Elevated beta‐hydroxybutyrate within a pediatric population and its associated pathology: A retrospective case series
Bibliographic record
Abstract
Elevated beta-hydroxybutyrate (BHB) is a marker for ketoacidosis. Post-mortem values for the diagnosis of fatal ketoacidosis and the associated clinical and histologic findings are limited in the pediatric population. A retrospective case series of pediatric autopsy records and histology slides was conducted. Deaths occurring between 2010 and 2022 of children (ages<18 years) with an elevated BHB level (vitreous BHB >2 mmol/L or blood >200 mg/L) were analyzed. Histology of the heart, lung, liver, and kidneys was reviewed and scored. Five hundred twelve pediatric autopsies were conducted during the study period, of which 20 cases (3.9%) met the inclusion criteria. The age ranged from stillborn to 17 years, with a mean age of 6.3 years and a median age of 3.5 years. The mean concentration of vitreous BHB was 3.9 mmol/L (median 2.69; range 2.0-11.86 mmol/L; n = 17 cases) and the blood BHB had a mean of 416 mg/L (median 291; range from <50 mg/L to 1188 mg/L; n = 9 cases). Death was attributed to diabetic ketoacidosis, infection, malignancy, trauma, congenital heart disease, and drug toxicity. Histological changes were seen in all tissues examined in this pediatric population including hepatic steatosis (n = 17), glycogenated hepatocyte nuclei (n = 5), renal tubular vacuoles (n = 7) and heart vacuoles (n = 9). The only statistically significant correlation was found between vitreous BHB and renal tubular vacuoles (p = 0.014). Overall, elevated BHB levels were identified in blood and/or vitreous in fatal diabetic and non-diabetic cases, including infection. Diabetic ketoacidosis had the highest level of BHB at 11.86 mmol/L.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".