Contributo chimico-tossicologico alla diagnosi post-mortale di chetoacidosi metabolica

Postmortem diagnosis of diabete ketoacidosis is a complex process. As suggest by the specialist literature, circumstantial data must be supported by toxicological and chemical findings. The Authors describe two cases of death in insulin-dependent men where the autopsy revealed no significant findings in determining the causes of death. Blood and urine werw submitted for glucose analysis and showed for both cases level exceeding 500 mg/dL. No drugs were detected in toxicological screening. Glucose was also confirmed on pretreated samples of blood by fully-scan gaschromatography -mass spectrometry (GC/MS) with a previous derivation with BSTFA. The femoral blood samples of each case were divided in two portions. One of these was preserved in a glass tube with sodium fluoride and investigated for volatile compounds by headspace gaschromatographic technique. Acetone and isopropanol have been detected in each case. No ethanol was detected. The second portion of femoral blood was placed in a glass tube without preservative, stored at 4°C and analysed two months later for volatile compounds and glucose. The analysis showed for both cases the absence of glucose and the presence of ethanol. That can attributed to postmortem phenomena. This cases report point out as the postmortem diagnosis of diabetic ketoacidosis can be supported by the chemical and toxicological investigations, above all when the antemortem clinical data and suitable biological samples are not available.