Postmortem Diagnosis of Ketoacidosis by Determining Beta-Hydroxybutyrate Levels in Three Types of Body Fluids by Two Different Methods

• Published in: Applied sciences 2022-06, Vol.12 (11), p.5541
• Main Authors: Iliescu, Diana Bulgaru, Furnica, Cristina, Girlescu, Nona, Chistol, Raluca Ozana, Perianu, Lacramioara, Diac, Madalina, Timofte, Andrei Daniel, Knieling, Anton, Ciureanu, Ioan-Adrian
• Format: Article
• Language: English
• Subjects: 3-beta-hydroxybutyrate; Alcoholism; Autopsies; Blood; Blood levels; Body fluids; Cerebrospinal fluid; Death; Diabetes; Diagnostic tests; Fatty acids; Fluorides; forensic; Forensic science; Glucagon; Hypothermia; Insulin resistance; Ketoacidosis; Mortality; Peripheral blood; Portability; Respiration; Risk analysis; Risk factors; Starvation; Technology assessment; Veins & arteries; Vertebrae; Vitreous humor; Vitreous humour
• ISSN: 2076-3417; 2076-3417
• DOI: 10.3390/app12115541

Background: Postmortem assessment of endogenous ketoacidosis is primarily focused on the determination of 3-beta-hydroxybutyrate (BHB). The aim of our study was to identify the most adequate body fluid and postmortem quantification method for assessing ketoacidosis status immediately prior to death. Material and method: We performed a prospective study on 53 cases of sudden death or in-hospital death that were considered forensic cases and could present a state of ketoacidosis prior to death, the autopsies being performed at a post-mortem interval of 24–72 h. BHB analysis was performed by Multi-Functional Monitoring System XPER Technology analyzer (method A—portable analyzer) for peripheral blood, and by BHB Assay MAK041 Kit (method B) for vitreous humor (VH) and cerebrospinal fluid (CSF). Results: We identified 11 ketoacidosis cases using method A and 9 ketoacidosis cases using method B. All nine cases of ketoacidosis identified using the MAK041 kit were confirmed with the portable analyzer. For the 2 cases of ketoacidosis identified only with the portable analyzer, the values obtained by method B were at the diagnostic limit. BHB concentrations determined in VH and CSF by method B were statistically significantly correlated with each other and with peripheral blood BHB concentration. Conclusion: BHB, a marker of ketoacidosis, should be determined post-mortem whenever a metabolic imbalance is suspected irrespective of known risk factors or obvious morphological substrate to help establish the thanatogenic mechanism. BHB quantification can easily be performed using a handheld automatic analyzer and a sample of peripheral blood as BHB levels in various body fluids correlate with each other.