Problems of Forensic Sciences 2000 Vol. 44 (XLIV) 55-75
USEFULNESS OF β-HYDROXYBUTYRIC ACID, ACETOACETIC ACID AND ACETONE DETERMINATIONS IN BLOOD, URINE AND VITREOUS HUMOUR FOR NECROCHEMICAL DIAGNOSIS OF PREMORTAL METABOLIC DISORDERS
Grzegorz TERESIŃSKI, Grzegorz BUSZEWICZ, Roman MĄDRO
Chair and Department of Forensic Medicine, Medical Academy, Lublin
Streszczenie
Ketone bodies are a major energetic substrate for brain cells in cases of intracellular glucose deficiency caused by starvation or a lack of insulin. Their retention is intensified by renal failure. However, ketoacidosis may also result from ethanol-induced hypoglycaemia, particularly in chronic alcoholism and the accompanying undernourishment. Moreover, ketoacidosis increases in cases of intensified release of insulin-antagonistic hormones (e.g. in hypothermia), which leads to elevated levels of free fatty acids and their breakdown to acetyl-CoA – a ketogenic precursor. In the present studies levels of acetoacetate (Ac-Ac), β-hydroxybutyrate (β-HBA) and acetone (determined by means of headspace gas chromatography following thermal decarboxylation of Ac-Ac and enzymatic oxidation of β-HBA to acetone) were compared in blood, urine and vitreous humour collected during 36 post mortem examinations (mainly of chronic alcoholics and those who died in low temperatures with no diabetic history) to evaluate possibilities of ketone body use in post mortem diagnosis of premortal biochemical disorders. It was found that evaluation of degree of ketoacidosis intensification required determination of β-HBA – which in practice determines the levels of all ketone bodies. Free acetone concentrations determined additionally in blood ethanol tests using gas chromatography do not allow us to differentiate ketoacidosis from exogenic acetone intoxication but they may be used as a screening method to detect very advanced ketoacidosis. Autopsy blood was found to be the best medium to evaluate the severity of ketoacidosis in the premortal period. Furthermore, it was noted that determination of ketone bodies was a useful tool for explaining death mechanisms in chronic alcoholics and in cases in which hypothermia was suspected to be the cause of death.
Słowa kluczowe
Ketone bodies; Post-mortem diagnosis of hypoglycaemia; Chronic alcoholism; Alcohol-induced hypoglycaemia; Alcoholic ketoacidosis; Hypothermia.