Severe ketoacidosis can cause death. Elliott et al listed criteria for the diagnosis of ketoacidosis during a post-mortem examination. The authors are from ROAR Forensics in Malvern, England.


Types of ketoacidosis:

(1) diabetic

(2) alcoholic



(1) Initially screen blood and/or urine for alcohol and acetone.

(2) If acetone is present, then measure betahydroxybutyrate (BHB).


An alternative fluid for analysis is vitreous humor.


BHB Concentration in Blood or Urine


<= 50 mg/L


51 to 249 mg/L


>= 250 mg/L

pathologically significant


Alcohol can be detected in many but not all patients with alcoholic ketoacidosis.


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