title: Postmortem vitreous beta-hydroxybutyrate: interpretation in a forensic setting.
abstract: Vitreous beta-hydroxybutyrate (BHB) was retrospectively analyzed in 1795 forensic cases using the Pointe Scientific method. Comparison of vitreous BHB with vitreous glucose in 1781 of the cases showed moderately good correlation r = 0.731. Comparison with blood alcohol levels in 1561 of the cases showed no correlation r = -0.053. Vitreous BHB was a marker of diabetic ketoacidosis when above 6.0 mM with a vitreous glucose over 200 mg/dL. It was an indicator (>50%) for alcoholic ketoacidosis when above 6.0 mM with a vitreous glucose below 200 mg/dL. Recommendations for interpretation of vitreous BHB: <0.4 mM normal; 0.41-1.2 mM slightly elevated, rarely (<1%) of concern; 1.21-2.0 mM moderately elevated, less rarely (2.5%) of concern; 2.01-6.0 mM significantly elevated, frequently of concern (12-48%); >6.0 mM usually (100% in this study) indicated life-threatening conditions. Vitreous BHB was helpful evaluating cases with ketogenic conditions, especially diabetes and alcoholism.
authors.affiliation: Fulton County Medical Examiner's Center, Atlanta, GA 30312, USA. michael.heninger@fultoncountyga.gov
authors.forename: Michael
authors.initials: M
authors.lastname: Heninger
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000032:analysis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D002492:Central Nervous System Depressants / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D000431:Ethanol / Q000032:analysis; D005260:Female; D049429:Forensic Pathology; D005947:Glucose / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007662:Ketosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011180:Postmortem Changes; D012189:Retrospective Studies; D014822:Vitreous Body / Q000737:chemistry*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002492:Central Nervous System Depressants; D000431:Ethanol; D005947:Glucose; D020155:3-Hydroxybutyric Acid