose. The Federal Aviation Administration's Office of Aviation Medicine (OAM) is responsible for

the certification of pilots with diabetic conditions. Therefore, it is essential for OAM to monitor pilots

involved in fatal accidents for abnormal glucose levels, which might have caused performance impairment/

incapacitation. The present study evaluated the use of postmortem vitreous humor and urine glucose levels

in transportation accident fatalities as indicators of potentially incapacitating medical conditions or

performance impairment. Methods. Vitreous humor and/or urine from 192 accident fatalities were

analyzed for glucose using a hexokinase method. Cases with values below the lower limit of detection (10

mg/dL) and above 3 standard deviations (SD) from the mean were not included in the final statistics. All

cases more than 5 SD above the mean were deemed abnormal and a full case history was evaluated based

on the available medical history. Results. The mean glucose concentration was 30 mg/dL (SD: 21 mg/dL)

from 98 postmortem vitreous humor specimens, while it was 27 mg/dL (SD: 16 mg/dL) from 127

postmortem urine samples. Nine of the 192 cases were identified as having abnormal glucose levels.

Abnormal glucose levels were found in 5 of the 8 cases with a known diabetic condition. Glycosuria or low

renal threshold was reported in 2 fatal pilots; 1 of these pilots had an abnormal glucose level. Conclusions.

Hyperglycemia can be established from the vitreous humor and urine glucose levels, but hypoglycemia

cannot, because of the rapid postmortem drop in vitreous humor glucose levels. All of the pilot abnormal

glucose cases detected were previously identified during the medical certification process or had a medical

reason for the abnormal level. The elevated vitreous humor and urine glucose levels have proven useful in

identifying individuals with a pre-existing diabetic condition that might have been a factor in the accident.

17. Key Words 18. Distribution Statement

Forensic Science, Toxicology, Diabetes, Document is available to the public through the

Glucose, Urine, Vitreous humor, Postmortem National Technical Information Service

Aircraft Accident Investigation Springfield, Virginia 22161

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price

Unclassified Unclassified 13

Form DOT F 1700.7 (8-72) Reproduction of completed page is authorized

1

ABNORMAL GLUCOSE LEVELS FOUND IN TRANSPORTATION ACCIDENTS

INTRODUCTION

The Federal Aviation Administration’s (FAA)

Office of Aviation Medicine (OAM) is tasked with

determining the fitness of diabetic pilots to fly. Therefore, it is important to monitor glucose levels in pilots

involved in fatal aviation accidents to determine if

abnormal glucose levels were a factor in the accident.

The present study was undertaken to determine the

concentration of glucose in postmortem vitreous

humor and urine that could be considered abnormal.

This information will provide accident investigators

with medical information about the operator, which

may help determine the cause of the accident and will

allow OAM to closely monitor diabetic pilots who

have been medically certified to fly.

Many research studies have addressed the issue of

postmortem glucose levels (1-12). These researchers

agree that hypoglycemia cannot currently be determined from postmortem specimens using existing

procedures. However, postmortem vitreous humor

has proven useful in predicting hyperglycemia because “the vitreous humor of the eye constitutes an

isolated pool of material suitable for many analyses

and is far less susceptible than the blood to rapid

chemical changes or contamination” (6). Therefore,

postmortem vitreous humor was chosen as a suitable

specimen for use in this research to determine abnormal postmortem glucose levels in pilots.

A rapid decrease in vitreous humor glucose levels

is caused by anaerobic degradation (glycolysis). An

earlier study found vitreous humor glucose levels to

fall 35% in 1 hour and 70% within 6 hours at room

temperature (1). Glycolysis has been determined to

be complete within 3.5 to 7 hours after death (11, 8).

After 18 hours, the decrease in glucose levels stops

(1). Cold temperatures retard glycolysis (7) and will

delay the time for completion of glycolysis.

Most vitreous humor glucose studies conducted

until now have utilized relatively fresh vitreous humor specimens (within 2 hours of death) to establish

an abnormal vitreous humor glucose level. However,

the collection of specimens and analysis of specimens

by the FAA’s Toxicology and Accident Research

Laboratory takes no less then 48 hours and in most

cases specimens are not actually analyzed until about

7 days or longer after death. Therefore, glycolysis in

vitreous humor fluid should have been complete in

most of the cases reported in this research. This study

will define the abnormal vitreous humor glucose

levels for specimens analyzed several days after death.

The rapid decrease in postmortem vitreous humor

glucose levels makes it extremely difficult to accurately predict normal antemortem vitreous humor

levels. Data collected by Coe (6) indicate that the

normal antemortem glucose level is much higher

than was first thought by Sturner (12). Coe suggests

that the antimortem vitreous humor glucose level is

0.85 of the plasma values, which is much higher then

the 0.50 proposed by Sturner (12). Antimortem

blood glucose values above 200 mg/dL are considered diagnostic of diabetes mellitus (14). This would

suggest, using the conservative estimates of Coe, that

antimortem vitreous humor levels above 170 mg/dL

are diagnostic of diabetes mellitus. Research by

Dimaio and Dimaio (13) has shown that normal

vitreous humor glucose levels do not exceed 200 mg/

dL “even if intravenous glucose infusions are administered for hours prior to death.” They have also

found that postmortem vitreous humor glucose levels above 200 mg/dL are considered to be diagnostic

of diabetes mellitus (13).

Pilot medical certification includes the testing of

urine for glucose. All urine glucose levels above 100

mg/dL are considered to be abnormal and would lead

to further testing of the applicant. Therefore, urine

was included as a part of this research.

METHODS AND MATERIALS

Samples

During the time of this study, vitreous humor,

urine, blood, liver, kidney, muscle, heart, brain, bile,

gastric, spinal fluid, and spleen from almost all fatal

aviation accidents occurring in the USA were collected at the accident site and sent to the Civil

Aeromedical Institute’s (CAMI’s) Toxicology and

Accident Research Laboratory for analysis. In
2

addition, selected surface accidents were sent to the

laboratory by the National Transportation Safety

Board (NTSB) for analysis. Specimens are normally

shipped to CAMI for analysis within 2 to 10 days

after the death of the pilot or operator. The specimens

are frozen and shipped with ice bags in an ice chest,

the samples are normally received the next day. When

shipped according to instructions, the temperature of

the specimen is between 4° to 8° C. After receipt, the

specimens are weighed and aliquoted into batches for

the analysis of glucose, pharmacological agents, alcohol, carbon monoxide, and cyanide. The remaining

specimens are stored in a walk-in freezer at -20° C,

and the batches are stored at 4° C until tested.

Batches are issued for analysis at the end of each week.

Specimens are normally analyzed within 5 to 10 days

after receipt.

Glucose Analysis

When available, urine and vitreous humor are

tested for glucose using a Du Pont Analyst benchtop

chemistry system, made by Du Pont Company (Medical Products, Willmington, DE). The measured glucose values are entered into a Microsoft Excel sheet

for statistical analysis (Table 1).

In this study, vitreous humor and/or urine from

192 fatal accident victims were analyzed for the

presence of glucose. Specimens were analyzed by a

hexokinase method and standard glucose test strips.

Cases with values below the lower limit of detection

(LOD) of 10 mg/dL and above 3 standard deviations

(SD) of the mean were not included in the final

statistics. All cases more then 5 SD from the mean

were deemed abnormal, and a full case history was

evaluated. Accident case histories were obtained from

the NTSB database. The medical history of the pilot

was obtained from the Office of Aviation Medicine

(OAM) Medical Certification Division, and the historical case aspects were compared with the glucose

levels found. The cause of the accident reported by

the NTSB was reviewed to check for possible inflight medical incapacitation of the pilot in those

cases with abnormal glucose levels.

RESULTS

The mean concentration of glucose in 98 postmortem vitreous humor specimens was found to be 30

mg/dL, with an SD of 21 mg/dL (Table 2). The

median concentration occurred between 0 and 9 mg/

dL (Fig. 1) for all 170 vitreous humor specimens

tested. The mean concentration of glucose in 127

postmortem urine specimens was 27 mg/dL, with an

SD of 16 mg/dL (Table 3). The median concentration occurred between 10mg/dL and 19 mg/dL (Fig.

1) for all 162 urine specimens tested.

Nine (5%) of the 192 cases were identified as

having abnormal glucose levels. There were 8 (5%) of

the 178 subjects with a known medical history who

were found to have a diabetic condition. Abnormal

glucose levels were found in 5 (63%) of the 8 known

diabetic subjects. One case, with 189 mg/dL of glucose in urine, had a medical history of diabetes

controlled by hypoglycemic drugs. Another case,

with 256 mg/dL of glucose in vitreous humor and

8815 mg/dL of glucose in urine, had a medical

history of diabetes controlled by diet. One diabetic

pilot had an abnormal urine glucose level of 760 mg/

dL and a vitreous humor glucose level of 119 mg/dL.

The urine glucose level of another diabetic pilot was

found to be 2315 mg/dL. A surface accident victim

with diabetes had a urine glucose concentration of

1221 mg/dL. Glycosuria, or low renal threshold, was

reported in 2 of the fatal pilots; one of these pilots had

an abnormal glucose level in urine. This case had

3055 mg/dL of glucose in urine and a medical history

of glycosuria with a low renal threshold. No prior

reported medical history, which would account for

an elevated glucose level, was found in 2 of the pilots.

Both of these pilots survived the accident and received emergency medical treatment, which could

account for the elevated glucose levels found in

vitreous fluid (5). Eight subjects were known to have

received emergency medical treatment (Table 1).

Only 2 of these 8 subjects had elevated vitreous

humor glucose levels, and none of them had elevated

urine glucose levels.

DISCUSSION & CONCLUSION:

A level of 125 mg/dL of glucose in postmortem

vitreous humor, approximately 5 SD above the mean,

was defined as being an abnormally high glucose

level. This value was established to minimize false

positive individuals and because all the cases in this

range were found to have a medical reason for the

abnormal glucose level. Based on this research, it was

decided that a glucose level above 125mg/dL in

postmortem vitreous humor would be diagnostic of

a potentially incapacitating illness. The abnormal
3

Table 1. Glucose data collected in this study. All glucose data reported in mg/dL. Interval is reported in

days. Medical Refers to medical history of the individual: NO = No medical history for abnormal glucose

levels; PA = Passenger no medical history on file; PM = Pilot no medical history on file; DI = Diabetic; EM =

Emergency medical treatment; GL = Glycosuria or low renal threshold; SU = surface accident, no medical

history on file.

CaseNum Urine Vitreous Accident Date Date of Result Interval Medical

9 1 800301001 1 08 1 8 2-Oct-9 1 7 8-Nov-9 3 I D

9 8 800134001 2 34 8 2 8 6-May-9 1 4 8-Aug-9 8 I D

9 9 800186001 1 5 8 4 8 2 8 6-Jun-9 1 3 8-Aug-9 5 I D

9 8 900049001 3 79 9 2 9 2-Mar-9 1 1 2-Apr-9 2 I D

9 0 800332001 7 9 6 1 8 1 0 9 4-Dec-9 1 0 3-Jan-9 4 I D

9 5 800290001 8 6 81 2 8 5 2 8 5-Sep-9 1 3 7-Nov-9 5 I D

9 1 910012001 1 9 22 0 9 3-Jun-9 0 5 8-Jul-9 3 I D

9 5 900097001 2 9 31 1 9 9-May-9 2 6I 5-May-9 D

9 9 900038001 1 09 0 9 8-Mar-9 1 1 9-Mar-9 1 ME

9 08 800251001 1 8 2-Sep-9 2 3 5-Sep-9 1 ME

9 4 800289001 2 01 8 1 8 0-Oct-9 1 8 7-Nov-9 3 ME

9 3 800311001 2 02 8 1 8 0-Nov-9 1 7M 7-Nov-9 E

9 4 900051001 4 04 9 2 9 4-Mar-9 1 9 2-Apr-9 1 ME

9 9 900147001 3 17 9 0 9 3-Jul-9 2 7 0-Jul-9 1 ME

9 5 800216001 6 7 1 8 4 3 8 1-Jul-9 1 8 8-Aug-9 1 ME

9 4 900047001 1 9 9 1 9 0-Mar-9 1 3 2-Apr-9 3 ME

9 5 800208001 3 2 05 1 8 0 8 5-Jul-9 1 5 9-Aug-9 4 LG

9 4 800312001 1 8 0 8 3-Nov-9 1 4 7-Nov-9 1 LG

9 003 300152001 2 3 8-Jun-9 1 1 9-Jul-9 2 ON

9 0 08 800209001 2 8 6-Jul-9 1 3 8-Aug-9 2 ON

9 00 8 800333001 2 9 9-Nov-9 1 5 3-Jan-9 4 ON

9 00 8 800338001 1 9 2-Dec-9 1 2 3-Jan-9 3 ON

9 00 9 900041001 1 9 5-Mar-9 1 8 2-Apr-9 2 ON

9 00 9 900050001 2 9 6-Mar-9 1 7 2-Apr-9 1 ON

9 009 900053001 0 9 3-Apr-9 1 9O 2-Apr-9 N

9 1 800317002 1 08 1 9 2-Nov-9 1 2 3-Jan-9 6 ON

9 2 800328001 1 08 2 9 1-Nov-9 1 3 3-Jan-9 5 ON

9 2 900067001 1 09 2 9 2-Apr-9 1 9 1-May-9 1 ON

9 2 900162001 1 09 1 9 7-Jul-9 2 0 7-Jul-9 1 ON

9 3 900017001 1 08 2 9 6-Dec-9 0 1 5-Feb-9 4 ON

9 4 800212001 1 08 3 8 1-Jul-9 1 8 8-Aug-9 1 ON

9 4 800317001 1 08 1 9 2-Nov-9 1 2 3-Jan-9 6 ON

9 5 900017002 1 08 2 9 6-Dec-9 0 1 5-Feb-9 4 ON

9 5 900040001 1 09 1 9 3-Mar-9 1 0 2-Apr-9 3 ON

9 5 900087001 1 09 0 9 8-May-9 2 7 5-May-9 1 ON

9 7 800217001 1 08 0 8 2-Aug-9 1 6 8-Aug-9 1 ON

9 8 800305001 1 08 0 8 2-Nov-9 1 6 8-Nov-9 1 ON

9 9 800267001 1 08 0 8 8-Sep-9 1 0 7-Nov-9 7 ON

9 9 800279001 1 08 0 8 1-Oct-9 1 7 7-Nov-9 4 ON

9 9 900119001 1 09 2 9 8-May-9 2 4 1-Jun-9 2 ON

9 0 900083001 2 09 0 9 4-May-9 1 7O 1-May-9 N

9 1 800284001 2 08 0 8 9-Oct-9 1 9 7-Nov-9 3 ON

9 2 900026001 2 09 0 9 5-Feb-9 0 4 1-Mar-9 2 ON

9 3 800228001 2 08 1 8 5-Aug-9 0 7 1-Sep-9 1 ON
4

Table 1. (Continued)

CaseNum Urine Vitreous Accident Date Date of Result Interval Medical

9 6 900082001 2 09 2 9 3-Apr-9 1 8 1-May-9 1 ON

9 7 800202001 2 08 2 8 0-Jul-9 1 9 8-Aug-9 2 ON

9 8 900016001 2 09 2 9 7-Jan-9 0 9O 5-Feb-9 N

9 9 800342001 2 08 2 9 3-Dec-9 1 1 3-Jan-9 2 ON

9 3 800285001 3 08 0 8 6-Oct-9 1 2 7-Nov-9 4 ON

9 5 900060001 3 09 1 9 7-Apr-9 2 0 7-Apr-9 1 ON

9 6 900036001 3 09 1 9 1-Feb-9 1 6 9-Mar-9 3 ON

9 9 800339001 3 08 1 9 5-Dec-9 1 9 3-Jan-9 2 ON

9 5 800232001 4 08 2 8 0-Aug-9 0 8 7-Sep-9 1 ON

9 8 800235001 4 08 2 8 2-Aug-9 0 6 7-Sep-9 1 ON

9 8 900108001 4 09 2 9 9-May-9 0 0 8-Jun-9 1 ON

9 4 900118001 6 09 0 9 7-Jun-9 2 4 1-Jun-9 1 ON

9 5 800233001 6 08 2 8 1-Aug-9 0 7 7-Sep-9 1 ON

9 09 900088001 0 9 3-May-9 2 2 5-May-9 2 ON

9 09 900097002 1 9 9-May-9 2 6O 5-May-9 N

9 08 800164001 0 8 6-Jun-9 1 3 8-Aug-9 7 ON

9 08 800230001 1 8 9-Aug-9 0 3 1-Sep-9 1 ON

9 08 800249002 0 8 6-Aug-9 2 0 5-Sep-9 5 ON

9 08 800268001 2 8 3-Sep-9 1 5 7-Nov-9 5 ON

9 08 800329001 2 9 4-Nov-9 1 0 3-Jan-9 5 ON

9 08 800330001 0 9 8-Nov-9 1 6 3-Jan-9 6 ON

9 08 800331001 2 9 9-Nov-9 1 5 3-Jan-9 4 ON

9 08 800343001 2 9 5-Dec-9 1 9 3-Jan-9 1 ON

9 08 800345001 1 9 0-Oct-9 1 5 3-Jan-9 9 ON

9 09 900005001 0 9 6-Jan-9 2 8 3-Feb-9 4 ON

9 09 900010001 1 9 9-Jan-9 2 5 3-Feb-9 3 ON

9 7 800229001 8 01 8 1 8 2-Aug-9 0 0 1-Sep-9 2 ON

9 0 900168001 1 9 1 9 7-Jul-9 2 0 7-Jul-9 1 ON

9 2 800248001 1 11 8 0 8 7-Sep-9 2 8 5-Sep-9 1 ON

9 5 800236001 1 11 8 1 8 9-Jul-9 0 0 7-Sep-9 5 ON

9 2 900120001 2 11 9 0 9 8-Jun-9 2 3 1-Jun-9 1 ON

9 3 800242002 2 11 8 2 8 9-Aug-9 0 9O 7-Sep-9 N

9 9 800281001 2 11 8 0 8 8-Oct-9 1 0 7-Nov-9 4 ON

9 1 900136001 1 9 1 9 9-Jun-9 0 9 8-Jul-9 1 ON

9 1 800222001 2 21 8 1 8 1-Aug-9 1 7O 8-Aug-9 N

9 4 800224001 2 21 8 1 8 5-Aug-9 0 7 1-Sep-9 1 ON

9 7 800250001 2 21 8 0 8 2-Sep-9 2 3 5-Sep-9 2 ON

9 9 800226001 3 21 8 1 8 4-Aug-9 0 8 1-Sep-9 1 ON

9 2 600285001 1 6 3 7 1-Oct-9 2 0 8-Feb-9 1 O 2 N

9 03 900080001 1 9 0 9 2-May-9 1 9O 1-May-9 N

9 2 800231001 1 31 8 3 8 1-Jul-9 0 2 1-Sep-9 3 ON

9 3 900142001 2 31 9 2 9 5-Jun-9 0 3 8-Jul-9 1 ON

9 3 900073001 1 9 2 9 3-Apr-9 1 8 1-May-9 1 ON

9 3 900135001 1 41 9 1 9 8-Jun-9 0 0 8-Jul-9 2 ON

9 6 800314001 1 41 8 0 8 7-Nov-9 1 0 7-Nov-9 1 ON

9 1 800242001 2 41 8 2 8 9-Aug-9 0 9O 7-Sep-9 N

9 05 800181001 1 8 2 8 5-Jun-9 1 4 8-Aug-9 5 ON

9 5 900012001 1 51 9 2 9 2-Jan-9 2 2 3-Feb-9 3 ON

9 9 900068001 1 51 9 2 9 2-Apr-9 1 9 1-May-9 1 ON

9 0 800187001 2 51 8 0 8 1-Jul-9 1 8 8-Aug-9 4 ON

9 5 900123001 1 9 0 9 3-Jun-9 2 8 1-Jun-9 1 ON

9 2 800198001 2 61 8 1 8 6-Jul-9 1 3 8-Aug-9 3 ON

9 6 800255001 1 8 0 8 9-Sep-9 2 6 5-Sep-9 1 ON
5

Table 1. (Continued)

CaseNum Urine Vitreous Accident Date Date of Result Interval Medical

9 6 800151001 1 71 8 0 8 4-Jun-9 1 5 8-Aug-9 7 ON

9 4 800241002 6 71 8 2 8 9-Aug-9 0 9O 7-Sep-9 N

9 2 900056001 1 81 9 0 9 1-Apr-9 1 1 2-Apr-9 1 ON

9 5 800225001 1 81 8 1 8 5-Aug-9 0 7 1-Sep-9 1 ON

9 8 900144001 1 9 2 9 9-Jun-9 0 9O 8-Jul-9 N

9 8 800247001 1 8 0 8 4-Sep-9 2 1 5-Sep-9 2 ON

9 8 800275001 1 8 0 8 4-Oct-9 1 4 7-Nov-9 4 ON

9 3 800295001 1 91 8 1 8 8-Oct-9 1 0 7-Nov-9 3 ON

9 8 800234001 1 91 8 0 8 4-Aug-9 0 4 7-Sep-9 3 ON

9 4 800215001 4 91 8 0 8 4-Aug-9 1 4 8-Aug-9 1 ON

9 9 900059001 1 9 1 9 7-Apr-9 2 0 7-Apr-9 1 ON

9 8 900008001 1 02 9 0 9 4-Jan-9 2 0 3-Feb-9 5 ON

9 0 800272001 2 8 0 8 3-Oct-9 1 5 7-Nov-9 4 ON

9 0 900169001 2 12 9 2 9 8-Jun-9 2 9 7-Jul-9 2 ON

9 3 900121001 4 12 9 0 9 5-Jun-9 2 6 1-Jun-9 1 ON

9 3 800221001 1 22 8 0 8 9-Aug-9 1 9O 8-Aug-9 N

9 2 900091001 2 9 0 9 9-May-9 2 6 5-May-9 1 ON

9 2 800308001 2 8 0 8 4-Nov-9 1 3 7-Nov-9 1 ON

9 9 800294001 1 32 8 1 8 7-Oct-9 1 1 7-Nov-9 3 ON

9 3 900144002 2 9 2 9 9-Jun-9 0 9O 8-Jul-9 N

9 4 900011001 1 52 9 2 9 1-Jan-9 2 3 3-Feb-9 3 ON

9 4 900009001 3 52 8 2 9 7-Dec-9 2 8 3-Feb-9 5 ON

9 0 800277001 3 62 8 0 8 5-Oct-9 1 3 7-Nov-9 4 ON

9 9 900153001 2 72 9 0 9 7-Jul-9 2 3 0-Jul-9 1 ON

9 8 900064001 2 9 1 9 4-Apr-9 2 3 7-Apr-9 1 ON

9 7 800276001 1 03 8 0 8 5-Oct-9 1 3 7-Nov-9 4 ON

9 0 800241001 3 8 2 8 9-Aug-9 0 0 8-Sep-9 1 ON

9 3 800302001 2 13 8 0 8 1-Nov-9 1 7 8-Nov-9 1 ON

9 3 800309001 2 23 8 0 8 6-Nov-9 1 1 7-Nov-9 1 ON

9 2 900095001 3 9 1 9 1-May-9 2 4 5-May-9 1 ON

9 2 900146001 3 9 0 9 2-Jul-9 2 8 0-Jul-9 1 ON

9 3 800170001 3 8 1 8 9-Jun-9 1 0 8-Aug-9 6 ON

9 4 800259001 3 8 1 8 8-Sep-9 1 0 7-Nov-9 6 ON

9 8 900054001 2 63 9 0 9 1-Apr-9 1 1 2-Apr-9 1 ON

9 6 900004001 3 9 0 9 2-Jan-9 2 2 3-Feb-9 5 ON

9 1 800196001 4 8 1 8 5-Jul-9 1 4 8-Aug-9 3 ON

9 7 800326001 3 64 8 2 9 1-Nov-9 1 3 3-Jan-9 5 ON

9 5 900062001 1 94 9 1 9 5-Apr-9 2 2 7-Apr-9 1 ON

9 00 800288001 5 8 1 8 3-Oct-9 1 5 7-Nov-9 3 ON

9 0 800243001 3 25 8 2 8 9-Aug-9 0 9O 7-Sep-9 N

9 2 900169002 2 55 9 2 9 8-Jun-9 2 9 7-Jul-9 2 ON

9 7 900027001 5 9 1 9 2-Feb-9 0 7 1-Mar-9 1 ON

9 9 900139001 5 9 2 9 3-Jun-9 0 5 8-Jul-9 1 ON

9 9 800207001 5 8 2 8 5-Jul-9 1 5 9-Aug-9 2 ON

9 3 800192001 1 06 8 3 8 0-Jun-9 1 9 8-Aug-9 4 ON

9 3 900003001 6 8 1 9 8-Dec-9 1 6 3-Jan-9 2 ON

9 9 800188001 2 66 8 1 8 0-Jul-9 1 9 8-Aug-9 3 ON

9 7 900030001 6 66 9 2 9 0-Feb-9 0 9O 1-Mar-9 N

9 7 800213002 2 96 8 0 8 2-Aug-9 1 6 8-Aug-9 1 ON

9 2 800260001 7 8 1 8 8-Sep-9 1 0 7-Nov-9 6 ON

9 3 900100001 2 67 9 2 9 0-May-9 0 9 8-Jun-9 1 ON

9 7 800166001 7 8 1 8 6-Jun-9 1 3 8-Aug-9 6 ON

9 1 900150001 8 9 1 9 1-Jul-9 2 9O 0-Jul-9 N

9 9 800258001 8 8 1 8 6-Sep-9 1 2 7-Nov-9 6 ON
6

Table 1. (Continued)

CaseNum Urine Vitreous Accident Date Date of Result Interval Medical

9 2 800265001 4 2 1 8 0 2 8 6-Sep-9 1 2 7-Nov-9 5 ON

9 8 800335001 1 5 1 8 0 0 9 4-Dec-9 1 0 3-Jan-9 4 ON

9 5 900037001 6 3 1 9 1 0 9 8-Mar-9 1 1 9-Mar-9 1 ON

90 8 800336001 0 9 4-Dec-9 1 0 3-Jan-9 4 ON

90 9 900071001 2 9 2-Apr-9 1 9 1-May-9 1 ON

9 0 900007001 1 9 1 9 6-Jan-9 2 8 3-Feb-9 3 ON

9 2 900149002 1 9 0 9 9-Jul-9 2 1 0-Jul-9 1 ON

9 4 900149001 1 9 0 9 9-Jul-9 2 1 0-Jul-9 1 ON

9 4 900164001 1 9 0 9 5-Jul-9 2 2 7-Jul-9 2 ON

9 5 900126001 1 9 1 9 1-Jun-9 2 0 1-Jun-9 1 ON

9 6 900109001 1 9 2 9 9-May-9 0 0 8-Jun-9 1 ON

9 6 900112001 1 9 3 9 0-May-9 0 9O 8-Jun-9 N

9 7 900110001 1 9 2 9 9-May-9 0 0 8-Jun-9 1 ON

9 7 900159001 1 9 1 9 2-Jul-9 2 8O 0-Jul-9 N

9 8 900076001 1 9 2 9 8-Apr-9 1 3 1-May-9 1 ON

9 8 900105001 1 9 2 9 5-May-9 0 4 8-Jun-9 1 ON

9 2 900089002 2 9 0 9 7-May-9 2 8 5-May-9 1 ON

9 2 900101001 2 9 2 9 5-May-9 0 4 8-Jun-9 1 ON

9 3 900089001 2 9 0 9 7-May-9 2 8 5-May-9 1 ON

9 3 900090002 2 9 0 9 2-May-9 2 3 5-May-9 2 ON

9 7 900157001 2 9 1 9 1-Jul-9 2 9O 0-Jul-9 N

9 9 800271001 2 8 0 8 1-Oct-9 1 7 7-Nov-9 4 ON

9 9 900085002 2 9 0 9 1-May-9 1 0 1-May-9 1 ON

9 1 900111001 3 9 2 9 9-May-9 0 0 8-Jun-9 1 ON

9 2 900104001 3 9 2 9 3-May-9 0 6 8-Jun-9 1 ON

9 9 800270001 3 8 2 8 6-Sep-9 1 2 7-Nov-9 5 ON

9 5 900115001 4 9 2 9 4-May-9 2 8 1-Jun-9 2 ON

9 0 900070001 1 9 0 2 9 1-Apr-9 1 0 1-May-9 2 ON

9 7 800217002 2 08 0 8 2-Aug-9 1 6 8-Aug-9 1 AP

9 1 900118002 7 09 0 9 7-Jun-9 2 4 1-Jun-9 1 AP

9 4 900012002 1 31 9 2 9 2-Jan-9 2 2 3-Feb-9 3 AP

9 5 900009002 3 31 8 2 9 7-Dec-9 2 8 3-Feb-9 5 AP

9 4 800221002 1 61 8 0 8 9-Aug-9 1 9A 8-Aug-9 P

9 1 800166002 2 8 1 8 6-Jun-9 1 3 8-Aug-9 6 AP

9 5 800218001 2 8 0 8 8-Aug-9 1 0 8-Aug-9 1 AP

9 7 800276002 2 72 8 0 8 5-Oct-9 1 3 7-Nov-9 4 AP

90 8 800325001 2 9 1-Nov-9 1 3 3-Jan-9 5 AP

9 6 800282002 1 8 0 8 9-Oct-9 1 9 7-Nov-9 3 AP

9 00 1 100106001 0 1 6-Apr-9 1 3 9-Apr-9 1 MP

9 5 900048001 1 09 2 9 1-Feb-9 1 0 2-Apr-9 5 MP

9 6 800294002 1 08 1 8 7-Oct-9 1 1 7-Nov-9 3 MP

9 6 800257001 6 08 1 8 6-Sep-9 2 9M 5-Sep-9 P

9 03 300146001 7 3 1 3 8-Jun-9 1 1 9-Jul-9 3 MP

9 08 810006001 2 8 0-Jun-9 1 9 8-Aug-9 5 US

9 0 990001001 1 33 9 0 9 4-Jun-9 2 7 1-Jun-9 1 US

9 1 910011002 2 9 0 9 3-Jun-9 0 5 8-Jul-9 3 US

9 1 910006001 1 9 2 1 9 5-Mar-9 1 8 2-Apr-9 2 US
7

Table 2. Calculation of standard deviation and mean for postmortem vitreous humor.

Levey-Jennings Chart Conf +99% ----- 94 +3SD

Conf +95% ----- 73 +2SD

Conf +68% ----- 51 +1SD

Mean ------------- 30

Conf -68% -------- 9 -1SD

Conf -95% ----- -12 -2SD

Conf -99% ----- -34 -3SD

Statistics

N= -----------98

Mean --------30

Variance-- 452

SD -----------21

CV -----------70

Observ. # X-Vitreous X-Mean (X-Mean)^2

1 01 8 - 8 20.1 407.3

2 01 8 - 8 20.1 407.3

3 01 8 - 8 20.1 407.3

4 11 8 - 1 19.1 368.0

5 11 8 - 1 19.1 368.0

6 11 8 - 1 19.1 368.0

7 11 8 - 1 19.1 368.0

8 11 8 - 1 19.1 368.0

9 11 8 - 1 19.1 368.0

1 2 0 1 8 - 5 18.1 330.6

1 2 1 1 8 - 5 18.1 330.6

1 2 2 1 8 - 5 18.1 330.6

1 2 3 1 8 - 5 18.1 330.6

1 2 4 1 8 - 5 18.1 330.6

1 2 5 1 8 - 5 18.1 330.6

1 3 6 1 8 - 8 17.1 295.2

1 3 7 1 8 - 8 17.1 295.2

1 3 8 1 8 - 8 17.1 295.2

1 3 9 1 8 - 8 17.1 295.2

2 3 0 1 8 - 8 17.1 295.2

2 3 1 1 8 - 8 17.1 295.2

2 4 2 1 8 - 1 16.1 261.9

2 4 3 1 8 - 1 16.1 261.9

2 4 4 1 8 - 1 16.1 261.9

2 4 5 1 8 - 1 16.1 261.9

2 5 6 1 8 - 4 15.1 230.5

2 5 7 1 8 - 4 15.1 230.5

2 5 8 1 8 - 4 15.1 230.5

2 5 9 1 8 - 4 15.1 230.5

3 5 0 1 8 - 4 15.1 230.5

3 6 1 1 8 - 8 14.1 201.1

3 6 2 1 8 - 8 14.1 201.1

3 6 3 1 8 - 8 14.1 201.1

3 7 4 1 8 - 1 13.1 173.8

3 7 5 1 8 - 1 13.1 173.8

3 8 6 1 8 - 4 12.1 148.4

3 8 7 1 8 - 4 12.1 148.4

Observ. # X-Vitreous X-Mean (X-Mean)^2

3 8 8 1 8 - 4 12.1 148.4

3 8 9 1 8 - 4 12.1 148.4

4 8 0 1 8 - 4 12.1 148.4

4 9 1 1 8 - 7 11.1 125.0

4 9 2 1 8 - 7 11.1 125.0

4 9 3 1 8 - 7 11.1 125.0

4 9 4 1 8 - 7 11.1 125.0

4 0 5 2 8 - 1 10.1 103.7

4 0 6 2 8 - 1 10.1 103.7

4 0 7 2 8 - 1 10.1 103.7

4 1 8 2 8 - 4 9.1 84.3

4 1 9 2 8 - 4 9.1 84.3

5 1 0 2 8 - 4 9.1 84.3

5 2 1 2 8 - 7 8.1 66.9

5 2 2 2 8 - 7 8.1 66.9

5 2 3 2 8 - 7 8.1 66.9

5 3 4 2 8 - 1 7.1 51.6

5 3 5 2 8 - 1 7.1 51.6

5 5 6 2 8 - 7 5.1 26.8

5 5 7 2 8 - 7 5.1 26.8

5 5 8 2 8 - 7 5.1 26.8

5 6 9 2 8 - 0 4.1 17.5

6 7 0 2 8 - 4 3.1 10.1

6 7 1 2 8 - 4 3.1 10.1

6 8 2 2 8 - 7 2.1 4.7

6 0 3 3 8 - 3 0.1 0.0

6 0 4 3 8 - 3 0.1 0.0

6 1 5 3 2 0 7 .8 0.6

6 2 6 3 2 1 0 .8 3.3

6 2 7 3 2 1 0 .8 3.3

6 2 8 3 2 1 0 .8 3.3

6 3 9 3 2 2 3 .8 7.9

7 3 0 3 2 2 3 .8 7.9

7 4 1 3 2 3 6 .8 14.5

7 6 2 3 2 5 3 .8 33.8

7 6 3 3 2 5 3 .8 33.8

7 0 4 4 2 9 6 .8 96.3
8

0

10

20

30

40

50

60

70

80

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100

mg/dL

Frequency

Urine

Vitreous

Figure 1. Glucose Frequency Chart

Table 2. (Continued)

Observ. # X-Vitreous X-Mean (X-Mean)^2

7 1 5 4 2 1 9 0.8 116.9

7 3 6 4 2 1 6 2.8 164.2

7 5 7 4 2 1 2 4.8 219.5

7 6 8 4 2 1 6 5.8 250.1

7 9 9 4 2 1 5 8.8 354.0

8 0 0 5 2 1 9 9.8 392.6

8 2 1 5 2 2 5 1.8 475.9

8 5 2 5 2 2 5 4.8 615.8

8 7 3 5 2 2 2 6.8 719.1

8 9 4 5 2 2 8 8.8 830.3

8 9 5 5 2 2 8 8.8 830.3

8 0 6 6 2 2 1 9.8 889.0

8 3 7 6 2 3 1 2.8 1076.9

8 6 8 6 2 3 1 5.8 1282.8

8 6 9 6 2 3 1 5.8 1282.8

9 9 0 6 2 3 1 8.8 1506.7

9 1 1 7 2 4 7 0.8 1665.9

9 2 2 7 2 4 1 1.8 1748.6

9 3 3 7 2 4 4 2.8 1833.2

9 6 4 7 2 4 4 5.8 2099.1

9 7 5 7 2 4 7 6.8 2191.7

9 1 6 8 2 5 0 0.8 2582.3

9 9 7 8 2 5 6 8.8 3459.3

9 7 8 9 2 6 2 6.8 4464.4
9

Table 3. Calculation of standard deviation and mean for postmortem urine.

Levey-Jennings Chart Conf +99% ----- 76 +3SD

Conf +95% ----- 59 +2SD

Conf +68% ----- 43 +1SD

Mean ------------- 27

Conf -68% ------ 10 -1SD

Conf -95% ------- -6 -2SD

Conf -99% ----- -22 -3SD

Statistics

N= --------- 127

Mean --------27

Variance-- 266

SD -----------16

CV -----------61

Observ. # X-Urine X-Mean (X-Mean)^2

1 01 7 - 7 16.6 277.8

2 01 7 - 7 16.6 277.8

3 11 7 - 3 15.6 245.5

4 11 7 - 3 15.6 245.5

5 21 7 - 9 14.6 215.1

6 21 7 - 9 14.6 215.1

7 21 7 - 9 14.6 215.1

8 21 7 - 9 14.6 215.1

9 21 7 - 9 14.6 215.1

1 2 0 1 7 - 9 14.6 215.1

1 2 1 1 7 - 9 14.6 215.1

1 3 2 1 7 - 5 13.6 186.8

1 3 3 1 7 - 5 13.6 186.8

1 3 4 1 7 - 5 13.6 186.8

1 3 5 1 7 - 5 13.6 186.8

1 3 6 1 7 - 5 13.6 186.8

1 4 7 1 7 - 1 12.6 160.5

1 4 8 1 7 - 1 12.6 160.5

1 4 9 1 7 - 1 12.6 160.5

2 4 0 1 7 - 1 12.6 160.5

2 4 1 1 7 - 1 12.6 160.5

2 4 2 1 7 - 1 12.6 160.5

2 4 3 1 7 - 1 12.6 160.5

2 5 4 1 7 - 7 11.6 136.1

2 5 5 1 7 - 7 11.6 136.1

2 5 6 1 7 - 7 11.6 136.1

2 5 7 1 7 - 7 11.6 136.1

2 5 8 1 7 - 7 11.6 136.1

2 5 9 1 7 - 7 11.6 136.1

3 5 0 1 7 - 7 11.6 136.1

3 5 1 1 7 - 7 11.6 136.1

3 5 2 1 7 - 7 11.6 136.1

3 6 3 1 7 - 3 10.6 113.8

3 6 4 1 7 - 3 10.6 113.8

3 6 5 1 7 - 3 10.6 113.8

3 6 6 1 7 - 3 10.6 113.8

3 6 7 1 7 - 3 10.6 113.8

Observ. # X-Urine X-Mean (X-Mean)^2

3 6 8 1 7 - 3 10.6 113.8

3 7 9 1 7 - 0 9.6 93.5

4 7 0 1 7 - 0 9.6 93.5

4 7 1 1 7 - 0 9.6 93.5

4 7 2 1 7 - 0 9.6 93.5

4 8 3 1 7 - 6 8.6 75.1

4 8 4 1 7 - 6 8.6 75.1

4 8 5 1 7 - 6 8.6 75.1

4 8 6 1 7 - 6 8.6 75.1

4 8 7 1 7 - 6 8.6 75.1

4 8 8 1 7 - 6 8.6 75.1

4 9 9 1 7 - 2 7.6 58.8

5 9 0 1 7 - 2 7.6 58.8

5 9 1 1 7 - 2 7.6 58.8

5 9 2 1 7 - 2 7.6 58.8

5 9 3 1 7 - 2 7.6 58.8

5 9 4 1 7 - 2 7.6 58.8

5 0 5 2 7 - 8 6.6 44.4

5 0 6 2 7 - 8 6.6 44.4

5 0 7 2 7 - 8 6.6 44.4

5 1 8 2 7 - 4 5.6 32.1

5 1 9 2 7 - 4 5.6 32.1

6 1 0 2 7 - 4 5.6 32.1

6 1 1 2 7 - 4 5.6 32.1

6 2 2 2 7 - 0 4.6 21.8

6 2 3 2 7 - 0 4.6 21.8

6 2 4 2 7 - 0 4.6 21.8

6 2 5 2 7 - 0 4.6 21.8

6 2 6 2 7 - 0 4.6 21.8

6 2 7 2 7 - 0 4.6 21.8

6 3 8 2 7 - 6 3.6 13.4

6 3 9 2 7 - 6 3.6 13.4

7 3 0 2 7 - 6 3.6 13.4

7 3 1 2 7 - 6 3.6 13.4

7 3 2 2 7 - 6 3.6 13.4

7 3 3 2 7 - 6 3.6 13.4

7 3 4 2 7 - 6 3.6 13.4
10

Observ. # X-Urine X-Mean (X-Mean)^2

1 5 02 3 3 8 0 .3 69.4

1 6 03 3 3 9 6 .3 87.0

1 7 04 3 3 1 2 0.3 106.7

1 8 05 3 3 1 8 1.3 128.3

1 9 06 3 3 1 5 2.3 152.0

1 9 07 3 3 1 5 2.3 152.0

1 9 08 3 3 1 5 2.3 152.0

1 9 09 3 3 1 5 2.3 152.0

1 2 10 4 3 1 3 5.3 235.0

1 3 11 4 3 1 9 6.3 266.6

1 4 12 4 3 1 5 7.3 300.3

1 4 13 4 3 1 5 7.3 300.3

1 5 14 4 3 1 1 8.3 336.0

1 5 15 4 3 1 1 8.3 336.0

1 8 16 4 3 2 0 1.3 455.0

1 8 17 4 3 2 0 1.3 455.0

1 4 18 6 3 3 8 7.3 1393.5

1 4 19 6 3 3 8 7.3 1393.5

1 5 20 6 3 3 4 8.3 1469.2

1 5 21 6 3 3 4 8.3 1469.2

1 5 22 6 3 3 4 8.3 1469.2

1 6 23 6 3 3 0 9.3 1546.9

1 7 24 6 3 4 7 0.3 1626.5

1 1 25 7 3 4 1 4.3 1965.2

1 7 26 8 3 6 9 0.3 3639.7

1 0 27 1 3 0 7 9 3.3 5377.3

Observ. # X-Urine X-Mean (X-Mean)^2

7 3 5 2 7 - 6 3.6 13.4

7 3 6 2 7 - 6 3.6 13.4

7 4 7 2 7 - 3 2.6 7.1

7 4 8 2 7 - 3 2.6 7.1

7 6 9 2 7 - 5 0.6 0.4

8 7 0 2 3 0 1 .3 0.1

8 7 1 2 3 0 1 .3 0.1

8 7 2 2 3 0 1 .3 0.1

8 7 3 2 3 0 1 .3 0.1

8 7 4 2 3 0 1 .3 0.1

8 7 5 2 3 0 1 .3 0.1

8 8 6 2 3 1 7 .3 1.7

8 8 7 2 3 1 7 .3 1.7

8 8 8 2 3 1 7 .3 1.7

8 9 9 2 3 2 3 .3 5.4

9 9 0 2 3 2 3 .3 5.4

9 9 1 2 3 2 3 .3 5.4

9 9 2 2 3 2 3 .3 5.4

9 9 3 2 3 2 3 .3 5.4

9 9 4 2 3 2 3 .3 5.4

9 0 5 3 3 3 9 .3 11.0

9 0 6 3 3 3 9 .3 11.0

9 1 7 3 3 4 6 .3 18.7

9 2 8 3 3 5 2 .3 28.4

9 3 9 3 3 6 8 .3 40.0

1 4 00 3 3 7 4 .3 53.7

1 5 01 3 3 8 0 .3 69.4

Table 3. (Continued)

postmortem vitreous humor value was set at approximately 5 SD above the mean to remain conservative

and reduce the risk of including individuals with

normal glucose levels. All the subjects tested with a

postmortem vitreous humor glucose concentration

above 125 mg/dL had a previous medical history that

would account for the elevated levels. Postmortem

glucose blood levels above 200 mg/dL are considered

diagnostic of hyperglycemia (11). Therefore, postmortem vitreous humor glucose levels above 170 mg/

dL, which is 85% of the blood glucose level (10),

should be diagnostic of hyperglycemia. The rapid

loss of 70% of glucose in postmortem vitreous humor

within the first 6 hours (7) after death would suggest

that postmortem vitreous humor glucose levels above

51 mg/dL in samples tested more than 6 hours after

death should be considered abnormal. The frequency

chart (Fig. 1) indicates that very few cases (<15%)

were found with a postmortem vitreous humor glucose level above 51 mg/dL. Our results are consistent

with earlier reports for normal glucose levels of 30-80

mg/dL in human postmortem vitreous humor (12).

A level of 100 mg/dL of glucose in postmortem

urine, approximately 5 SD above the mean, was

considered to be abnormal. This value was chosen to

avoid false positive results and because pilots with a

urine glucose level above 100 mg/dL at the time of

their physical would be considered abnormal. Postmortem urine glucose concentrations above 100 mg/

dL were determined to be abnormal and indicators of

a medical abnormality. This is based on the mean

postmortem glucose level of 27 mg/dL and the SD of
11

16 mg/dL for all accident victims. All of the subjects

tested with a postmortem urine glucose concentration above 100 mg/dL had a previous medical history

that could account for the elevated levels.

Elevated glucose levels in postmortem vitreous

humor and urine can help identify transportation

operators with pre-existing medical conditions that

may have been an important factor in accident causation. Hyperglycemic conditions can be tracked using

postmortem vitreous humor and urine glucose levels.

Hypoglycemic conditions cannot be determined using postmortem vitreous humor glucose levels due to

the rapid drop in postmortem vitreous humor glucose levels. This was determined by comparing the

median postmortem vitreous humor glucose level of

0 to 9 mg/dL and the normal antimortem vitreous

humor glucose level (63 mg/dL to 90 mg/dL).

Emergency medical treatment has been considered as a possible cause for elevated glucose levels (5),

and this study did find 2 subjects with abnormal

vitreous humor glucose levels who received emergency medical treatment. However, the majority (75%)

of the victims receiving emergency medical treatment

did not have elevated vitreous humor glucose levels.

None of the individuals receiving emergency medical

treatment had elevated urine glucose levels.

It is important to note that all of the cases with an

elevated glucose level had been identified during the

normal medical certification process or could be

explained by post-accident medical treatment. This

is a 100% success rate for the medical certification

process in identifying medical conditions that result

in abnormal glucose levels. The NTSB determined

that the mishap associated with a glucose level of

3055 mg/dL in the urine and a 12 mg/dL of glucose

in vitreous humor was caused by pilot error. The

remaining accidents are still under investigation by

the NTSB.

REFERENCES

1. Bray M, Luke JL, Blackbourne BD. Vitreous

humor chemistry in deaths associated with rapid

chilling and prolonged freshwater immersion. J

Forensic Sci 1983 Jul; 28(3):588-93.

2. Moses, RA. Adler’s Physiology of the eye clinical

application. 7th ed, St. Louis: C.V. Mosby Co.;

1981.

3. Sippel H, Mottonen M. Combined glucose and

lactate values in vitreous humour for postmortem

diagnosis of diabetes mellitus. Forensic Sci Int

1982; 19:217-22.

4. Schoning P, Strafuss AC. Postmortem biochemical changes in canine vitreous humor. J Forensic

Sci 1980 Jan; 25(1):53-59.

5. Peclet C, Picotte P, Jobin F. The use of vitreous

humor levels of glucose, lactic acid and blood

levels of acetone to establish antemortem hyperglycemia in diabetics. Forensic Sci Int 1994;

65:1-6.

6. Coe J. Postmortem chemistries on human vitreous humor. The Am J Clin Pathol 1969;

51(6):741-50.

7. Bray M. The effect of chilling, freezing, and

rewarming on the postmortem chemistry of

vitreous humor. J Forensic Sci 1984 Apr;

29(2):404-11.

8. Pex JO, Meneely KD, Andrews FC. Time of

death estimation in blacktail deer by temperature

and aqueous humor glucose. J Forensic Sci 1983

Jul; 28(3):594-600.

9. Bray M. The eye as a chemical indicator of environmental temperature at the time of death. J

Forensic Sci 1984 Apr; 29(2):396-403.

10. Coe, JI. Use of chemical determinations on vitreous humor in forensic pathology. J Forensic Sci

1972 Oct; 17(4):541-6.

11. Hamilton-Paterson JL, Johnson, EW. Postmortem glycolysis. J Path Bact 1940 May;

50(3):473-82.

12. Sturner WQ, Gantner GF. Postmortem vitreous

glucose determinations. J Forensic Sci 1964 Oct;

9(4):485-91.

13. Dimaio DJ, Dimaio VJM. Forensic Pathol London: CRC Press; 1993.

14. Sacher RA. Widmann’s Clinical interpretation of

laboratory tests. 10th ed. Philadelphia: F.A. Davis

Company; 1991.
12