The diagnoses of ketoacidosis and disturbances of glucose metabolism are difficult at autopsy because of changes in glucose concentrations postmortem. The Armanni-Ebstein lesion is a histological change in the kidney that has been reported as a marker of diabetic ketoacidosis. This paper examines the specificity of the Armanni-Ebstein lesion and the diagnosis of alterations in glucose metabolism and ketoacidosis at autopsy. The Armanni-Ebstein lesion consists of subnuclear vacuolation of the proximal tubules. The vacuoles contain fat and can be demonstrated on fresh and formalin fixed tissue using standard fat stains. Recently it has been reported in other conditions associated with non-diabetic ketoacidosis. The lesion has the same appearance whatever the cause of the ketoacidosis. This review, with illustrative cases shows the Armanni-Ebstein lesion is a marker of ketoacidosis and not specific for diabetic ketoacidosis. It may be seen in cases of diabetic and alcoholic ketoacidosis and in starvation and hypothermia, in which ketoacidosis occurs. It has also been reported in isopropanol poisoning.
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