ROAR Forensics, Malvern Hills Science Park, Malvern, UK.
Forensic Sci Int. 2010 May 20;198(1-3):53-7. doi: 10.1016/j.forsciint.2009.10.019. Epub 2009 Dec 1.
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 (<10mg/dL) or absent in cases of AKA. Also, the absence of acetone precludes [corrected] a high BHB (>250mg/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 (<50mg/L), raised (51-249mg/L), high and pathologically significant (>250mg/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.
由于酗酒（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氧化酮体生成，血液 pH 值降低（酮症酸中毒），在许多死亡病例中都有这种情况，并且可以分析证据来支持病理诊断，或者在没有其他具有病理意义的发现的情况下提供可能的死因。通过对 350 多例分为酗酒者、糖尿病患者、酗酒合并糖尿病患者的尸体进行 BHB、丙酮和乙醇分析，并结合推测性病例和其他死因的病例，重新检查了现有的关于 BHB 浓度、丙酮和乙醇之间关系的观念。独特的是，使用选择性 GC-MS 测量了死后血液、尿液和玻璃体液中的 BHB 浓度。结果表明，现有的观念需要重新评估。在 AKA 病例中，乙醇并不总是低（<10mg/dL）或不存在。此外，丙酮的缺乏排除了[纠正]高 BHB（>250mg/L），因此丙酮可作为病理性显著酮症酸中毒的初始标志物。对于血液和尿液 BHB 浓度，可以使用以下解释范围（mg/L）；正常（<50mg/L）、升高（51-249mg/L）、高和病理性显著（>250mg/L）。初步数据表明，在没有血液的情况下，玻璃体液 BHB 可能是一种有用的替代物（也可能适用相同的解释范围）。还提出了死后酮症酸中毒的分析建议。
