Title POSTMORTALNA ANALIZA BETA-HIDROKSIMASLAČNE KISELINE KAO POMOĆ KOD ODREĐIVANJA ŠEĆERNE BOLESTI
Title (english) POST MORTEM ANALYSIS OF BETA-HIDROXYBUTYRIC ACID AS AN AID IN DETERMINATION OF DIABETES
Author Milena Ćurković
Mentor Valter Stemberga (mentor)
Committee member Dražen Cuculić (predsjednik povjerenstva)
Committee member Dražen Kovač (član povjerenstva)
Committee member Valter Stemberga (član povjerenstva)
Granter University of Rijeka Faculty of Health Studies (Department of Laboratory and Radiological Diagnostics) Rijeka
Defense date and country 2018-09-26, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Forensic Medicine
Abstract U forenzičkoj/sudskoj medicini ponekad je klasična obdukcija nedostatna da se utvrdi pravi uzrok smrti te se u tim slučajevima moraju provesti i dodatne laboratorijske pretrage. Osim toksikološke, histopatološke mikroskopske pretrage, molekularne dijagnostike koristi se i biokemijska laboratorijska pretraga kao pomoć u utvrđivanju uzroka smrti. Određivanjem koncentracija pojedinih biokemijskih markera u tjelesnim tekućinama možemo pojasniti vrijeme i uzrok smrti odnosno sistemske patofiziološke promjene u procesu umiranja. Uzorci u biokemijskim pretragama su krv i mokraća i/ili druge biološke tekućine (staklovina, perikardijalna i cerebrospinalna tekućina).
Šećerna bolest, odnosno njena fatalna komplikacija dijabetička ketoacidoza, koja nastaje zbog akumulacije ketonskih tijela u krvi, jedno je od stanja koje može dovesti do nagle smrti i time postaje predmet interesa sudske medicine. Diljem svijeta 30 milijuna ljudi, boluje od dijabetesa, te je on jedan od vodećih uzroka smrti u razvijenim zemljama. Te brojke povećava pretilost i ukupno starenje populacije ljudi. Značajan postotak osoba s dijabetesom nema dijabetes prepoznat kao bolest jer ga je teško dijagnosticirati dok klinički simptomi ne postanu vidljivi i pojave se komplikacije. Isto tako teško je povezati šećernu bolest kao komplikaciju koja dovodi i do smrti bez dodatnih laboratorijskih pretraga.
Jedan od postmortalnih biokemijskih markera, čije određivanje može uvelike pomoći kod utvrđivanja šećerne bolesti i potvrde ketoacidoze kao uzroka smrti je proizvod ketoacidoze ketonsko tijelo β-hidroksibutirat ili β -hidroksimaslačna kiselina . Kiselinski je anion, te njegov porast u krvi rezultira sniženjem pH organizma što dovodi do ketoacidoze. U ketoacidozi β-hidroksibutirat predstavlja 65-75 % ukupne koncentracije ketonskih tijela.
Koncentraciju β –hidroksibutirata možemo određivati iz niza bioloških uzoraka kao što su krv, mokraća, staklovina, cerebrospinalna, perikardijalna i sinovijalna tekućina, te iz homogenata jetre.
Vrijednosti β –hidroksibutirata u pojedinim biološkim uzorcima u dobroj su korelaciji. Stabilan je spoj na čije vrijednosti truležne promjene ne utječu. Iz tog razloga, razina β-hidroksibutirata može se smatrati odgovarajućim biokemijskim parametrom u procjeni koncentracije β - hidroksibutirata u vrijeme smrti čime se može potvrditi ili opovrgnuti ketoacidoza kao uzrok smrti.
Abstract (english) In forensic medicine, classic autopsy is sometimes insufficient to determine the true cause of death, and in these cases additional laboratory tests have to be carried out. In addition to the toxicological, histopathological microscopic examination, and molecular diagnostics, biochemical laboratory analyses are used to help determine the cause of death. Determining the concentration of certain biochemical markers in body fluids can clarify the time and cause of death or the systemic pathophysiological changes in the dying process. Samples used in biochemical examinations include blood and urine and / or other biological fluids (the vitreous, pericardial and cerebrospinal fluid).
Diabetes mellitus, or its sometimes fatal complication diabetic ketoacidosis, which occurs due to the accumulation of ketones in the blood, is one of the conditions that can lead to sudden death and has thus become the subject of forensic medicine. 30 million people around the world are suffering from diabetes, and it is one of the leading causes of death in developed countries. Obesity and aging of populations drive an increase in these conditions. In a significant percentage of people diabetes is not recognized as a disease because it is difficult to diagnose until clinical symptoms become apparent and complications appear. It is also difficult to identify diabetes mellitus as a complication leading to death without additional laboratory examinations. One of the postmortal biochemical markers, whose determination can greatly assist in determining diabetes and ketoacidosis as a cause of death, is the product of the ketoacidosis-the ketone body, β-hydroxybutyrate or β-hydroxysaturic acid. This acid is an anion, and its increase in blood results in a decrease in the pH of the organism leading to ketoacidosis. In ketoacidosis, β-hydroxybutyrate represents 65-75% of the total concentration of ketone bodies.
The β-hydroxybutyrate concentration can be determined from a variety of biological samples such as blood, urine, vitreous, cerebrospinal, pericardial and synovial fluid, and liver homogenates.
The values of β-hydroxybutyrate in certain biological samples are in good correlation. It is a stable compound whose values do not change with decomposition. For this reason, β-hydroxybutyrate levels can be considered an appropriate biochemical parameter to estimate the β-hydroxybutyrate concentration at the time of death, thus confirming or disproving ketoacidosis as a cause of death.
Keywords
β –hidroksibutirat
postmortalna biokemija
šećerna bolest
ketoacidoza
Keywords (english)
β-hydroxybutyrate
postmortal biochemistry
diabetes
ketoacidosis
Language croatian
URN:NBN urn:nbn:hr:184:392083
Study programme Title: Graduate university study of medical laboratory diagnostics (Biomedicine and Healthcare; clinical medical sciences) Study programme type: university Study level: graduate Academic / professional title: magistar/magistra medicinsko laboratorijske dijagnostike (magistar/magistra medicinsko laboratorijske dijagnostike)
Type of resource Text
File origin Born digital
Access conditions Access restricted to students and staff of home institution
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Created on 2018-12-13 10:41:11