Forensic Assessment of Postmortem Biochemical Changes in Starvation and Dehydration: Correlation with Duration of Nutritional and Fluid Deprivation in Adult Autopsy Cases.

BACKGROUND

Starvation and dehydration are critical physiological states that leave distinct biochemical and pathological markers detectable in postmortem examinations. Accurately identifying these changes is essential for forensic pathologists in determining the cause of death and differentiating between fatal nutritional deprivation and other conditions. This study aimed to investigate and compare the biochemical and histopathological alterations associated with varying durations of starvation and dehydration in postmortem cases and to evaluate their forensic relevance.

MATERIALS AND

METHODS

An observational cross-sectional study was conducted on 135 postmortem cases at Vinayaka Mission's Medical College. Subjects were categorized into two groups based on estimated starvation duration (1-3 days and 4-7 days). Biochemical markers (e.g., cortisol, aldosterone, insulin, electrolytes, blood urea nitrogen [BUN], creatinine, and liver enzymes) were measured using enzyme-linked immunosorbent assays and standard biochemical assays. Histopathological analysis was conducted on the liver, kidney, heart, and gastrointestinal tissues. Statistical analysis included t-tests, Mann-Whitney U-tests, and multivariate regression.

RESULTS

Cortisol and aldosterone levels were elevated in 88.1% and 64.4% of cases, respectively, with significantly higher levels in the prolonged starvation group (P < 0.001). Insulin was suppressed in 50% of long-duration cases. Electrolyte imbalances, particularly hyponatremia (75%), hypokalemia (65%), and hypochloremia (65%), worsened with starvation duration. Renal markers such as elevated BUN (85%) and creatinine (P < 0.001) indicated renal hypoperfusion. Histopathology revealed advanced muscle wasting, organ atrophy, and hepatic steatosis, correlating strongly with biochemical abnormalities.

CONCLUSIONS

The study confirms that specific biochemical and pathological markers vary significantly with the duration of starvation and dehydration, supporting their forensic utility. Quantitative thresholds for key markers may enhance the accuracy of postmortem cause-of-death determinations, particularly in the absence of reliable clinical history.