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

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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 ( (500-1,200 a all and be bhb bhb. case cut detected. for high in l l) many not of off, raised recommend samples screen therefore this to we with would>1,000 μmol/L) vitreous/urine glucose and HbA1C must be measured to distinguish DKA from other types of ketoacidosis.
TidsskriftScandinavian Journal of Forensic Science
Udgave nummer1
Sider (fra-til)5-8
Antal sider4
StatusUdgivet - 2019

ID: 245275165