Significant ketoacidosis at autopsy: a single-centre systematic review

Area of Science:

• Forensic Pathology
• Clinical Biochemistry
• Toxicology

Background:

• Sudden unexpected death investigations require comprehensive biochemical analysis.
• Ketoacidosis, a metabolic derangement, can be a contributing factor in mortality.
• Diagnostic markers for ketoacidosis in post-mortem toxicology are crucial.

Purpose of the Study:

• To evaluate the utility of vitreous beta-hydroxybutyrate and serum acetone in identifying ketoacidosis in sudden unexpected death cases.
• To correlate biochemical findings with clinical history and autopsy results.

Main Methods:

• Retrospective analysis of coroner's autopsy reports over 24 months.
• Inclusion of cases with significant ketoacidosis.
• Analysis of demographic data, medical history, autopsy findings, and biochemical parameters (vitreous glucose, serum/vitreous alcohol).

Main Results:

• Forty-two cases of ketoacidosis were identified (50% alcoholic ketoacidosis, 19% diabetic ketoacidosis).
• Alcoholic ketoacidosis cases showed low vitreous glucose and low/undetected blood alcohol.
• Raised vitreous glucose levels were exclusively observed in diabetic ketoacidosis cases.

Conclusions:

• Ketoacidosis is a significant, often overlooked, cause of sudden death.
• Vitreous beta-hydroxybutyrate and serum acetone aid in differentiating types of ketoacidosis.
• Consider ketoacidosis in unexplained sudden deaths, especially in patients with alcohol or diabetes history.