The relationship of a high level of serum beta-hydroxybutyrate to cause of death

Jun Kanetake, Yoshimasa Kanawaku, Sohtaro Mimasaka, Jun Sakai, Masaki Hashiyada, Masayuki Nata, Masato Funayama

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)


To examine the state of ketoacidosis in relation to the cause of death, three kinds of ketone bodies (acetoacetate, beta-hydroxybutyrate and acetone) were measured in postmortem serum. Of 100 autopsy cases, 22 had ketone body increasing pathophysiological conditions, overlapped in some cases, namely a poorly-nourished state (10 cases), alcoholic fatty liver damage (10), diabetes (5) and infectious disease (5). Of the 3, 11, 7 and 15 cases in which the beta-hydroxybutyrate concentration was greater than 10,000, 1000-10,000, 500-1000 and 200-500 μmol/l, 3 (100%), 8 (73%), 3 (43%) and 5 (33%), respectively, had one or more pathophysiological conditions that usually produce ketone bodies. Of the 64 cases in which the beta-hydroxybutyrate concentrations were less than 200 μmol/l, only 3 (5%) had some of these conditions. Cases showing high levels of ketone bodies tended to have pathophysiological states that can produce them, although the level of beta-hydroxybutyrate and these states did not show parallel relationships. When autopsy findings fail to explain the cause of death, a diagnosis as death caused by ketoacidosis would be reasonable if the serum beta-hydroxybutyrate level is over 1000 μmol/l and the body has pathophysiological conditions that tend to increase ketone bodies.

Original languageEnglish
Pages (from-to)169-174
Number of pages6
JournalLegal Medicine
Issue number3
Publication statusPublished - 2005 May


  • Beta-hydroxybutyrate
  • Body serum
  • Cause of death
  • Ketoacidosis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Issues, ethics and legal aspects


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