title: Death due to diabetic ketoacidosis: Induction by the consumption of synthetic cannabinoids?
abstract: We present a case study on a man who suffered from diabetic ketoacidosis, probably following consumption of synthetic cannabinoids. In blood from a femoral vein AB-CHMINACA, AB-FUBINACA, AM-2201, 5F-AMB, 5F-APINACA, EAM-2201, JWH-018, JWH-122, MAM-2201, STS135 and THJ 2201 could be detected by LC-MS/MS. Diagnosis of ketoacidosis as cause of death was carried out using biochemical measurements of glucose and lactate concentrations in vitreous humour (sum formula: 463 mg/dl) and cerebrospinal fluid (sum formula: 506 mg/dl), of acetone (163 mg/l in femoral venous blood) and of HbA1c (98 mmol/mol). Death due to hyperglycaemia could have been induced by skipping of insulin doses due to his intoxicated state or by the cannabinoids which were described to be able to produce hyperglycaemia themselves.
authors.affiliation: University of Bonn, Institute of Forensic Medicine, Department Forensic Toxicology, Stiftsplatz 12, 53111 Bonn, Germany. Electronic address: cohess@uni-bonn.de.
authors.forename: C
authors.initials: C
authors.lastname: Hess
authors.affiliation: University of Bonn, Institute of Forensic Medicine, Department Forensic Toxicology, Stiftsplatz 12, 53111 Bonn, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Stockhausen
authors.affiliation: University of Bonn, Institute of Forensic Medicine, Department Forensic Toxicology, Stiftsplatz 12, 53111 Bonn, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kernbach-Wighton
authors.affiliation: University of Bonn, Institute of Forensic Medicine, Department Forensic Toxicology, Stiftsplatz 12, 53111 Bonn, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Madea
mesh_terms: D000096:Acetone / Q000097:blood; D000328:Adult; D002186:Cannabinoids / Q000009:adverse effects* / Q000097:blood*; D015198:Designer Drugs / Q000009:adverse effects* / Q000032:analysis*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis*; D017809:Fatal Outcome; D053593:Forensic Toxicology; D005947:Glucose / Q000032:analysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019344:Lactic Acid / Q000032:analysis; D008297:Male; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D000096:Acetone; D002186:Cannabinoids; D015198:Designer Drugs; D005947:Glucose; D006442:Glycated Hemoglobin; D019344:Lactic Acid; C517652:hemoglobin A1c protein, human
keywords: AB-FUBINACA; Diabetic coma; Ketoacidosis; Synthetic cannabinoids