48-years old man was found dead at home, lying in his bed. There was a bucket with liquid vomited remnants with no addition of fresh or digested blood found near the bed and an empty bottle of alkaline mineral water often used to attenuate the gastric pain. Up to the information from the man's relative, he was a chronic alcohol consumer, being last seen alive the day before in the pub, drinking small amount of beer. His personal anamnesis was negative for the previous injuries or any pathological entity which could have potential fatal outcome. External observation of the body did not uncover any signs of mechanical violence on the body. The only pathological findings at the autopsy were: very mild generalised atherosclerosis without stenosis of blood vessels, configuration of the heart with the weight of 400 g was physiological, with no signs of chronic venostatic changes on the internal organs. The microscopical examination did not find any ischemic changes of myocardial muscle. The deceased had diffuse alcoholic steatosis of the liver. The brain was mildly swollen (weight 1300 g) without conformation of conuses and cross section revealed no pathological or traumatic lessions. Results of alcoholimetric analysis were absolutely negative for the presence of ethanol in blood or urine. Toxicological analysis did not notice any psychoactive substances or medicaments, the only finding was positive acetone in blood, level of which was 435 mg/l and highly increased betahydroxybutyric acid (BHBA) blood level of 272 mg/l, while acetonuria was 962 mg/l. Biochemical analysis showed a reduced blood pH=7.21 which is not reliable as it could be the only a postmortem artefact. Sample of vitreous humour showed glucose levels of 3.1 mmol/l.
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