Postmortem Vitreous Beta-Hydroxybutyrate: Interpretation in a Forensic Setting


  • Michael Heninger M.D.

    1. Fulton County Medical Examiner’s Center, 430 Pryor Street SW, Atlanta, GA 30312.
    2. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Rm H183, 1364 Clifton Road NE, Atlanta, GA 30322.
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  • Paper presented at the 63th Annual Meeting of the American Academy of Forensic Sciences February 25, 2011, in Chicago, IL.

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Michael Heninger, M.D.
Fulton County Medical Examiner’s Center
430 Pryor Street SW
Atlanta, GA 30312


Abstract:  Vitreous beta-hydroxybutyrate (BHB) was retrospectively analyzed in 1795 forensic cases using the Pointe Scientific method. Comparison of vitreous BHB with vitreous glucose in 1781 of the cases showed moderately good correlation r = 0.731. Comparison with blood alcohol levels in 1561 of the cases showed no correlation = −0.053. Vitreous BHB was a marker of diabetic ketoacidosis when above 6.0 mM with a vitreous glucose over 200 mg/dL. It was an indicator (>50%) for alcoholic ketoacidosis when above 6.0 mM with a vitreous glucose below 200 mg/dL. Recommendations for interpretation of vitreous BHB: <0.4 mM normal; 0.41–1.2 mM slightly elevated, rarely (<1%) of concern; 1.21–2.0 mM moderately elevated, less rarely (2.5%) of concern; 2.01–6.0 mM significantly elevated, frequently of concern (12–48%); >6.0 mM usually (100% in this study) indicated life-threatening conditions. Vitreous BHB was helpful evaluating cases with ketogenic conditions, especially diabetes and alcoholism.