Brinkmann B, Fechner G, Karger B, DuChesne A
Institut für Rechtsmedizin, Westfälische Wilhelms-Universität, Munster, Germany.
Int J Legal Med. 1998;111(3):115-9. doi: 10.1007/s004140050130.
In clinical medicine, severe keto- or lactic acidosis associated with vomiting, nausea, abdominal pain, tachycardia or pathological respiration, has been described in chronic alcoholics. This study reports on fatalities of chronic alcoholics where the cause of death could not be determined by thorough autopsy, histology and toxicology including determination of alcohol concentration. In a first series, acetone was determined in the blood of such chronic alcoholics (n = 24), diabetics with metabolic decompensation (n = 7), cases of hypothermia (n = 7) and controls (n = 218). Among the 24 chronic alcoholics where the cause of death was unknown, 9 cases showed very high levels of acetone (74-400 mg/l). These comprised 6 cases without additional findings and 3 cases where a second patho-mechanism such as intoxication possibly contributed to the cause of death. In a second series, the sum values according to Traub (lactate/glucose) were determined in cerebrospinal liquor of chronic alcoholics with undetermined cause of death (n = 45), diabetics (n = 6) and controls (n = 39). Among the 45 alcoholics, 17 cases showed very high sum values (294-594 mg/dl) including 8 cases where non-lethal intoxications may have contributed to the final outcome. Other causes of a ketoacidosis or lactic acidosis (e.g. diabetes) were excluded in both groups of alcoholics. Consequently, ketoacidosis and lactic acidosis can be the cause of death of chronic alcoholics in a considerable number of cases where no pathomorphological or toxicological changes are present. A scheme for medical and laboratory examination is described.
在临床医学中，慢性酒精中毒患者曾出现过与呕吐、恶心、腹痛、心动过速或病理性呼吸相关的严重酮症或乳酸酸中毒。本研究报告了一些慢性酒精中毒患者的死亡案例，这些案例经全面尸检、组织学检查和毒理学检查（包括酒精浓度测定）后仍无法确定死因。在第一组研究中，测定了此类慢性酒精中毒患者（n = 24）、代谢失代偿的糖尿病患者（n = 7）、体温过低患者（n = 7）以及对照组（n = 218）血液中的丙酮含量。在24例死因不明的慢性酒精中毒患者中，9例丙酮水平极高（74 - 400毫克/升）。其中6例无其他异常发现，3例可能存在第二种病理机制，如中毒，这可能对死因有影响。在第二组研究中，测定了死因不明的慢性酒精中毒患者（n = 45）、糖尿病患者（n = 6）和对照组（n = 39）脑脊液中根据特劳布法计算的总和值（乳酸/葡萄糖）。在45例酒精中毒患者中，17例总和值极高（294 - 594毫克/分升），其中8例可能存在非致命性中毒，这可能对最终结果有影响。两组酒精中毒患者均排除了其他导致酮症酸中毒或乳酸酸中毒的原因（如糖尿病）。因此，在相当多的病例中，酮症酸中毒和乳酸酸中毒可能是慢性酒精中毒患者的死因，而此时并无病理形态学或毒理学改变。本文还描述了医学和实验室检查方案。
