PMID- 27930814
OWN - NLM
STAT- MEDLINE
DCOM- 20171011
LR  - 20171011
IS  - 1556-4029 (Electronic)
IS  - 0022-1198 (Linking)
VI  - 62
IP  - 1
DP  - 2017 Jan
TI  - Septic Ketoacidosis-A Potentially Lethal Entity with Renal Tubular Epithelial 
      Vacuolization.
PG  - 122-125
LID - 10.1111/1556-4029.13245 [doi]
AB  - Fatal ketoacidosis due to diabetes mellitus, alcoholism, and starvation may 
      produce characteristic basal vacuolization of renal tubular epithelial cells 
      (RTEC). Septic ketoacidosis has recently been recognized clinically as a distinct 
      condition in which septicemia can lead to elevation of ketones and various anions 
      unrelated to diabetes mellitus, alcoholism, or caloric deprivation. We report 
      four lethal cases with significantly elevated vitreous ketones secondary to 
      sepsis and/or severe localized infection in individuals with no history of 
      diabetes mellitus, alcoholism, or starvation. Three of four cases exhibited 
      typical basal vacuolization of RTEC. We suggest that septic ketoacidosis is an 
      appropriate cause of death in the forensic setting where sepsis or severe 
      localized infection is found with significant ketoacidosis (beta-hydroxybutyrate > 5 
      mmol/L)-in the absence of diabetes mellitus, alcoholism, starvation, or other 
      states associated with accelerated ketogenesis. The finding of basal 
      vacuolization of RTEC in such cases provides morphological support for the 
      underlying metabolic derangement.
CI  - (c) 2016 American Academy of Forensic Sciences.
FAU - Zhou, Chong
AU  - Zhou C
AD  - The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, 
      Australia.
AD  - Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
FAU - Byard, Roger W
AU  - Byard RW
AD  - The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, 
      Australia.
AD  - Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20161208
PL  - United States
TA  - J Forensic Sci
JT  - Journal of forensic sciences
JID - 0375370
RN  - 0 (Ketones)
RN  - 33X04XA5AT (Lactic Acid)
RN  - TZP1275679 (3-Hydroxybutyric Acid)
SB  - IM
CIN - J Forensic Sci. 2017 Jul;62(4):1116. PMID: 28425088
MH  - 3-Hydroxybutyric Acid/metabolism
MH  - Adult
MH  - Aged
MH  - Epithelial Cells/*pathology
MH  - Fatal Outcome
MH  - Female
MH  - Humans
MH  - Ketones/metabolism
MH  - Ketosis/*diagnosis
MH  - Kidney Tubules/*pathology
MH  - Lactic Acid/blood
MH  - Male
MH  - Retrospective Studies
MH  - Sepsis/*diagnosis/microbiology
MH  - Vacuoles/*pathology
MH  - Vitreous Body/metabolism
OTO - NOTNLM
OT  - alcoholism
OT  - basal vacuolization
OT  - diabetes mellitus
OT  - forensic science
OT  - ketoacidosis
OT  - sepsis
OT  - starvation
OT  - subnuclear vacuolization
EDAT- 2016/12/09 06:00
MHDA- 2017/10/12 06:00
CRDT- 2016/12/09 06:00
PHST- 2016/01/14 00:00 [received]
PHST- 2016/04/03 00:00 [accepted]
PHST- 2016/12/09 06:00 [pubmed]
PHST- 2017/10/12 06:00 [medline]
PHST- 2016/12/09 06:00 [entrez]
AID - 10.1111/1556-4029.13245 [doi]
PST - ppublish
SO  - J Forensic Sci. 2017 Jan;62(1):122-125. doi: 10.1111/1556-4029.13245. Epub 2016 
      Dec 8.