The post-mortem relationship between beta-hydroxybutyrate (BHB), acetone and ethanol in ketoacidosis
The post-mortem relationship between beta-hydroxybutyrate (BHB), acetone and ethanol in ketoacidosis
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DOI：
10.1016/j.forsciint.2009.10.019
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发表时间：
2010-05-20
影响因子：
2.2
通讯作者：
Cassidy, Diane
中科院分区：
文献类型：
--
作者：
Elliott, Simon;Smith, Christopher;Cassidy, Diane
由于酒精中毒（酒精性酮症酸中毒，AKA）或糖尿病（糖尿病酮症酸中毒，DKA）导致β-氧化酮体产生而导致的血液pH值降低（酮症酸中毒）可能是许多死亡的特征，分析证据可用于支持病理诊断，或在没有其他病理学显著发现的情况下提供可能的死亡原因。通过对350多例死亡病例（分为酗酒者、糖尿病患者、酒精性糖尿病患者）中BHB、丙酮和乙醇的分析，重新检查了关于BHB浓度、丙酮和乙醇之间关系的现有信念，再加上推测性病例和其他死因。独特的是，BHB的浓度测定在死后的血液，尿液和玻璃体液中使用选择性GC-MS。结果表明，现有的信念需要重新评估。乙醇并不总是很低（250 mg/L），因此丙酮可用作病理学显著性酮症酸中毒的初始标志物。对于血液和尿液BHB浓度，可使用以下解释范围（mg/L）;正常（250 mg/L）。初步数据表明，玻璃体液BHB可能是一个有用的替代品，在没有血液（相同的解释范围也可能适用）。还提出了对尸检酮症酸中毒调查的分析建议。皇冠版权所有（C）2009由爱思唯尔爱尔兰有限公司出版。保留所有权利。
A reduced blood pH (ketoacidosis) from the production of beta-oxidative ketone bodies as a result of alcoholism (alcoholic ketoacidosis, AKA) or diabetes (diabetic ketoacidosis, DKA) can feature in many fatalities and analytical evidence can be used to support a pathological diagnosis, or provide a possible cause of death in the absence of other pathologically significant findings. Existing beliefs concerning the relationship of BHB concentrations, acetone and ethanol have been re-examined by analysis of BHB, acetone and ethanol in over 350 fatalities grouped into alcoholics, diabetics, alcoholic diabetics, coupled with speculative cases and those with an alternative cause of death. Uniquely, the concentrations of BHB were measured in post-mortem blood, urine and vitreous humour using selective GC-MS. The results showed that existing beliefs need to be re-evaluated. Ethanol is not always low (250 mg/L), therefore acetone can be used as an initial marker pathologically significant ketoacidosis. For blood and urine BHB concentrations the following interpretative ranges can be used (in mg/L); normal (250 mg/L). Initial data suggest vitreous humour BHB could be a useful alternative in the absence of blood (same interpretative ranges may also apply). Analytical recommendation for investigation of post-mortem ketoacidosis is also presented. Crown Copyright (C) 2009 Published by Elsevier Ireland Ltd. All rights reserved.