Evaluation of postmortem calcium and magnesium levels in the pericardial fluid with regard to the cause of death in medicolegal autopsy

Abstract

Previous studies have suggested the usefulness of postmortem serum calcium (Ca) and magnesium (Mg) for investigating cause of death. The present study investigated their levels in the pericardial fluid of serial autopsy cases of adults within 48 h postmortem ( n = 385), including fatalities from blunt injury ( n = 57), sharp instrument injury ( n = 9), mechanical asphyxiation ( n = 28), salt- and freshwater drowning ( n = 14 and n = 61, respectively), fire fatality ( n = 35), intoxication ( n = 23), hypothermia (cold exposure, n = 12), hyperthermia (heat stroke, n = 7), acute cardiac death (ACD, n = 86), pneumonia ( n = 9) and spontaneous cerebral hemorrhage ( n = 11). The pericardial Ca level was independent of the postmortem interval, showing a value similar to that of the clinical reference range in cases other than saltwater drowning, while the Mg level was higher than the clinical reference range and showed a mild postmortem time-dependent increase. Pericardial Ca was significantly higher for saltwater drowning than other groups, and a lower level was seen for hyperthermia, and some cases of blunt injury and intoxication. The Mg level was also significantly higher for saltwater drowning than the other groups, and showed a higher level for sharp instrument injury, but a lower level for hypothermia. The Mg/Ca ratio was higher for sharp instrument injury and saltwater drowning, but was lower for hypothermia. These findings suggest that postmortem pericardial Ca and Mg can be used to investigate the cause of death, especially for saltwater drowning, hypothermia and hyperthermia.