title: Septic Ketoacidosis-A Potentially Lethal Entity with Renal Tubular Epithelial Vacuolization.
abstract: Fatal ketoacidosis due to diabetes mellitus, alcoholism, and starvation may produce characteristic basal vacuolization of renal tubular epithelial cells (RTEC). Septic ketoacidosis has recently been recognized clinically as a distinct condition in which septicemia can lead to elevation of ketones and various anions unrelated to diabetes mellitus, alcoholism, or caloric deprivation. We report four lethal cases with significantly elevated vitreous ketones secondary to sepsis and/or severe localized infection in individuals with no history of diabetes mellitus, alcoholism, or starvation. Three of four cases exhibited typical basal vacuolization of RTEC. We suggest that septic ketoacidosis is an appropriate cause of death in the forensic setting where sepsis or severe localized infection is found with significant ketoacidosis (β-hydroxybutyrate > 5 mmol/L)-in the absence of diabetes mellitus, alcoholism, starvation, or other states associated with accelerated ketogenesis. The finding of basal vacuolization of RTEC in such cases provides morphological support for the underlying metabolic derangement.
authors.affiliation: The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, Australia.|Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhou
authors.affiliation: The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, Australia.|Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000378:metabolism; D000328:Adult; D000368:Aged; D004847:Epithelial Cells / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007659:Ketones / Q000378:metabolism; D007662:Ketosis / Q000175:diagnosis*; D007684:Kidney Tubules / Q000473:pathology*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D014617:Vacuoles / Q000473:pathology*; D014822:Vitreous Body / Q000378:metabolism
chemical_list: D007659:Ketones; D019344:Lactic Acid; D020155:3-Hydroxybutyric Acid
keywords: alcoholism; basal vacuolization; diabetes mellitus; forensic science; ketoacidosis; sepsis; starvation; subnuclear vacuolization