A study on the correlation of blood and vitreous humour alcohol levels in the late absorption and elimination phases.
ABSTRACT By using the urine:blood alcohol level ratio as the indicator, the correlation of blood alcohol level (B) and vitreous humour alcohol level (V) in the late absorption and elimination phases was studied. It was found to be good (r = 0.98) and B = 0.76V + 4.7. It is suggested that this equation can safely be used to estimate the minimum blood alcohol level where cadaveric blood is unsuitable or unavailable for analysis and that the B/V ratio can be used to infer the phase in which death occurred where urine is not available.
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ABSTRACT: We searched the scientific literature for articles dealing with postmortem aspects of ethanol and problems associated with making a correct interpretation of the results. A person's blood-alcohol concentration (BAC) and state of inebriation at the time of death is not always easy to establish owing to various postmortem artifacts. The possibility of alcohol being produced in the body after death, e.g. via microbial contamination and fermentation is a recurring issue in routine casework. If ethanol remains unabsorbed in the stomach at the time of death, this raises the possibility of continued local diffusion into surrounding tissues and central blood after death. Skull trauma often renders a person unconscious for several hours before death, during which time the BAC continues to decrease owing to metabolism in the liver. Under these circumstances blood from an intracerebral or subdural clot is a useful specimen for determination of ethanol. Bodies recovered from water are particular problematic to deal with owing to possible dilution of body fluids, decomposition, and enhanced risk of microbial synthesis of ethanol. The relationship between blood and urine-ethanol concentrations has been extensively investigated in autopsy specimens and the urine/blood concentration ratio might give a clue about the stage of alcohol absorption and distribution at the time of death. Owing to extensive abdominal trauma in aviation disasters (e.g. rupture of the viscera), interpretation of BAC in autopsy specimens from the pilot and crew is highly contentious and great care is needed to reach valid conclusions. Vitreous humor is strongly recommended as a body fluid for determination of ethanol in postmortem toxicology to help establish whether the deceased had consumed ethanol before death. Less common autopsy specimens submitted for analysis include bile, bone marrow, brain, testicle, muscle tissue, liver, synovial and cerebrospinal fluids. Some investigators recommend measuring the water content of autopsy blood and if necessary correcting the concentration of ethanol to a mean value of 80% w/w, which corresponds to fresh whole blood. Alcoholics often die at home with zero or low BAC and nothing more remarkable at autopsy than a fatty liver. Increasing evidence suggests that such deaths might be caused by a pronounced ketoacidosis. Recent research has focused on developing various biochemical tests or markers of postmortem synthesis of ethanol. These include the urinary metabolites of serotonin and non-oxidative metabolites of ethanol, such as ethyl glucuronide, phosphatidylethanol and fatty acid ethyl esters. This literature review will hopefully be a good starting point for those who are contemplating a fresh investigation into some aspect of postmortem alcohol analysis and toxicology.Forensic Science International 02/2007; 165(1):10-29. · 2.31 Impact Factor
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ABSTRACT: To determine the concentrations of ethanol in femoral venous blood (FVB) and vitreous humour (VH) obtained during forensic necropsies. The ratios of ethanol concentrations in VH and FVB, the reference interval, and the associated confidence limits were calculated to provide information about the uncertainty in estimating FVB ethanol concentrations indirectly from that measured in VH. Ethanol concentrations were determined in specimens of FVB and VH obtained from 706 forensic necropsies. The specimens were analysed in duplicate by headspace gas chromatography (HS-GC), with a precision (coefficient of variation) of 1.5% at a mean ethanol concentration of 500 mg/litre. The limit of detection of ethanol in body fluids by HS-GC in routine casework was 100 mg/litre. In 34 instances, ethanol was present in VH at a mean concentration of 154 mg/litre, whereas the FVB ethanol concentration was reported as negative (< 100 mg/litre). These cases were excluded from the statistical analysis. The concentration of ethanol in FVB was higher than in VH in 93 instances, with a mean difference of 160 mg/litre (range 0 to 900). The mean concentration of ethanol in FVB (n = 672) was 1340 mg/litre (SD, 990) compared with 1580 mg/litre (SD, 1190) in VH. The arithmetic mean VH/FVB ratio of ethanol was 1.19 (SD, 0.285) and the 95% range was 0.63 to 1.75. The mean and SD of the differences (log VH - log FVB) was 0.063 (SD, 0.109), which gives 95% limits of agreement (LOA) from -0.149 to 0.276. Transforming back to the original scale of measurement gives a geometric mean VH/FVB ratio of 1.16 and 95% LOA from 0.71 to 1.89. These parametric estimates are in good agreement, with a median VH/FVB ratio of 1.18 and 2.5th and 97.5th centiles of 0.63 and 1.92. The ethanol distribution ratios (VH/FVB) show wide variation and this calls for caution when results of analysing VH at necropsy are used to estimate the concentration in FVB. Dividing the ethanol concentration in VH by 2.0 would provide a very conservative estimate of the ethanol content in FVB, being less than the true value, with a high degree of confidence.Journal of Clinical Pathology 09/2001; 54(9):699-702. · 2.44 Impact Factor
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ABSTRACT: There were 285 autopsy cases in 2010 where ethanol was the only toxin. To try to ascertain the toxicity of ethanol alone, those cases where clinical details stated 'sudden death', 'collapsed', 'brought in dead to hospital', 'found dead at home', 'fell down stairs and dead at end of stairs', 'sudden death in alcoholic' and 'brought in dead and seizures' were extracted. There were 55 males aged from 23 to 76years and 17 females aged from 41 to 71years who fulfilled these criteria. Blood ethanol ranged from <50 to 556mg/dl. The median band in males is 200-249mg/dl and the 31% of male cases are in the 200smg/dl range, levels conventionally considered benign. The levels found in females were spread relatively evenly across the range 150-600mg/dl. The urine/blood ethanol ratios ranged from 0.13 to 2.02. The blood/vitreous ratios in 10 cases ranged from 0.76 to 1.24 with a median value of 1.16. Calculated blood ethanol from vitreous levels showed a negative bias when compared to the measured value but not in all cases. This limits the role of calculated values in legal cases. The threshold for lethal alcohol toxicity is indistinct and likely to be lower than conventionally acknowledged.Legal Medicine 11/2012; · 1.08 Impact Factor