Abstract

Ethanol concentrations were measured in femoral venous blood in deaths attributed to acute alcohol poisoning (N = 693) or chronic alcoholism (N = 825), according to the forensic pathology report. Among acute alcohol poisonings were 529 men (76%) with mean age 53 years and 164 women (24%) with mean age 53 years. In the chronic alcoholism deaths were 705 men (85%) with mean age 55 years and 120 women (15%) with mean age 57 years. The blood-ethanol concentrations were not related to the person's age (r = -0.17 in acute poisonings and r = -0.09 in chronic alcoholism). The distribution of blood-ethanol concentrations in acute poisoning cases agreed with a normal or Gaussian curve with mean, median, standard deviation, coefficient of variation, and spread of 0.36 g/100 mL, 0.36 g/100 mL, 0.086 g/100 mL, 24% and 0.074 to 0.68 g/100 mL, respectively. The corresponding concentrations of ethanol in chronic alcoholism deaths were not normally distributed and showed a mode between 0.01 and 0.05 g/100 mL and mean, median, and spread of 0.172 g/100 mL, 0.150 g/100 mL, and 0.01 to 0.56 g/100 mL, respectively. The 5th and 95th percentiles for blood-ethanol concentration in acute poisoning deaths were 0.22 and 0.50 g/100 mL, respectively. However, these values are probably conservative estimates of the highest blood-ethanol concentrations before death owing to metabolism of ethanol until the time of death. In 98 chronic alcoholism deaths (12%) there was an elevated concentration of acetone in the blood (>0.01 g/100 mL), and 50 of these (6%) also had elevated isopropanol (>0.01 g/100 mL). This compares with 28 cases (4%) with elevated blood-acetone in the acute poisoning deaths and 22 (3%) with elevated blood-isopropanol. We offer various explanations for the differences in blood-ethanol and blood-acetone in acute poisoning and alcoholism deaths such as chronic tolerance, alcohol-related organ and tissue damage (cirrhosis, pancreatitis), positional asphyxia or suffocation by inhalation of vomit, exposure to cold coupled with alcohol-induced hypothermia, as well as various metabolic disturbances such as hypoglycemia and ketoacidosis.

References

1.
Schulz
M
,
Schmolot
A
.
Therapeutic and toxic blood concentrations of more than 500 drugs
.
Pharmazie
1997
;
52
:
895
91
.
2.
Repetto
MR
,
Repetto
M
.
Concentrations in human fluids: 101 drugs affecting the digestive system and metabolism
.
J Toxicol Clin Toxicol
1999
;
37
:
1
8
.
3.
Stead
AH
,
Moffat
AC
.
A collection of therapeutic, toxic and fatal blood drug concentrations in man
.
Human Tox
1983
;
3
:
437
64
.
4.
Winek
CL
,
Wahba
WW
,
Wineck
CL
 Jr
,
Winek-Balzer
TW
,
Drug and chemical blood-level data 2001
Forensic Sci Intern
 0379-0738
2001
;
122
:
107
23
.
5.
Sylvester
PA
,
Womg
NA
,
Warren
BF
,
Ranson
DL
.
Unacceptably high site variability in postmortem blood alcohol analysis
.
J Clin Pathol
 0021-9746
1998
;
51
:
250
2
.
6.
Prouty
RW
,
Anderson
WH
.
A comparison of postmortem heart blood and femoral blood ethyl alcohol concentrations
.
J Anal Toxicol
 0146-4760
1987
;
11
:
191
7
.
7.
Prouty
RW
,
Anderson
WH
.
The forensic science implications of site and temporal influences on postmortem blood drug concentrations
.
J Forensic Sci
 0022-1198
1990
;
35
:
243
70
.
8.
Pounder
DJ
,
Smith
DEW
.
Postmortem diffusion of alcohol from the stomach
.
Am J Forens Med Pathol
 0195-7910
1995
;
16
:
89
96
.
9.
Barnhart
FE
,
Bonnell
HJ
,
Rossum
KM
.
Postmortem drug redistibution
.
Forensic Sci Rev
2001
;
13
:
101
29
.
10.
O'Neal
CL
,
Poklis
A
.
Postmortem production of ethanol and factors that influence interpretation: a critical review
.
Am J Forens Med Pathol
 0195-7910
1996
;
17
:
8
20
.
11.
Jones
AW
.
Alcohol—postmortem
.
Encyclopaedia of forensic sciences
.
Academic Press
2000
;
112
26
.
12.
Druid
H
,
Holmgren
P
,
Löwenhielm
P
.
Computer-assisted systems for forensic pathology and forensic toxicology
.
J Forensic Sci
 0022-1198
1996
;
41
:
830
6
.
13.
Druid
H
,
Holmgren
P
.
A compilation of fatal and control concentrations of drugs in postmortem femoral blood
.
J Forensic Sci
 0022-1198
1997
;
42
:
79
87
.
14.
Jones
AW
,
Schuberth
J
.
Computer-aided headspace gas chromatography applied to blood-alcohol analysis; Importance of on-line process control
.
J Forensic Sci
 0022-1198
1989
;
34
:
1116
27
.
15.
Hobbs
WR
,
Rall
TW
,
Verdoorn
TA
. Chapter 17:
Hypnotics and sedatives; ethanol
. In:
Goodman
and
Gilman
, editors.
The pharmacological basis of therapeutics
. 9th ed.
New York
:
McGraw-Hill
,
1996
;
361
96
.
16.
Little
HJ
.
Mechanisms that may underlie the behavioral effects of ethanol
.
Prog Neurbiol
1991
;
36
:
171
94
.
17.
Mehta
AK
,
Ticku
MK
.
An update on GABAA receptors
.
Brain Res Rev
1999
;
29
:
196
217
.
18.
Kalant
H
,
LeBlanc
SE
,
Gibbins
RJ
.
Tolerance to and dependence on some non-opiate psychotropic drugs
.
Pharmacol Rev
1971
;
23
:
135
91
.
19.
Kalant
H
.
Research on tolerance: What can we learn from history
.
Alcohol Clin Exp Res
1998
;
22
:
67
76
.
20.
Urso
T
,
Gavaler
JS
, Van
Thiel
DH
.
Blood ethanol levels in sober alcohol users seen in an emergency room
.
Life Sci
1981
;
28
:
1053
6
.
21.
Davis
AR
,
Lipson
AH
.
Central nervous system tolerance to high blood alcohol levels
.
Med J Aust
1986
;
144
:
9
12
.
22.
Jones
AW
.
Medicolegal alcohol determinations; blood or breath-alcohol concentration
.
Forensic Sci Rev
2000
;
12
:
24
47
.
23.
Jones
AW
.
The drunkest drinking driver in Sweden; blood-alcohol concentration, 0.545%
.
J Stud Alcohol
1999
;
60
;
400
6
.
24.
Johnson
HRM
.
At what blood levels does alcohol kill
.
Med Sci Law
1985
;
25
:
127
30
.
25.
Odesanmi
WO
.
The fatal blood alcohol level in acute poisoning
.
Med Sci Law
1983
;
23
:
25
30
.
26.
Heatley
MK
,
Crane
J
.
The blood alcohol concentration at postmortem in 175 fatal cases of alcohol intoxication
.
Med Sci Law
1990
;
30
:
101
5
.
27.
Teige
B
,
Fleischer
E
.
Blodkonsentrasjoner ved akutte forgiftningsdodsfall
.
Tidsskr Nor Laegeforen
1983
;
103
:
679
85
.
28.
Kaye
S
,
Haag
HB
.
Terminal blood alcohol concentrations in 94 fatal cases of acute alcoholism
.
JAMA
1957
;
165
:
451
2
.
29.
Koski
A
,
Ojanperä
I
,
Vuori
E
.
Alcohol and benzodiazepines in fatal poisonings
.
Alcohol Clin Exp Res
2002
;
26
:
956
9
.
30.
Jones
AW
.
Disappearance rate of ethanol from blood in human subjects; Implications in forensic toxicology
.
J Forensic Sci
 0022-1198
1993
;
38
:
104
18
.
31.
Jones
AW
,
Sternebring
B
.
Kinetics of ethanol and methanol in alcoholics during detoxication
.
Alc Alcohol
1992
;
27
:
641
7
.
32.
Marcinkowski
T
,
Przybylski
Z
.
Evaluation of the cause of death in cases of acute alcohol poisoning
.
Forensic Sci Intern
 0379-0738
1974
;
4
:
233
8
.
33.
Kalant
H
,
Le
AD
.
Effects of ethanol on thermoregulation
.
Pharmacol Ther
1984
;
23
:
313
64
.
34.
Kortelainen
ML
.
Drugs and alcohol in hypothermia and hyperthermia related deaths. A retrospective study
.
J Forensic Sci
 0022-1198
1987
;
32
:
1704
12
.
35.
Gallaher
MM
,
Fleming
DW
,
Berger
LR
,
Sewell
CM
.
Pedestrian and hypothermia deaths among native Americans in New Mexico
.
JAMA
1992
;
267
:
1345
8
.
36.
Penttilä
A
,
Karhunen
PJ
,
Vuori
E
.
Blood alcohol in sudden and unexpected deaths
.
Forensic Sci Intern
 0379-0738
1989
;
43
:
96
102
.
37.
Sjögren
H
,
Eriksson
A
,
Ahlm
K
.
Role of alcohol in unnatural deaths: A study of all deaths in Sweden
.
Alcohol Clin Exp Res
2000
;
24
:
1050
6
.
38.
Sellers
EM
,
Kalant
H
.
Alcohol intoxication and withdrawal
.
N Engl J Med
1976
;
294
:
757
62
.
39.
Bloom
JH
,
Mapoles
JE
,
Simon
FR
.
Alcoholic liver disease: new concepts of pathogenesis and treatment
.
Adv Intern Med
1994
;
39
:
49
92
.
40.
Brinkmann
B
,
Fechner
G
,
Karger
B
,
DuChesne
A
.
Ketoacidosis and lactic acidosis—frequent causes of death in chronic alcoholics?
Int J Leg Med
1989
;
111
:
115
9
.
41.
Pounder
DJ
,
Stevenson
RJ
,
Taylor
KK
.
Alcoholic ketoacidosis at autopsy
.
J Forensic Sci
 0022-1198
1998
;
43
:
812
6
.
42.
Iten
PX
,
Meier
M
.
Beta-hydroxybutyric acid—an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers
.
J Forensic Sci
 0022-1198
2000
;
45
:
624
32
.
43.
Jones
AW
,
Lund
M
,
Andersson
E
.
Drinking drivers in Sweden who consume denatured alcohol preparations; an analytical-toxicological study
.
J Anal Toxicol
 0146-4760
1989
;
13
:
199
203
.
44.
Jones
AW
,
Andersson
L
.
Biotransformation of acetone to isopropanol observed in a motorist involved in a sobriety control
.
J Forensic Sci
 0022-1198
1995
;
40
:
686
7
.
45.
Jones
AW
,
Sagarduy
A
,
Ericsson
E
,
Arnqvist
H
.
Concentrations of acetone in venous blood samples from drinking drivers, type 1 diabetic outpatients, and healthy blood donors
.
J Anal Toxicol
 0146-4760
1993
;
17
:
182
5
.
46.
Jones
AW
.
Elimination half-life of acetone in humans: case reports and review of the literature
.
J Anal Toxicol
 0146-4760
2000
;
24
:
8
10
.
47.
Taylor
HL
,
Hudson
RP
.
Acute ethanol poisoning: a two-year study of deaths in North Carolina
.
J Forensic Sci
 0022-1198
1977
;
22
:
639
53
.
48.
Minion
GE
,
Slovis
CM
,
Boutiett
L
.
Severe alcohol intoxication of 204 consecutive patients
.
J Toxicol Clin Toxicol
1989
;
27
:
375
84
.
49.
Clarke
JC
.
Sudden death in the chronic alcoholic
.
Forensic Sci Intern
 0379-0738
1988
;
36
:
105
11
.
50.
Hansen
AU
,
Simonsen
J
.
The manner and cause of death in a forensic series of chronic alcoholics
.
Forensic Sci Intern
 0379-0738
1991
;
49
:
171
8
.
This content is only available via PDF.
You do not currently have access to this content.