Fatal diabetic ketoacidosis associated with excessive soft drink consumption: a case report

We report a case of sudden and unexpected death due to diabetic ketoacidosis in a severely obese young woman (height, 146 cm; weight, 98 kg) with no prior diagnosis of diabetes mellitus but a history of prolonged excessive consumption of sugary beverages. Autopsy and histopathological findings revealed no fatal organic pathology except for severe fatty liver, and the toxicological examination was negative. Postmortem biochemical analysis showed markedly elevated serum glucose (1890 mg/dL), vitreous glucose (1900 mg/dL), glycated hemoglobin (13.7%), and acetone levels in the cardiac blood (65 µg/mL), peripheral blood (68 µg/mL), and urine (119 µg/mL). Tests for glutamic acid decarboxylase antibodies were negative. Based on these findings and the scene investigation, the cause of her death was determined to be diabetic ketoacidosis in the context of chronic excessive sugar intake, consistent with the phenomenon of "soft drink ketosis." This report highlights the essential role of postmortem biochemical analyses in elucidating the metabolic causes of sudden death.