In a suspected case of diabetic ketoacidosis as cause of death, which postmortem vitreous finding would BEST support this diagnosis?
- A Vitreous potassium > 15 mEq/L
- B Elevated vitreous beta-hydroxybutyrate with elevated vitreous glucose ✓
- C Vitreous sodium < 130 mEq/L
- D Reduced vitreous urea nitrogen
Correct answer: B. Elevated vitreous beta-hydroxybutyrate with elevated vitreous glucose
Explanation
In diabetic ketoacidosis, antemortem hyperglycemia and ketogenesis produce elevated glucose and beta-hydroxybutyrate. Vitreous humor, being sequestered from rapid postmortem changes, preserves these elevated levels. Vitreous beta-hydroxybutyrate > 2 mmol/L with elevated vitreous glucose is considered strong biochemical evidence of DKA as the mode of death. Elevated vitreous potassium (A) reflects postmortem interval, not DKA specifically. Hyponatremia (C) may occur in many conditions. Vitreous urea (D) reflects antemortem renal function.
Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.
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