title: Comparison of blood-ethanol concentration in deaths attributed to acute alcohol poisoning and chronic alcoholism.
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.
authors.affiliation: Department of Forensic Toxicology, University Hospital, 581 85 Linköping, Sweden.
authors.forename: A W
authors.initials: AW
authors.lastname: Jones
authors.forename: P
authors.initials: P
authors.lastname: Holmgren
mesh_terms: D019840:2-Propanol / Q000097:blood; D000096:Acetone / Q000097:blood; D000437:Alcoholism / Q000097:blood*; D016208:Databases, Factual; D000431:Ethanol / Q000097:blood* / Q000506:poisoning*; D005260:Female; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012997:Solvents / Q000032:analysis
chemical_list: D012997:Solvents; D000096:Acetone; D000431:Ethanol; D019840:2-Propanol