TY - JOUR

T1 - Death from diabetic ketoacidosis in the Eastern part of Denmark in 2016-2018. Beta-hydroxybutyrate as a marker

AU - Simonsen, Kirsten Wiese

AU - Linnet, Kristian

AU - Rasmussen, Brian Schou

PY - 2019

Y1 - 2019

N2 - Diabetes mellitus is a disease caused by a deficiency in (type 1) or inability to use insulin (type 2). Untreated it can lead to diabetic ketocidosis (DKA) – state with high levels of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate (BHB)). This state can be life threatening. Measurement of ketone bodies together with vitreous/urine glucose and glycosylated hemoglobin (HbA1C) are therefore essential to diagnose DKA-related deaths. All autopsy samples received at our department in the period 2016-2018 for toxicological investigations were analyzed for acetone, BHB, and vitreous glucose (N = 1394). In case of a high level of BHB, HbA1C and urine glucose were measured. Thirty two cases (2.3%) were concluded to be DKA-related deaths. Eleven (34%) of these had no known history of diabetes. BHB accounts for the major part of ketone bodies and is directly associated with the acidosis effect. Therefore, BHB is preferred to acetone when evaluating DKA and other ketoacidosis-related deaths. We compared acetone and BHB levels to evaluate if the easy acetone measurement could cover our needs for screening. We found that high BHB levels (>2000 μmol/L) were detected if the acetone cut off was set to 0.01 g/L. But, many samples would have low BHB < 3-500 μmol/L with this cut off, and many samples with raised BHB (500-1,200 μmol/L) would not be detected. We therefore recommend to screen all samples for BHB. In case of a high BHB (>1,000 μmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.

AB - Diabetes mellitus is a disease caused by a deficiency in (type 1) or inability to use insulin (type 2). Untreated it can lead to diabetic ketocidosis (DKA) – state with high levels of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate (BHB)). This state can be life threatening. Measurement of ketone bodies together with vitreous/urine glucose and glycosylated hemoglobin (HbA1C) are therefore essential to diagnose DKA-related deaths. All autopsy samples received at our department in the period 2016-2018 for toxicological investigations were analyzed for acetone, BHB, and vitreous glucose (N = 1394). In case of a high level of BHB, HbA1C and urine glucose were measured. Thirty two cases (2.3%) were concluded to be DKA-related deaths. Eleven (34%) of these had no known history of diabetes. BHB accounts for the major part of ketone bodies and is directly associated with the acidosis effect. Therefore, BHB is preferred to acetone when evaluating DKA and other ketoacidosis-related deaths. We compared acetone and BHB levels to evaluate if the easy acetone measurement could cover our needs for screening. We found that high BHB levels (>2000 μmol/L) were detected if the acetone cut off was set to 0.01 g/L. But, many samples would have low BHB < 3-500 μmol/L with this cut off, and many samples with raised BHB (500-1,200 μmol/L) would not be detected. We therefore recommend to screen all samples for BHB. In case of a high BHB (>1,000 μmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.

KW - Faculty of Health and Medical Sciences

KW - Diabetic ketoacidosis, BHB, HbA1C, vitreous glucose, postmortem blood

U2 - 10.2478/sjfs-2019-0002

DO - 10.2478/sjfs-2019-0002

M3 - Journal article

VL - 25

SP - 5

EP - 8

JO - Scandinavian Journal of Forensic Science

JF - Scandinavian Journal of Forensic Science

SN - 1503-9552

IS - 1

M1 - 1

ER -