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Significant ketoacidosis at autopsy: a single-centre systematic review
  1. Paida Gwiti1,
  2. Fiona Davidson2,
  3. Peter Beresford2,
  4. Patrick J Gallagher3
  1. 1 Department of Histopathology, North West Anglia NHS Foundation Trust, Peterborough, UK
  2. 2 Department of Clinical Biochemistry, Southmead Hospital, Bristol, UK
  3. 3 Department of Medical Education, University of Bristol, Bristol, UK
  1. Correspondence to Dr Patrick J Gallagher, Medical Education, University of Bristol, Bristol, UK; mdzpxg{at}


Aim To examine the value of vitreous beta-hydroxybutyrate and serum acetone in the investigation of sudden unexpected death.

Methods Coroners’ autopsy reports from a provincial UK city, with a population of approximately 900 000, over a 24-month period with significant ketoacidosis were studied. Demographic features, medical history, anatomical and histological findings, and biochemical parameters, including renal function, vitreous glucose, serum and vitreous alcohol, were analysed.

Results Forty-two cases (28 males and 14 females) were identified; 55% had a history of alcohol and/or substance misuse, and mental health problems, particularly depression and anxiety, and 16% were diabetic. In all, 50% of subjects had alcoholic ketoacidosis (AKA), 19% had diabetic ketoacidosis (DKA) and 12% had a history of both diabetes and alcohol abuse. In 19% of cases, an exact cause of ketoacidosis was established. In AKA, the subjects typically had low vitreous glucose and low or undetected blood alcohol levels. All of the subjects with raised vitreous glucose levels had DKA.

Conclusion Ketoacidosis is relatively common and should be considered as a cause of sudden death, especially in alcoholic patients and patients with diabetes with no clear cause of death at autopsy.

  • biochemistry
  • alcohol drinking
  • death
  • sudden
  • cardiac
  • diabetes mellitus

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Tahir S Pillay.

  • Contributors PG and PJG designed the study, compiled the data and drafted the manuscript. FD and PB provided the toxicology data. All authors contributed to the construction of the original and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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