No abstract

Diabetes and alcohol abuse may cause severe metabolic disturbances that can be fatal. These may be difficult to diagnose in autopsies based solely on macroscopical and histological findings. In such cases, metabolic markers, such as postmortem glucose and ketone levels, can provide supporting information. Glucose or combined glucose and lactate, the Traub value, is often used to indicate hyperglycemia. The use of the Traub value, however, has been questioned by some, because the lactate levels are known to elevate in postmortem samples also due to other reasons than glycolysis of glucose molecules. Ketoacidosis can be detected by analyzing ketone body levels, especially beta-hydroxybutyric acid (BHB). Acetone is also elevated in severe cases of ketoacidosis. Here, we have evaluated the value of these biomarkers for postmortem determination of the metabolic disturbances. Retrospective data of 980 medico-legal autopsies performed in Finland, where glucose, lactate and ketone bodies were analyzed, was collected. Our findings show that the Traub value indicates hyperglycemia, even when glucose levels are low. For diagnosis, evaluation of complementing markers, e.g. ketone bodies and glycated hemoglobin is needed. Our results show that BHB can be used for screening and diagnosis of ketoacidosis. Acetone alone is not sufficient, since it is elevated only in the most severe cases. We also found that alcohol abuse rarely causes severe ketoacidosis. However, sporadic cases do exist where ketone body levels are extremely high. Despite this, alcoholic ketoacidosis is very rarely diagnosed as the cause of death.

No abstract

Glycated hemoglobin (HbA1c) is used for diagnosis of diabetes and evaluation of the glycemic control of diabetics in clinical medicine. It is also a useful biomarker for analyzing postmortem samples, since it is relatively stable and correlates well with clinical samples. We wanted to evaluate the information provided by HbA1c analysis of postmortem blood samples using a HPLC based, fully automated analyzer. Autopsy data from 55 cases, in which glucose, lactate, ketone bodies, and HbA1c were analyzed as a part of cause of death investigation, were selected for the study. Another set of 71 samples were analyzed in parallel with Mono S HPLC and automated BioRad D-10 HPLC. The results of 64 samples attained using both methods were compared using a Bland-Altman plot. We conclude that HbA1c can be analyzed reliably and cost-effectively from postmortem samples using a fully automated HPLC based analyzer. It is necessary, particularly in ketoacidotic cases, to determine the HbA1c level to help distinguish diabetic ketoacidosis from other causes.