The Importance of BHB Testing on the Post-Mortem Diagnosis of Ketoacidosis.

Stina Ahlström,Henrik Green,Johan Ahlner,Anna K Jönsson

doi:10.3390/biom12010009

Stina Ahlström, Henrik Green + Show 2 more

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https://doi.org/10.3390/biom12010009

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Abstract

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.

Highlights

Analysis of BHB enables the diagnosis of alcoholic ketoacidosis (AKA) post mortem [4,5]
There were 1069 cases in which the cause of death was marked by the forensic pathologist as diabetes ketoacidosis (DKA), AKA, hyperosmolar hyperglycaemic syndrome (HHS), hypothermia, acidosis NOS, diabetes NOS, or chronic alcoholism, but in which BHB was not analysed
It has been postulated that post-mortem biochemical markers are viewed with some scepticism in the field of forensic pathology [3,27,28,29]

Summary

Introduction

Beta-hydroxybutyrate (BHB) is a ketone body which is used as an indicator for a metabolic disturbance, ketosis, which develops due to an insufficient intake of carbohydrates. Ketone bodies such as BHB, are well tolerated, but high concentrations lead to ketoacidosis, which may lead to death [1]. Metabolic disorders are frequent among the non-traumatic causes of death encountered in forensic medical practice [2,3]. Analysis of BHB enables the diagnosis of alcoholic ketoacidosis (AKA) post mortem [4,5]. It has proved important in the diagnosis of diabetes and related acute complications [6] and in the diagnosis of hypothermia [7]

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