Characteristics of post-mortem beta-hydroxybutyrate-positivet cases – A retrospective study on age, sex and BMI in 1407 forensic autopsies

• Published in: Forensic science international 2021-08, Vol.325, p.110878, Article 110878
• Main Authors: Ahlström, Stina, Thiblin, Ingemar, Jönsson, Anna K., Green, Henrik
• Format: Article
• Language: English
• Subjects: 3-hydroxybutyric acid; Acidosis; Age; alcohol abuse; Alcoholism; alcohols; Autopsies; Autopsy; Beta-hydroxybutyrate; Blood; BMI; Body mass; Body mass index; Body size; Diabetes; Diabetes mellitus; Diabetic ketoacidosis; Drug abuse; females; Forensic pathology; Forensic science; Forensic sciences; Glucose; Hypothermia; Investigations; Ketoacidosis; Ketosis; Males; Medical records; medicine; necropsy; Obesity; Osmotic pressure; Post-mortem; retrospective studies; Sex; Subgroups
• ISSN: 0379-0738; 1872-6283; 1872-6283
• DOI: 10.1016/j.forsciint.2021.110878

Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations. 1407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS [hyperosmolar hyperglycaemic state], acidosis NOS [not otherwise specified], or hypothermia. Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded. Cases of AKA and DKA were most numerous (184 and 156, respectively). In DKA and in its male subgroup, cases with severe ketosis (BHB>1000 µg/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250–1000 µg/g) and controls (P