Paola A. Magni OSI

In this case, a 43 years old mentally disabled man died of septic shock, caused by severe and untreated burns. He lived in an apartment in a flat complex, owned and also inhabited by his mother and various relatives who, beyond denying any knowledge of his living conditions, did not seek any medical assistance after a fire broke out into his apartment a few days before death. The carcasses of a dog, a cat and a turtle in different stages of decomposition were also found in the apartment. The following investigation, beyond cause, mode and manner of death, was directed to assess the timeline of the deceased’s mental disability, thus the duration of potential neglect from the family part. The investigation was multidisciplinary, and it revealed about 20 years of neglect of a person whose mental disability was completely unknown by health, social and welfare services. The veterinary forensics assessment determined that also the pets were neglected, and most likely starved to death.

A case of suicide by insulin overdose is apparently simple to handle and file, but it triggers more than a few questions and reflections, both because it is rare and because the postmortem assessment can be quite complex. In this example the deceased person was not immediately identified, and the body was found in the open and close to a water source (creek). Critical information, such as clinical and psychiatric history, and/or a farewell letter, were missing, the body had been hastily moved from the death scene by rescue staff. An entomology expert was also needed for the estimation of the postmortem interval (PMI). The external examination and the autopsy ruled out external violence, but the decomposition stage prevented any reliable identification of injection marks. Postmortem biochemistry on blood was consistent with the hypothesis of hypoglycemic encephalopathy by insulin overdose with suicidal intent as cause, mode and manner of death. A short review of up to date literature on insulin overdoses is also outlined, with the aim of providing solid scientific references for similar cases.