title: The postmortem diagnosis of alcoholic ketoacidosis.
abstract: OBJECTIVE
  The aim of this article is to review the forensic literature covering the postmortem investigations that are associated with alcoholic ketoacidosis fatalities and report the results of our own analyses.
  
  
  METHODS
  Eight cases of suspected alcoholic ketoacidosis that had undergone medico-legal investigations in our facility from 2011 to 2013 were retrospectively selected. A series of laboratory parameters were measured in whole femoral blood, postmortem serum from femoral blood, urine and vitreous humor in order to obtain a more general overview on the biochemical and metabolic changes that occur during alcoholic ketoacidosis. Most of the tested parameters were chosen among those that had been described in clinical and forensic literature associated with alcoholic ketoacidosis and its complications.
  
  
  RESULTS
  Ketone bodies and carbohydrate-deficient transferrin levels were increased in all cases. Biochemical markers of generalized inflammation, volume depletion and undernourishment showed higher levels. Adaptive endocrine reactions involving insulin, glucagon, cortisol and triiodothyronine were also observed.
  
  
  CONCLUSIONS
  Metabolic and biochemical disturbances characterizing alcoholic ketoacidosis can be reliably identified in the postmortem setting. The correlation of medical history, autopsy findings and biochemical results proves therefore decisive in identifying pre-existing disorders, excluding alternative causes of death and diagnosing alcoholic ketoacidosis as the cause of death.
authors: Corresponding author: University Center of Legal Medicine, Rue du Bugnon 21, 1011 Lausanne, Switzerland. cristian.palmiere@chuv.ch.
authors: Cristian
authors: C
authors: Palmiere
authors: Marc
authors: M
authors: Augsburger
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000652:urine; D015415:Biomarkers / Q000378:metabolism; D002423:Cause of Death; D006801:Humans; D007662:Ketosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014822:Vitreous Body / Q000378:metabolism
chemical_list: D015415:Biomarkers