Kodikara Sarathchandra, Paranitharan P, Pollanen Michael S
Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada M7A 2G9.
J Forensic Leg Med. 2013 Feb;20(2):108-11. doi: 10.1016/j.jflm.2012.05.003. Epub 2012 Jun 27.
Diabetic ketoacidosis (DKA) is an acute severe complication of diabetes and characterized by a complex disordered metabolic state due to an absolute or relative insulin deficiency, leads to hyperglycaemia, ketoacidosis and ketonuria. DKA can cause sudden unexpected death and often yields minimal and/or subtle autopsy findings or a negative autopsy and the diagnosis mainly depends upon biochemical analysis of body fluids. This communication highlights the role of Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in 25 adult cases of fatal diabetic ketoacidosis. The study recognises and reconfirms that fatal DKA occurs in both type I and II diabetes. The macroscopic autopsy features observed in this study are non-specific and do not guide the pathologist towards the diagnosis of fatal DKA. Once other possibilities have been excluded, the Armanni-Ebstein lesion alone or the combination of hepatic steatosis and Armanni-Ebstein lesion in an otherwise negative autopsy of a sudden unexpected death should raise the suspicion of DKA as the cause of death and indicate biochemical analysis of body fluids. Our findings also remind forensic pathologists to search for fatal DKA in sudden unexpected death with a negative autopsy, where there is a history of second generation anti-psychotic treatment.
糖尿病酮症酸中毒（DKA）是糖尿病的一种急性严重并发症，其特征是由于绝对或相对胰岛素缺乏导致复杂的代谢紊乱状态，进而引发高血糖、酮症酸中毒和酮尿症。DKA可导致猝死，且尸检结果往往不明显和/或很细微，甚至尸检结果为阴性，诊断主要依赖于体液的生化分析。本文着重介绍了阿尔曼尼-埃布斯坦病变、肝脂肪变性、生化分析以及第二代抗精神病药物在25例成人致命性糖尿病酮症酸中毒病例中的作用。该研究认识并再次证实，致命性DKA在1型和2型糖尿病中均有发生。本研究中观察到的宏观尸检特征不具有特异性，无法引导病理学家诊断致命性DKA。一旦排除其他可能性，在突发意外死亡且尸检结果为阴性的情况下，单独出现的阿尔曼尼-埃布斯坦病变或肝脂肪变性与阿尔曼尼-埃布斯坦病变同时出现，应引起对DKA作为死因的怀疑，并提示进行体液生化分析。我们的研究结果还提醒法医病理学家，对于有第二代抗精神病药物治疗史且尸检结果为阴性的突发意外死亡病例，要排查致命性DKA。
