Postmortem vitreous humor β-hydroxybutyrate: its utility for the postmortem interpretation of diabetes mellitus

• Published in: Forensic science international Vol. 153; no. 2; pp. 189 - 195
• Main Authors: Osuna, Eduardo, Vivero, Guillermo, Conejero, Josefa, Abenza, José M., Martínez, Pedro, Luna, Aurelio, Pérez-Cárceles, María D.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 29.10.2005; Elsevier; The Lancet Publishing Group, a division of Elsevier Science Ltd
• Subjects: 3-Hydroxybutyric Acid - analysis; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - analysis; Cadaver; Diabetes; Diabetes mellitus; Diabetic acidosis; Diabetic Ketoacidosis - diagnosis; Discriminant Analysis; Female; Forensic Medicine; Fructosamine; Fructosamine - analysis; Fructose; General aspects; Glucose - analysis; Humans; Investigative techniques, diagnostic techniques (general aspects); Ketoacidosis; Lactic Acid - analysis; Male; Medical sciences; Middle Aged; Postmortem; Public health. Hygiene; Public health. Hygiene-occupational medicine; ROC Curve; Sensitivity and Specificity; Vitreous Body - chemistry; Vitreous humor; β-Hydroxybutyrate; Vitreous humor; Fructosamine; β-Hydroxybutyrate; Diabetes mellitus; Ketoacidosis; Postmortem; Endocrinopathy; Ketone body; Forensic science; Legal medicine; Vitreous body; Forensic aspect; Acid base balance disorder; Interpretation; Humor; Metabolic disorder
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/j.forsciint.2004.09.105

Ketoacidotic coma is one of the most serious complications arising from diabetes mellitus, especially type I, and may be the cause of sudden death especially in diabetes type I. Since beta-hydroxybutyrate (β-OHB) serum concentrations might provide more information on the severity of ketoacidosis, the aim of this study was to evaluate the concentrations of β-OHB in vitreous humor and its correlation with other biochemical parameters during postmortem examination. We intended to ascertain the sensitivity and the specificity of these markers for diagnosing diabetes mellitus and the presence of ketoacidosis. This study involved 453 cadavers with a mean age of 57.6 years (S.D. 20.7) and a mean postmortem interval of 17.8 h (S.D. 9.6, range 2–61 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of diabetes mellitus, based on the patients’ medical records. In vitreous humor statistically significant differences were found in biochemical marker concentrations between the two diagnostic groups, the highest values being obtained in the group of subjects with a previous diagnosis of diabetes mellitus. The measurement of β-OHB in vitreous humor may be a useful alternative to using blood during postmortem analysis. The presence of high levels of β-OHB may help interpret the cause of death in diabetics when the autopsy result is negative.