Investigation of markers to indicate and distinguish death due to Alcoholic Ketoacidosis, Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State using post-mortem samples

Vitreous Humor: A Short Review on Post-mortem Applications

“…New onset of insulin-dependent diabetes mellitus often presents with Diabetic Ketoacidosis (DKA), which along with Hyperglycemic Hyperosmolar State (HHS), are the two main conditions causing death in the diabetic population [62][63][64]. The diagnosis of various metabolic conditions is often difficult to make post-mortem due to major changes in the blood and other tissues [65].…”

“…A high VH glucose concentration in conjunction with a significant BHB concentration can be used to identify hyperglycemia and distinguish death due to DKA from ketoacidosis caused by other circumstances [64]. A high glucose concentration also indicates that an individual was a possible diabetic, a condition that may not have been diagnosed prior to death [64].…”

“…A high glucose concentration also indicates that an individual was a possible diabetic, a condition that may not have been diagnosed prior to death [64]. Of course, increased glucose concentrations may be seen in other causes of death, including postmortem cases after prolonged agony, trauma, emergency resuscitation attempts, or surgery [64].…”

“…However, further investigation is required to verify this suggestion and to determine a suitable reference range [64]. BHB concentrations alone do not distinguish between DKA and Alcoholic Ketoacidosis (AKA).…”

“…Therefore, glucose measurement is essential to determine hyperglycemia and, therefore, to distinguish between DKA and ketoacidosis from other causes. Some authors suggest VH glucose concentrations should be routinely measured (where possible) in all cases where BHB is detected in significant concentrations [64]. They also suggest that VH glucose concentrations should be routinely measured in all unexplained deaths, irrespective of whether a significant concentration of BHB is detected or not and especially in cases with risk factors for diabetes including obesity, old age or a history of mental health problems [64].…”