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Post-mortem β-hydroxybutyrate determination in synovial fluid.

Cristian Palmiere1, Dominique Werner2

  • 1University Center of Legal Medicine, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

Forensic Science International
|May 27, 2014
PubMed
Summary
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Postmortem synovial fluid can reflect antemortem blood beta-hydroxybutyrate levels, aiding hypothermia diagnosis. However, this method is invasive and may be limited to specific forensic cases.

Area of Science:

  • Forensic Pathology
  • Biochemistry
  • Toxicology

Background:

  • Beta-hydroxybutyrate (BHB) levels in blood can indicate metabolic changes, including those seen in hypothermia.
  • Medico-legal investigations require accurate determination of cause of death, especially in cases involving environmental exposure.

Purpose of the Study:

  • To characterize beta-hydroxybutyrate distribution in synovial fluid.
  • To assess the utility of postmortem synovial fluid BHB levels for diagnosing antemortem blood BHB abnormalities, particularly in hypothermia cases.

Main Methods:

  • Determination of beta-hydroxybutyrate concentrations in blood and synovial fluid.
  • Systematic performance of unenhanced CT scans, autopsies, histology, neuropathology, toxicology, and biochemistry.
  • Inclusion of medico-legal cases: hypothermia fatalities, individuals found deceased in cold environments, and non-hypothermia controls.

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Main Results:

  • Abnormalities in antemortem blood beta-hydroxybutyrate levels, consistent with hypothermia, were reflected in postmortem synovial fluid values.
  • The study observed a correlation between blood and synovial fluid BHB levels in hypothermia fatalities.

Conclusions:

  • Postmortem synovial fluid beta-hydroxybutyrate levels may serve as an indicator of antemortem blood BHB abnormalities.
  • Synovial fluid analysis for BHB is unlikely for general application due to invasiveness, but may be useful in specific forensic scenarios where standard biological fluids are unavailable.