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
Protocol:
(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
Interpretation
<= 50 mg/L
normal
51 to 249 mg/L
increased
>= 250 mg/L
pathologically significant
Alcohol can be detected in many but not all patients with alcoholic ketoacidosis.
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