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Postmortem biochemistry revealed pathologically decreased aldosterone, cortisol, and dehydroepiandrosterone levels in postmortem serum from femoral blood as well as decreased cortisol and 17\u2010hydroxycorticosteroid in urine. Decreased vitreous sodium and increased 3\u2010beta\u2010hydroxybutyrate and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>\u2010reactive protein concentrations were observed. The cause of death was determined to be acute adrenocortical insufficiency. Fasting ketoacidosis was postulated to have precipitated the <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>ddisonian crisis. Traumatic causes of death and third\u2010party involvement were excluded. The case highlights the importance of systematically performing exhaustive postmortem biochemical investigations to formulate appropriate hypothesis regarding the pathophysiological mechanisms involved in the death process.<\/jats:p>","DOI":"10.1111\/1556-4029.12446","type":"journal-article","created":{"date-parts":[[2014,2,20]],"date-time":"2014-02-20T15:14:14Z","timestamp":1392909254000},"page":"1146-1152","source":"Crossref","is-referenced-by-count":6,"title":["Ketoacidosis and Adrenocortical Insufficiency"],"prefix":"10.1111","volume":"59","author":[{"given":"Cristian","family":"Palmiere","sequence":"first","affiliation":[{"name":"University Centre of Legal Medicine Rue du Bugnon 21 1011 Lausanne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9bastien","family":"de Froidmont","sequence":"additional","affiliation":[{"name":"University Centre of Legal Medicine Rue du Bugnon 21 1011 Lausanne 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