Isopropyl alcohol in cows suffering from acetonaemia

Exhaled isopropanol: new potential biomarker in diabetic breathomics and its metabolic correlations with acetone

Concomitant findings of acetone (ACE) and isopropanol (IPA) in blood and other biological samples have been reported in diabetic decedents and clinic cases, but exhaled IPA has rarely been studied in breath research.

Postmortem diagnosis of diabetes mellitus and its complications

Diabetes mellitus has become a major cause of death worldwide and diabetic ketoacidosis is the most common cause of death in children and adolescents with type 1 diabetes. Acute complications of diabetes mellitus as causes of death may be difficult to diagnose due to missing characteristic macroscopic and microscopic findings. Biochemical analyses, including vitreous glucose, blood (or alternative specimen) beta-hydroxybutyrate, and blood glycated hemoglobin determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decompositional changes. In this article, we performed a review of the literature pertaining to the diagnostic performance of classical and novel biochemical parameters that may be used in the forensic casework to identify disorders in glucose metabolism. We also present a review focusing on the usefulness of traditional and alternative specimens that can be sampled and subsequently analyzed to diagnose acute complications of diabetes mellitus as causes of death.

Mixed ruminal microbes of cattle produce isopropanol in the presence of acetone but not 3-D-hydroxybutyrate

The objective was to evaluate the ability of mixed rumen microbes to synthesize isopropanol from acetone or 3-D-hydroxybutyrate. Rumen fluid from seven mature, nonpregnant, dry Holstein cows was incubated with starch or cellulose and additions of acetone, 3-D-hydroxybutyrate, or saline. Rumen fluid was analyzed for isopropanol after 0, 3, 6, and 9 h. No isopropanol was present in any sample at 0 h, and none was present in incubations containing saline or 3-D-hydroxybutyrate at any subsequent time. Incubations that included acetone produced small amounts of isopropanol from 0 to 3 and 3 to 6 h and significantly larger amounts from 6 to 9 h. With starch as the energy substrate, production from 6 to 9 h was 3.8 micromol/min per liter of rumen fluid and 3.7 micromol/min per liter with cellulose as the energy substrate; however, these values did not differ significantly. Mixed rumen microbes could synthesize isopropanol from acetone but not from 3-D-hydroxybutyrate, and rumen microbial metabolism of acetone was the likely source of plasma isopropanol seen in ketotic ruminants.

Detection of isopropyl alcohol in a patient with diabetic ketoacidosis

A 29-year-old man presented to the Emergency Department with acute mental status changes. He was unable to give a history. He was found to be in diabetic ketoacidosis, although his family reported no prior history of diabetes. A toxic exposure work-up revealed the presence of isopropyl alcohol in the patient's blood. His condition improved with treatment of the ketoacidosis, and he subsequently denied any exposure to isopropyl alcohol prior to presentation to the hospital. This case provides further support to a growing body of evidence that the detection of isopropyl alcohol may not represent an acute ingestion but, rather, a byproduct of acetone metabolism in certain disease states.

Detection of isopropanol in acetonemic patients not exposed to isopropanol

Isopropanol has been identified in five acetonemic patients not exposed to this compound. Serum concentrations ranged up to 297 mg/L for IPA and up to 321 mg/L for acetone. Concentration ratios (isopropanol:acetone) ranged up to 5.12. All five patients had Type I diabetes mellitus and were insulin-dependent. At the time isopropanol was detected each patient was hyperglycemic, and four patients were acidotic. These findings tend to corroborate clinically some earlier autopsy reports that acetone may be converted to isopropanol in physiological conditions in which reduced nicotinamide adenine dinucleotide is elevated. The conversion of acetone to isopropanol in vivo has significant clinical and forensic toxicological implications.