Beta-Hydroxybutyric Acid—An Indicator for an Alcoholic Ketoacidosis as Cause of Death in Deceased Alcohol Abusers

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. 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). 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. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.

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Hypothermia as the cause of death in forensic pathology: Autopsy study

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1008467n ◽

2010 ◽

Vol 138 (7-8) ◽

pp. 467-472 ◽

Cited By ~ 4

Author(s):

Slobodan Nikolic ◽

Magdalena Zivkovic ◽

Vladimir Zivkovic ◽

Fehim Jukovic

Keyword(s):

Risk Factors ◽

Cause Of Death ◽

Blood Alcohol Concentration ◽

Alcohol Concentration ◽

The Body ◽

Blood Alcohol ◽

Autopsy Study ◽

Alcohol Abusers ◽

Autopsy Findings ◽

Body Cooling

Introduction. The body cooling process goes through few clinical phases. These are followed by some morphological thanatological changes such as frost erythema and Wischnewsky's spots, which are used in diagnosis of death due to hypothermia. In such cases there is no any specific autopsy finding. Objective. To establish the frequency of hypothermia as the cause of death for a ten-year-period, and to analyze the sample according to gender and age, risk factors and autopsy findings of subjects. Methods. A retrospective autopsy study was performed for a ten-year-period (total of 12,765 forensic autopsies). The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. The sample was analyzed according to gender, age, scene of death, blood alcohol concentration, risk factors, and autopsy findings of all observed subjects. Results. The sample included 67 subjects, 42 males and 25 females (?2=4.31; p<0.05), of average age 63.9?14.7 years (min=27, max=92; med=65, mod=55). Nineteen of subjects were found at in-door places. In 13 subjects blood alcohol concentration ranged from 0.50 to 3.32 promille (average 1.81?0.93). The younger the observed subject was, the higher the blood alcohol concentration (?=-0.251; p=0.04). One third of the observed subjects were chronic alcohol abusers. Thirteen persons had psychiatric diseases. In 43 observed subjects the concomitant appearance of frost erythema and Wischniewsky's spots were established (?2=49.59; df=3; p<0.001). Conclusion. In the analyzed ten-year period hypothermia was not often the cause of death; it was disclosed only in 0.5% of the total number of the studied autopsies. The most of the deceased were older males with cardiovascular problems found in unprotected open-air places. The most frequent thanatological findings in the analyzed subjects were frost erythema and Wischnewsky's spots.

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Abstract #418 Alcoholic Ketoacidosis: A Multifaceted Presentation

Endocrine Practice ◽

10.1016/s1530-891x(20)46762-x ◽

2019 ◽

Vol 25 ◽

pp. 198

Author(s):

Kimberly Lessard ◽

Serge Jabbour

Keyword(s):

Alcoholic Ketoacidosis

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Wiser Reasoning and Less Disgust Have the Potential to Better Achieve Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000709 ◽

2020 ◽

pp. 1-8

Author(s):

Chao S. Hu ◽

Jiajia Ji ◽

Jinhao Huang ◽

Zhe Feng ◽

Dong Xie ◽

...

Keyword(s):

High School ◽

Suicide Prevention ◽

Cause Of Death ◽

Facial Expressions ◽

Emotional Reaction ◽

Suicide Method ◽

University Teachers ◽

Advice Giving ◽

Prevention Techniques

Abstract. Background: High school and university teachers need to advise students against attempting suicide, the second leading cause of death among 15–29-year-olds. Aims: To investigate the role of reasoning and emotion in advising against suicide. Method: We conducted a study with 130 students at a university that specializes in teachers' education. Participants sat in front of a camera, videotaping their advising against suicide. Three raters scored their transcribed advice on "wise reasoning" (i.e., expert forms of reasoning: considering a variety of conditions, awareness of the limitation of one's knowledge, taking others' perspectives). Four registered psychologists experienced in suicide prevention techniques rated the transcripts on the potential for suicide prevention. Finally, using the software Facereader 7.1, we analyzed participants' micro-facial expressions during advice-giving. Results: Wiser reasoning and less disgust predicted higher potential for suicide prevention. Moreover, higher potential for suicide prevention was associated with more surprise. Limitations: The actual efficacy of suicide prevention was not assessed. Conclusion: Wise reasoning and counter-stereotypic ideas that trigger surprise probably contribute to the potential for suicide prevention. This advising paradigm may help train teachers in advising students against suicide, measuring wise reasoning, and monitoring a harmful emotional reaction, that is, disgust.

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Child and Adolescent Suicide Deaths in New Mexico, 1990-1994

Crisis ◽

10.1027//0227-5910.21.1.36 ◽

2000 ◽

Vol 21 (1) ◽

pp. 36-44 ◽

Cited By ~ 9

Author(s):

DD Werenko ◽

LM Olson ◽

L Fullerton-Gleason ◽

AW Lynch ◽

RE Zumwalt ◽

...

Keyword(s):

New Mexico ◽

Cause Of Death ◽

American Indians ◽

Adolescent Suicide ◽

Suicide Attempts ◽

Medical Examiner ◽

Contributing Factors ◽

Targeted Interventions ◽

And Gender ◽

Youth Activity

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U.S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

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