Aim of the study: List and develop useful parameters for the DKA diagnosis, matrix by matrix, exploring their post-mortem evolution. In this context, we conducted a literature review on diabetic ketoacidosis (DKA) post-mortem exploration. Junttila and Alpo Vuorio contributed equally to this work.Ī post-mortem biochemical exploration may be helpful when autopsy could not determine the cause of death. International civil aviation organization Pilot incapacitation Fatal flight accident Accident investigation Diabetes Glucose measurement Diabetic ketoacidose Hypoglycemia Hyperglycemia While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation. With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Additionally, autopsy results on coronary arteries were reviewed. In this study, DM-related fatal flight accidents in the US National Transport Bureau’s database between years 2011–2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. Constitutional factors should, therefore, be considered in potential AKA and DKA cases.ĭiabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. Cases with moderate ketosis had a lower BMI than controls (P<0.001).īHB concentration is associated with BMI in DKA and AKA, and with both BMI and age in DKA. In AKA and in its male subgroup, cases with severe ketosis had a lower BMI than those with moderate ketosis (P=0.0391 and P=0.0469) and controls (P<0.001). In DKA and in its female subgroup, cases with moderate ketosis cases were older (P=0.0218 and P=0.0083) than controls. In DKA and in its male subgroup, cases with severe ketosis (BHB > 1000 µg/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250 to 1000 µg/g) and controls (P<0.001). Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded.Ĭases of AKA and DKA were most numerous (184 and 156, respectively). To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations.ġ407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS, acidosis NOS, or hypothermia. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. It is unclear why death from alcoholism remained stable while AKA increased. The deaths from alcoholism, DKA, and hypothermia remained stable. AKA increased from three to 66 and acidosis from one to 20. The number of BHB analyses/year increased from 13 to 1417. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed.
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