Usefulness of a blood glucose and ketone monitoring device as a screening tool for lethal diabetic ketoacidosis

Peyron, Pierre-Antoine; Plawecki, Maëlle; Lossois, Maisy; Lotierzo, Manuela; Baccino, E.; Cristol, Jean‐Paul

doi:10.1007/s00414-020-02343-8

Cited by 2 publications

(3 citation statements)

References 18 publications

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“…This marker corresponds well to antemortem values, and it seems that it is stable after death for at least 36 h [16,25]. In order to determine an accurate value, any interference that could affect its value (i.e., anemia, splenectomy, polycythemia, pregnancy) must be excluded [16,24]. In this case, they were excluded.…”

Section: Discussionmentioning

confidence: 65%

“…The Ac was identified in the blood of the deceased at a value of 0.5 g/L, five times the detection limit (0.1 g/L). The determination of blood BHB level was carried out with a point-of-care monitoring device, with the resulting values above 2.5 mmol/L establishing the diagnosis of ketoacidosis [24]. The BHB value in the blood of the deceased was 7.3 mmol/L, thus almost three times the diagnostic threshold value.…”

Section: Discussionmentioning

confidence: 99%

“…The results are presented in Table 1. [16][17][18][19][20] and ketone bodies value increase five times above the normal threshold (normal values differ depending on the method of determination); for the colorimetric method, using the MAK041 kit, the diagnostic threshold value is 0.5 mmol/L [28]; for the point-of-care system XPER Technology, the diagnostic threshold value is 2.5 mmol/L [14,[16][17][18][19][20][21][22][23][24].…”

Section: Hba1c Methodsmentioning

confidence: 99%

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The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

et al. 2021

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Diabetic ketoacidosis (DKA) is a lethal acute hyperglycemic complication of diabetes mellitus (DM) and it represents the initial manifestation of DM in about 15–20% of cases in adults and about 30–40% of cases in children. Postmortem diagnosis of DKA can only be made by applying thanatochemistry. Biochemistry applied postmortem is viewed with skepticism by many practitioners in the forensic field, completely lacking in many forensic services around the world, and especially in the national ones. This article aims to underline the importance of the postmortem application of biochemistry by reviewing the case of a person in the third decade of life who died suddenly at home due to diabetic ketoacidosis (DKA), whose autopsy was performed at an early PMI of approximately 24 h. Routine postmortem examinations (macroscopic, anatomopathological, and toxicological) could not establish a clear cause of death. When attention was turned to biochemical determinations (i.e., determination of glycated hemoglobin, glucose and ketone bodies (acetone, beta-hydroxybutyrate) in the blood, vitreous humor, and cerebrospinal fluid), the identified values clarified the thanatogenic mechanisms by establishing the diagnosis of DKA.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Hba1c Methodsmentioning

confidence: 99%

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The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

et al. 2021

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Postmortem Diagnosis of Ketoacidosis by Determining Beta-Hydroxybutyrate Levels in Three Types of Body Fluids by Two Different Methods

et al. 2022

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Background: Postmortem assessment of endogenous ketoacidosis is primarily focused on the determination of 3-beta-hydroxybutyrate (BHB). The aim of our study was to identify the most adequate body fluid and postmortem quantification method for assessing ketoacidosis status immediately prior to death. Material and method: We performed a prospective study on 53 cases of sudden death or in-hospital death that were considered forensic cases and could present a state of ketoacidosis prior to death, the autopsies being performed at a post-mortem interval of 24–72 h. BHB analysis was performed by Multi-Functional Monitoring System XPER Technology analyzer (method A—portable analyzer) for peripheral blood, and by BHB Assay MAK041 Kit (method B) for vitreous humor (VH) and cerebrospinal fluid (CSF). Results: We identified 11 ketoacidosis cases using method A and 9 ketoacidosis cases using method B. All nine cases of ketoacidosis identified using the MAK041 kit were confirmed with the portable analyzer. For the 2 cases of ketoacidosis identified only with the portable analyzer, the values obtained by method B were at the diagnostic limit. BHB concentrations determined in VH and CSF by method B were statistically significantly correlated with each other and with peripheral blood BHB concentration. Conclusion: BHB, a marker of ketoacidosis, should be determined post-mortem whenever a metabolic imbalance is suspected irrespective of known risk factors or obvious morphological substrate to help establish the thanatogenic mechanism. BHB quantification can easily be performed using a handheld automatic analyzer and a sample of peripheral blood as BHB levels in various body fluids correlate with each other.

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Usefulness of a blood glucose and ketone monitoring device as a screening tool for lethal diabetic ketoacidosis

Cited by 2 publications

References 18 publications

The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

Postmortem Diagnosis of Ketoacidosis by Determining Beta-Hydroxybutyrate Levels in Three Types of Body Fluids by Two Different Methods

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