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Park, Kang, Won, Chung, and Lee: Postmortem Diagnosis of Diabetic Ketoacidosis: An Autopsy Case
Original Article

Korean J Leg Med 2016;40(1):19-22.

Published online: 19 December 2016

DOI: https://doi.org/10.7580/kjlm.2016.40.1.19

Postmortem Diagnosis of Diabetic Ketoacidosis: An Autopsy Case

Jong-Pil Park1, Hyun-Moo Kang1, Yu Jin Won1, Ik Jo Chung2, Bong-Woo Lee1

1Medical Examiner's Office, National Forensic Service, Wonju, Korea

2Forensic Medicine Division, National Forensic Service Daejeon Institute, Daejeon, Korea

Correspondence to Bong-Woo Lee Medical Examiner's Office, National Forensic Service, 10 Ipchun-ro, Wonju 26460, Korea Tel: +82-33-902-5211 Fax: +82-33-902-5911 E-mail: forensic@korea.kr

Received 19 January 201610 February 2016       Accepted 17 February 2016

Copyright © 2016 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic ketoacidosis is an acute complication of type 1 diabetes mellitus, which is observed frequently in routine autopsies. However, there are limitations of postmortem diagnosis of diabetic ketoacidosis. Clinical diagnostic criteria of the disease are not applicable to postmortem diagnosis because of the postmortem changes of the body; hence, diagnostic morphological changes cannot be observed. We report the case of a 47-year-old man that was diagnosed with diabetic ketoacidosis via routine autopsy and laboratory tests without information regarding his medical history. Additionally, we present a brief literature review.

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Keywords: Diagnosis, Diabetic ketoacidosis, Autopsy

REFERENCES

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5.Kodikara S., Paranitharan P., Pollanen MS. The role of the Armanni-Ebstein lesion, hepatic steatosis, biochemical analysis and second generation anti-psychotic drugs in fatal diabetic ketoacidosis. J Forensic Leg Med. 2013. 20:108–11.
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kjlm-40-19-f1.tif
Fig. 1.
Histological image of diabetic glomerulosclerosis shows capillary basement membrane thickening (arrowheads) and diffuse mesangial sclerosis (arrow) (A, H&E, ×100; B, H&E, ×400).
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kjlm-40-19-f2.tif
Fig. 2.
Histological image of the pancreas in type 1 diabetes mellitus shows reduction in the number and size of the islets and leukocytic infiltration of the islets (A, H&E, ×100; B, H&E, ×400).
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Table 1.
Laboratory values of diabetic ketoacidosis and postmortem change
Laboratory parameter DKA PM change This case Normal value
Glucose (mg/dL) 300-600 Decrease 374 <140
Sodium (meq/L) 125-135 Decrease 128 136-145
Potassium (meq/L) Normal to decrease Increase 9.8 3.5-5.0
Magnesium (meq/L) Normal Increase NA 0.8-1.2
Chloride (meq/L) Normal Decrease 86 98-106
Phosphate (meq/L) Decrease Increase NA 1.0-1.4
Creatinine (mg/dL) Slightly increase Normal 0.65 <1.5
Osmolality (mOsm/mL) 300-320 Increase NA 285-295
Plasma ketones ++++ – ++++ –
Serum bicarbonate (meq/L) <15 ND NA 21-30
Arterial pH 6.8-7.3 Decrease NA 7.38-7.44
Arterial PCO2 (mm Hg) 20-30 ND NA 35-45
Anion gap (mmol/L) Increase ND NA 10-12

DKA, diabetic ketoacidosis; PM, postmortem; NA, not accessed; ND, not determined.

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