ALCOHOLIC KETOACIDOSIS AS A CAUSE OF DEATH IN FORENSIC CASES

Forensic pathologists are familiar with alcohol abusers, who are found dead and in whom the cause of death cannot be ascertained. In order t o examine the possible role of ketoacidosis for the cause of death in this group of alcohol abusers, the concentrations of ketone bodies (ac etone, acetoacetate, D-beta-hydroxybutyrate) were determined in post m ortem blood specimens. Determination of the ketone body concentrations were made by a coupled enzymatic head-space gas chromatographic metho d. The material consisted of blood specimens from 131 deceased persons and was divided into three groups: Group 1: controls, 79 cases of non alcohol abusers; group 2: 35 cases of alcohol abusers with known caus es of death and group 3: 17 cases of alcohol abusers without ascertain able cause of death. The geometric means for the sum of the ketone bod y concentrations in blood were: controls, 109 mu mol/l; alcohol abuser s with known causes of death, 152 mu mol/l; and alcohol abusers withou t known cause of death, 590 mu mol/l. The limit value between the cont rols and the group of alcoholics with unascertainable cause of death w as by logistic regression found to be 531 mu mol/l (343-1224 mu mol/l) . The term 'ketoalcoholic death' is, therefore, suggested, when the me asured post mortem blood ketone body concentration in an alcoholic wit h otherwise unknown cause of death exceeds 531 mu mol/l.