Alcoholic ketoacidosis at autopsy

Area of Science:

• Forensic Toxicology
• Clinical Chemistry
• Biochemistry

Background:

• Ketone bodies are crucial biomarkers for metabolic status.
• Accurate measurement of ketone bodies in postmortem samples is vital for forensic investigations.
• Traditional methods face challenges with postmortem sample degradation.

Purpose of the Study:

• To evaluate vitreous humor and pericardial fluid as alternative autopsy specimens for total ketone body measurement.
• To compare ketone body levels across different autopsy specimens in non-alcoholics, chronic alcoholics, and diabetics.
• To assess the utility of clinical laboratory methods for postmortem ketone analysis.

Main Methods:

• Analysis of total ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate) in 105 medicolegal autopsies.
• Utilized a coupled enzymatic head-space gas chromatographic method.
• Collected samples from vitreous humour, pericardial fluid, and various blood sites (femoral vein, IVC, SVC, aorta).

Main Results:

• Vitreous ketone levels correlated well with blood and pericardial fluid levels.
• Non-alcoholic ketone levels (median): vitreous 0.49 mM/L, pericardial fluid 0.35 mM/L, femoral blood 1.00 mM/L.
• Elevated ketone levels were observed in some chronic alcoholics and diabetics, suggesting potential ketoacidosis as a contributing factor in deaths.

Conclusions:

• Vitreous humour and pericardial fluid are suitable alternatives to blood for postmortem ketone body analysis.
• Clinical laboratory methods can be applied to vitreous humor and pericardial fluid, simplifying analysis.
• Recommended for unexplained deaths in chronic alcoholics and diabetics, especially when ketoacidosis is suspected.