Deaths From Alcoholic and Diabetic Ketoacidosis at Autopsy-A Comparison Study

Area of Science:

• Forensic Pathology
• Toxicology
• Endocrinology

Background:

• Diabetes mellitus and alcoholism are prevalent disorders associated with sudden death.
• Ketoacidosis is a critical complication that can arise in both conditions.
• Accurate post-mortem diagnosis relies on clinical history, biochemistry, and toxicology.

Purpose of the Study:

• To compare the characteristics of deaths attributed to diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA).
• To analyze demographic and biochemical differences between DKA and AKA fatalities.
• To contribute to understanding the forensic implications of ketoacidosis in sudden death cases.

Main Methods:

• Retrospective analysis of autopsy data from two major centers over a defined study period.
• Inclusion of cases diagnosed with ketoacidosis, specifically DKA and AKA.
• Comparison of demographic data (age, sex, BMI) and post-mortem biochemical findings (acetone levels).

Main Results:

• Ketoacidosis accounted for 1.6% of 9332 autopsies (DKA: 0.9%, AKA: 0.5%).
• DKA and AKA deaths were more common in males, with median ages of 51 and 55 years, respectively.
• DKA cases exhibited significantly higher mean acetone concentrations (33.7 mg/100 mL) than AKA cases (16.9 mg/100 mL).
• Both DKA and AKA fatalities were frequently observed in individuals with lower BMIs, typically in their 50s.

Conclusions:

• Diabetic ketoacidosis and alcoholic ketoacidosis represent distinct causes of sudden death with identifiable demographic and biochemical profiles.
• Elevated acetone levels may serve as a differentiating biochemical marker in post-mortem investigations of ketoacidosis.
• Forensic pathologists should consider both DKA and AKA in sudden death cases, particularly in males with lower BMIs.