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December 19, 2002

Complications

Question from Toms River, New Jersey, USA:

My 39 year old brother recently died in his apartment, and since we do not know his doctor, there is no one we can go to for answers. Could you please help my family understand the medical examiner's report since the medical language is so foreign to us? It reads as follows: Diabetes mellitus with: Vitreous glucose 566 mg/dl [31.4 mmol/L] Blood acetone 0.05 g% Blood isopropanol 0.02 g% Atherosclerotic cardiovascular disease, with coronary artery atherosclerosis, marked Horseshoe kidney. Cause of death: diabetes mellitus with ketoacidosis. Manner of death: natural

Answer:

Perhaps it will be easier if I deal with the less complicated items first. The horseshoe kidney means that his kidneys were joined at the lower end. It is a relatively common anomaly and had no relation to his death. The marked coronary artery arteriosclerosis means that heart failure may have contributed to his death and in turn it suggests, but does not prove, that his diabetes had been in poor control for a good many years.

The ‘vitreous’ glucose is the level in the fluid inside the eye and postmortem and is a more reliable clue to blood sugar before death than a venous sample. At 566 mg/dl [31.4 mmol/L], it is about six times the normal fasting level and confirms the diagnosis of diabetes. Isopropanol is a precursor in the body of acetone and both levels are grossly elevated clearly indicating severe DKA [diabetic ketoacidosis].

The diagnosis was thus confirmed, but what is not obvious is why this should have occurred in a relatively young man. With no reported evidence of any complication such as an infection, it seems likely that it was mainly the consequence of having neglected his diabetes for some years.

DOB