Abstract
PurposeThis study aimed to compare the frequency of postmortem ethanol formation in blood, urine and vitreous humor according to negative ethylsulphate (EtS) in blood or positive putrefactive alcohols (PA’s) in either medium. Furthermore, it aimed to evaluate the interpretational value of calculated ethanol ratios in relation to EtS and PA results. MethodsBlood ethanol positive forensic cases were included; one dataset consisting of 2504 cases with EtS analysed in blood and another dataset with 8001 cases where PA’s were analysed. ResultsPA’s were found in 24.4% of cases. EtS was negative in 15.3%, 9.4% and 7.4% of cases that were positive for ethanol in blood, urine and vitreous humor, respectively. In EtS negative cases, the concentrations of ethanol in blood, urine and vitreous humor were lower than 0.20 g/kg in 51.3%, 67.4% and 77.8%, respectively. It was 1.0 g/kg or higher in blood in 4.2% of cases. More EtS negative and PA positive cases were seen in central compared to peripheral blood. Ethanol ratios between urine or vitreous humor and blood were significantly lower in both EtS negative and PA positive cases, but large variations were observed. ConclusionEtS and PA analysis improve the diagnostic accuracy of ethanol in postmortem cases. Postmortem ethanol formation in vitreous humor and urine were both more frequent than expected and we recommend the analysis of ethanol primarily in peripheral blood if available.
Highlights
Ethanol is amongst the most frequently occurring toxicological substances in postmortem cases [1]
The frequency of EtS negative cases decreased with increasing ethanol concentrations
Defined by negative blood EtS results, this study examined the frequency of postmortem formation of ethanol in urine and vitreous humor in addition to blood
Summary
Ethanol is amongst the most frequently occurring toxicological substances in postmortem cases [1]. Determining whether the measured ethanol concentration represents alcohol intake prior to death, postmortem formation, or a combination of the two, is important because it is possible ethanol may be either the causal or contributory factor of death. The non-oxidative ethanol metabolites, ethylglucuronide (EtG) and ethylsulphate (EtS), have more recently become recognized as direct markers for alcohol intake. Their pharmacokinetics are well understood [5,6,7,8,9,10] and their appearance has been studied in postmortem blood, urine and vitreous humor [11,12,13,14,15,16], where negative results indicate that ethanol was not ingested before death
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