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). In DKA and in its female subgroup, cases with moderate ketosis cases were older (P=0.0218 and P=0.0083) than controls. 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 to 1000 µg/g) and controls (P<0.001). Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded.Ĭases of AKA and DKA were most numerous (184 and 156, respectively). 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.ġ407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS, acidosis NOS, or hypothermia. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. It is unclear why death from alcoholism remained stable while AKA increased.
The deaths from alcoholism, DKA, and hypothermia remained stable. AKA increased from three to 66 and acidosis from one to 20. The number of BHB analyses/year increased from 13 to 1417. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. 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. 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). Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed.
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