Scordi-Bello Irini, Kirsch Daniel, Hammers Jennifer
New York Office of Chief Medical Examiner.
Acad Forensic Pathol. 2016 Jun;6(2):198-205. doi: 10.23907/2016.022. Epub 2016 Jun 1.
Diabetes mellitus is a well-recognized risk factor for arterial thrombosis, however its relationship to venous thromboembolism (VTE) in adults is still debated. We report here seven cases of fatal pulmonary thromboembolism in adults with diabetic ketoacidosis as the underlying cause. In four of seven cases, there was no prior diagnosis of diabetes mellitus and patients were newly diagnosed either upon presenting to the hospital in diabetic ketoacidosis (DKA) or at the time of autopsy by the vitreous glucose concentration. None of the patients had family history, recent surgery, recent trauma, long distance travel, or other strong risk factors for VTE. Only two patients had a body mass index greater than 35 kg/m and the same two cases had hospital stays that ranged from three to five days. We believe that DKA is a frequently unrecognized and sometimes overlooked risk factor for VTE, particularly in the forensic setting where routine toxicology and vitreous glucose analysis may not be standard practices. We encourage forensic pathologists, medical examiners, and coroners to consider the possibility of diabetic ketoacidosis as a risk factor, and in some cases, the underlying etiology for pulmonary thromboembolism. Additionally, we recommend vitreous glucose testing be performed if there are any signs of DKA or diabetes present, such as acetone in the blood.
糖尿病是动脉血栓形成的一个公认风险因素，然而其与成人静脉血栓栓塞（VTE）的关系仍存在争议。我们在此报告7例以糖尿病酮症酸中毒为根本病因的成人致命性肺血栓栓塞病例。在这7例病例中的4例中，此前未诊断出糖尿病，患者要么是在因糖尿病酮症酸中毒（DKA）入院时被新诊断出，要么是在尸检时通过玻璃体葡萄糖浓度被新诊断出。所有患者均无家族史、近期手术史、近期外伤史、长途旅行史或其他VTE的强风险因素。只有2例患者的体重指数大于35kg/m²，且这2例患者的住院时间为3至5天。我们认为DKA是VTE一个常未被认识且有时被忽视的风险因素，尤其是在法医环境中，常规毒理学和玻璃体葡萄糖分析可能并非标准做法。我们鼓励法医病理学家、法医和验尸官考虑糖尿病酮症酸中毒作为风险因素的可能性，在某些情况下，考虑其作为肺血栓栓塞的潜在病因。此外，我们建议如果存在任何DKA或糖尿病的迹象，如血液中的丙酮，则进行玻璃体葡萄糖检测。
