ALCOHOLIC KETOACIDOSIS AT AUTOPSY

Total ketone bodies (acetone, acetoacetate, and beta-hydroxybutyrate) were measured in 105 medicolegal autopsies (71 non-alcoholics, 22 chro nic alcoholics, and 12 diabetics) using a coupled enzymatic head-space gas chromatographic method. Samples included vitreous humour, pericar dial fluid, and blood from the femoral vein, inferior vena cava (IVC), superior vena cava (SVC), and aorta. Vitreous ketone levels showed go od correlation with blood and pericardial fluid levels, suggesting tha t vitreous could be used as an alternative autopsy specimen for this a nalysis. This opens up the possibility of using simpler clinical labor atory methodologies which cannot be applied to autopsy blood due to he molysis. In 71 non-alcoholics (age 18 to 96, median 67) total ketones (mM/L) were: vitreous 0.19 to 3.35, median 0.49; pericardial fluid 0.0 2 to 1.54, median 0.35; femoral blood 0.23 to 8.08, median 1.00; aorti c blood 0.25 to 9.96, median 0.90; IVC blood 0.30 to 6.49, median 1.27 ; SVC blood 0.32 to 6.00, median 1.07. Eleven outliers (>2.5 mM/L in f emoral blood) mostly had prolonged illness prior to death. The 22 alco holics (age 36 to 83, median 62) included four extreme outliers with f emoral blood total ketone levels of 129.9 (also diabetic), 39.4 (no an atomical cause of death), 38.5 (suicidal hanging), and 18.6 (hypotherm ia), suggesting that while alcoholic ketoacidosis may be a previously overlooked potential cause of death, interpretation must be guarded an d made within the total case context. The other 18 alcoholics had keto ne levels not statistically different from non-alcoholics, suggesting that ketoacidosis is a significant factor in at most a small minority of alcoholic deaths. Three of 12 diabetics had extreme elevations of f emoral blood ketone bodies: 87.5, 20.4, and 17.4 mM/L. Measurement of ketone bodies in vitreous humour or pericardial fluid using clinical l aboratory methodologies is recommended in unexplained deaths in chroni c alcoholics as well as diabetics.