[Death by alcoholic ketoacidosis--analytical procedure and case report]

Alcoholic ketoacidosis is a medical emergency, which is characterized at first by an elevated level of ketone bodies. The production of these ketone bodies is accompanied by an equimolar quantity of hydrogen ions and thus causes acidosis, which cannot be detected post-mortem due to anaerobic glycolysis, whereas the three ketone bodies beta-hydroxybutyrate, acetoacetate and acetone can be easily identified. However, the limits of ketone body concentrations mentioned in the literature for diagnosing ketoacidosis vary significantly, partly due to inhomogeneous study groups. A 44-year-old woman was found dead with numerous haematomas and partial mummification. Some days before, she had reported her partner to the police for rape. Consequently investigations for homicide were initiated. The autopsy itself did not reveal any morphologically identifiable cause of death. The ketone body concentrations in three matrices (vitreous humour, cerebrospinal fluid, cardiac blood) left no doubt that death was due to alcoholic ketoacidosis.