Citation

Gill JR, Storck K, Kelly S. Forensic Sci. Med. Pathol. 2012; 8(3): 259-262.

Copyright

(Copyright © 2012, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s12024-011-9303-0

PMID

22160736

Abstract

Exsanguination from hemodialysis vascular sites may cause a rapid death. Due to extensive blood loss at the scene, investigators may initially suspect a homicide or suicide. We reviewed 100 deaths due to hemorrhage from hemodialysis shunt sites. The majority (81%) of these hemorrhages occurred at home and 44% subsequently died at home. Recognition of this medical complication at the scene is important to prevent the dispatch of the crime scene or homicide unit. In these instances, the common causes of kidney failure included hypertensive cardiovascular disease and diabetes mellitus. The manners of death were certified as therapeutic complication (93%), accident (5%), and suicide (2%). These fatal shunt hemorrhages are rapid and large due to their superficial subcutaneous locations and elevated shunt pressures from the arterial-venous anastamosis. The cause of death statement must include the proximate cause of death, which is usually the disease that resulted in kidney failure, if it is known.

Language: en

Keywords

Humans; Accidents; Adult; Aged; Middle Aged; Cause of Death; Suicide; Autopsy; Forensic Pathology; Young Adult; Aged, 80 and over; Death Certificates; Time Factors; New York City; Renal Dialysis; Exsanguination; Arteriovenous Shunt, Surgical; Renal Insufficiency