International Journal of Legal Medicine

, Volume 132, Issue 2, pp 593–598 | Cite as

Postmortem 1H-MRS—Detection of Ketone Bodies and Glucose in Diabetic Ketoacidosis

  • Jakob Heimer
  • Dominic Gascho
  • Vasiliki Chatzaraki
  • Damaris Fröhlich Knaute
  • Vera Sterzik
  • Rosa Maria Martinez
  • Michael J. Thali
  • Niklaus Zoelch
Method Paper


Diabetic ketoacidosis (DKA) is a metabolic complication of diabetes mellitus that takes a lethal course if untreated. In this way relevant to forensic medicine, secure diagnosis of DKA usually involves the evidence of elevated levels of glucose and the ketone bodies acetone, acetoacetate, and β-hydroxybutyrate in corpse fluids. We conducted a postmortem hydrogen proton magnetic resonance spectroscopy (1H-MRS) in a case of lethal DKA. Distinctive resonances of all three ketone bodies as well as glucose were visible in spectra of cerebrospinal fluid, vitreous humor, and white matter. Estimated concentrations of ketone bodies and glucose supported the findings both of autopsy and biochemical analysis. Advantages of human postmortem 1H-MRS are the lack of movement and flow artifacts as well as lesser limitations of scan duration. Postmortem 1H-MRS is able to non-invasively measure concentrations of glucose and ketone bodies in small volumes of various regions of the brain. It may thus become a diagnostic tool for forensic investigations by quick determination of pathological metabolite concentrations in addition to conventional autopsy.


Diabetic Ketoacidosis Proton Magnetic Resonance Spectroscopy Postmortem 



The authors express their gratitude to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval was obtained by the Ethics Committee of the Canton of Zurich, Nr. KEK ZH-Nr. 15-0686.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Institute of Forensic Medicine, Department of Forensic Medicine and ImagingUniversity of ZurichZurichSwitzerland
  2. 2.Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity of ZurichZurichSwitzerland

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