J. Heimer, D. Gascho, B. Fliss, RM. Martinez and N. Zoelch (2018). Detection of elevated ketone bodies by postmortem 1H-MRS in a case of fetal ketoacidosis. Journal of forensic and legal medicine, 59, 16-19. https://doi.org/10.1016/j.jflm.2018.07.009

PubMed 30067991

[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. 1H-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. 1H-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.