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Biochemical Differences Between Vitreous Humor and Cerebral Spinal Fluid in a Death From Diabetic Ketoacidosis

Garland, Jack, BMed*; Philcox, Winston, BHSc; Kesha, Kilak, MD; McCarthy, Sinead, MBChB, DTM&H; Lam, Leo, MBChB§; Palmiere, Cristian, MD; O'Regan, Toni, MB ChB; Stables, Simon, MNZM MB, ChB, DAvMed, AsFACAsM, FNZSP, FRCPA; Tse, Rexson, BSc, MB, BS. FRCPA

The American Journal of Forensic Medicine and Pathology: June 2019 - Volume 40 - Issue 2 - p 188–191
doi: 10.1097/PAF.0000000000000450
Case Reports

Biochemical analysis of cerebrospinal fluid (CSF) and vitreous humor (VH) forms an important diagnostic ancillary test at autopsy. Cerebrospinal fluid can be sampled from the ventricular system (VA) and from lumbar puncture (LP), whereas VH can be sampled from the orbits. Biochemical electrolytes seem to vary between VH and CSF collected from different sites, but whether there is any difference in glucose and β-hydroxybutyrate is unclear. We present a case report of a 21-year-old man who died of diabetic ketoacidosis confirmed at autopsy. Ventricular system, LP, and VH were biochemically analyzed and showed that glucose was highest in VH (41 mmol/L) and was 6 and 8 mmol/L higher than CSF in the LP and VA, respectively. β-Hydroxybutyrate was also highest in VH (20 mmol/L) and was 5 and 6 mmol/L higher than LP and VA, respectively. Our findings suggest that postmortem CSF glucose and β-hydroxybutyrate may not truly reflect that of VH and vary between CSF sampling sites.

From the *Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia;

Faculty of Medical and Health Sciences, University of Auckland;

Departments of Forensic Pathology and

§Biochemistry, LabPLUS, Auckland City Hospital, Auckland, New Zealand;

CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland; and

Department of Forensic Pathology, MedLab Central, Palmerston North Hospital, Palmerston North, New Zealand.

Manuscript received August 31, 2018; accepted October 12, 2018.

The authors report no conflict of interest.

Reprints: Jack Garland, BMed, Resident Support Unit, Hornsby Ku-ring-gai Hospital, Hornsby 2077, Australia. E-mail:;

© 2019 by Lippincott Williams & Wilkins.