Detection of elevated ketone bodies by postmortem 1H-MRS in a case of fetal ketoacidosis. (October 2018)

• Record Type: Journal Article
• Authors: Heimer, Jakob; Gascho, Dominic; Fliss, Barbara; Martinez, Rosa Maria; Zoelch, Niklaus
• Is Part Of: Journal of forensic and legal medicine. Volume 59(2018)
• Page Start: 16
• Page End: 19
• Publication Date: 2018-10
• Subjects: 1H-MRS -- Ketoacidosis -- Ketone bodies -- Virtual autopsy; Medical jurisprudence -- Periodicals; Forensic sciences -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Electronic journals; 614.1
• DOI: 10.1016/j.jflm.2018.07.009
• Languages: English
• ISSNs: 1752-928X

Abstract

Abstract: We report a fetal loss following maternal ketoacidosis in a case of cryptic pregnancy. Biochemical analysis of peripheral blood revealed highly elevated levels of beta-hydroxybutyrate (BHB) in the mother (9.2 mmol/l) and the fetus (4.2 mmol/l). Fetal ketoacidosis with hypoxic-ischemic brain damage was determined to be the cause of death. 1 H-MRS of the right cerebral hemisphere presented with distinctive resonances of BHB and acetone. Acetoacetate and glucose were not detected. Due to reported chronic abuse of ethanol and a period of fasting, alcoholic ketoacidosis was concluded to be the cause of the metabolic disorder. 1 H-MRS is a viable examination for the postmortem detection of ketone bodies and may be a key supplement to noninvasive fetal autopsy for the diagnosis of ketoacidosis. Graphical abstract: Highlights: Maternal ketoacidosis may lead to fetal hypoxia and intrauterine death. Postmortem 1H-MRS presented with resonances for acetone and BHB, leading to the diagnosis of alcoholic ketoacidosis. Postmortem 1H-MRS is a viable, noninvasive examination for the diagnosis of fetal ketoacidosis.