Characteristics of post-mortem beta-hydroxybutyrate-positivet cases – A retrospective study on age, sex and BMI in 1407 forensic autopsies

Stina Ahlström,Henrik Green,Anna K Jönsson,Ingemar Thiblin

doi:10.1016/j.forsciint.2021.110878

Stina Ahlström, Henrik Green + Show 2 more

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https://doi.org/10.1016/j.forsciint.2021.110878

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Abstract

BackgroundPost-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. AimTo retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations. Methods1407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS [hyperosmolar hyperglycaemic state], acidosis NOS [not otherwise specified], or hypothermia. Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded. ResultsCases of AKA and DKA were most numerous (184 and 156, respectively). In DKA and in its male subgroup, cases with severe ketosis (BHB>1000 µg/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250–1000 µg/g) and controls (P<0.001). In DKA and in its female subgroup, cases with moderate ketosis cases were older (P = 0.0218 and P = 0.0083) than controls. In AKA and in its male subgroup, cases with severe ketosis had a lower BMI than those with moderate ketosis (P = 0.0391 and P = 0.0469) and controls (P<0.001). Cases with moderate ketosis had a lower BMI than controls (P<0.001). ConclusionsBHB concentration is associated with BMI in DKA and AKA, and with both BMI and age in DKA. Constitutional factors should, therefore, be considered in potential AKA and DKA cases.

Highlights

Ketoacidosis refers to a state of metabolic imbalance that may de velop when the glucose metabolism is impaired and fatty acids are subsequently released from adipocytes
The study results indicate that age and body mass index (BMI) differ between different concentrations of BHB in diabetic ketoacidosis (DKA) and alcoholic ketoacidosis (AKA), and that the correlations are affected by the sex of the individual
Severe DKA cases in men are associated with a lower age and a lower BMI, but for women the effects are less pronounced

Summary

Introduction

Ketoacidosis refers to a state of metabolic imbalance that may de velop when the glucose metabolism is impaired and fatty acids are subsequently released from adipocytes. Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increas ingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. Not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. Aim: To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations. In DKA and in its male subgroup, cases with severe ketosis (BHB > 1000 μg/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250–1000 μg/g) and controls (P < 0.001). In AKA and in its male subgroup, cases with severe ketosis had a lower BMI than those with moderate ketosis (P = 0.0391 and P = 0.0469) and controls (P < 0.001). Constitutional factors should, be considered in potential AKA and DKA cases

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