Investigation of markers to indicate and distinguish death due to alcoholic ketoacidosis, diabetic ketoacidosis and hyperosmolar hyperglycemic state using post-mortem samples.
نویسندگان
چکیده
Data from 191 post-mortem cases where post-mortem blood beta-hydroxybutyrate (βHB) and acetone concentrations and vitreous humor glucose concentrations (where available) had been measured were retrospectively investigated to determine the markers required to identify and distinguish between Alcoholic Ketoacidosis (AKA), Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). Blood βHB concentrations above 250 μg/mL were considered significant and it was shown to be the preferred marker of ketoacidosis. All cases with significant βHB detected also had acetone present (greater than 2mg/dL) demonstrating that acetone can be used as a marker to identify ketoacidosis and can be used to indicate when βHB measurement is necessary. Vitreous humor glucose concentrations above 6.9 mmol/L were considered high and indicative of hyperglycemia prior to death. Vitreous humor glucose concentrations can be used to distinguish between DKA and ketoacidosis from other causes and to identify deaths due to HHS. The data showed that ketoacidosis can occur without a history of alcoholism or diabetes. Many diabetics are undiagnosed for many years. Therefore, DKA or HHS should be considered in sudden or unexplained deaths and glucose should be routinely measured especially in cases with risk factors for diabetes including obesity, old age, a history of mental health problems or treatment with atypical antipsychotic drugs including clozapine, olanzapine, quetiapine and risperidone.
منابع مشابه
Diabetic ketoacidosis and hyperglycemic hyperosmolar state.
Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. The authors provide a review of the current epidemiology, precipitating factors, pathogenesis, clinical presentation, evaluation, and treatment of DKA and HHS. The discovery of insulin in 1921 changed the life ...
متن کاملمراحل اغماء دیابتیک
EXTRACT When you are faced with a diabetic person that has been numbness, lethargic or confuse condition and Likely to enter into a diabetic coma what nursing interventions should be done? The answer of question is related to complete review of symptoms by nurses. Typically, in the most cases hypoglycemia can cause coma. The next cause of coma is diabetic ketoacidosis ...
متن کاملDiabetic ketoacidosis and hyperglycemic hyperosmolar syndrome after renal transplantation in the United States
BACKGROUND: The incidence and risk factors for diabetic ketoacidosis (diabetic ketoacidosis) and hyperglycemic hyperosmolar syndrome (hyperglycemic hyperosmolar syndrome, previously called non-ketotic hyperosmolar coma) have not been reported in a national population of renal transplant (renal transplantation) recipients. METHODS: We performed a historical cohort study of 39,628 renal transplan...
متن کاملDiabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome
(a) History: Most patients with diabetic ketoacidosis (DKA) or with hyperosmolar hyperglycemic state (HHS) will have a history of diabetes, and a history of altered insulin dose, infection, signifi cant medical “stress”. Antecedent symptoms of polyuria and polydipsia, lassitude, blurred vision, and mental status changes may predominate the clinical picture. With DKA, abdominal pain and tachypne...
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ورودعنوان ژورنال:
- Forensic science international
دوره 214 1-3 شماره
صفحات -
تاریخ انتشار 2012