Blood Acetone in Forensic Autopsies: Why an Empty Stomach Tells a Deeper Story
Organized by: International Forensic Scientist Awards
Website: forensicscientist.org
12th Edition of Forensic Scientist Awards 29-30 July 2025 | New Delhi, India
When forensic pathologists analyze unexplained deaths, one of the key clues they often examine is the level of acetone in the blood. Acetone, a type of ketone body, is commonly associated with ketoacidosis, a condition linked to diabetes, starvation, or chronic alcohol use. But recent findings suggest there’s more to the story — and it begins in the stomach.
🔍 Understanding the Clue: Blood Acetone
In forensic autopsies, elevated blood acetone levels are typically seen as red flags. They can point to ketoacidosis, which can be fatal if left untreated. However, not all high acetone levels mean the person died from this condition. So what else could cause these levels to rise?
Stomach Contents Matter
A study examining 367 forensic autopsy cases uncovered a surprising pattern: people with empty stomachs at the time of death had significantly higher acetone concentrations in their blood. Interestingly, these elevated levels didn’t correlate with other expected markers like ethanol (alcohol), HbA1c (diabetes), C-reactive protein (inflammation), or even body mass index (BMI).
🧠 Key Finding
The absence of gastric content — in other words, no leftover food in the stomach — was the most important predictor of increased blood acetone. Logistic regression analysis confirmed this association, highlighting that fasting or starvation before death could lead to high acetone levels even in the absence of diabetic ketoacidosis.
⚖️ What This Means for Forensics
For forensic investigators, this research changes the game. When interpreting high acetone levels, it’s essential to consider whether the person had eaten before death. Failing to do so might mislead the determination of cause of death, especially in cases involving starvation, neglect, or prolonged illness.
🧬 In Conclusion
Blood acetone is a valuable forensic marker — but like any clue, context is everything. This study reinforces the need for a holistic approach in forensic evaluations. The presence or absence of food in the stomach may tell more about a person's final moments than previously understood.
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