title: Practical use of ethyl glucuronide and ethyl sulfate in postmortem cases as markers of antemortem alcohol ingestion.
abstract: In postmortem toxicology, it could be difficult to determine whether a positive blood ethanol concentration reflects antemortem ingestion or postmortem synthesis of alcohol. Measurement of the nonoxidative ethanol metabolite ethyl glucuronide (EtG) has been suggested as a marker of antemortem ingestion of alcohol, but EtG might degrade postmortem which could make interpretation difficult. So far, the published articles concern EtG only. Another nonoxidative metabolite, ethyl sulfate (EtS), which is more stable, has therefore been included in this study. We present a material of 36 deaths where postmortem formation of ethanol was suspected and where both EtG and EtS were measured in blood and urine to assist the interpretation. In 19 cases, EtG and EtS were positive in the body fluids analyzed. The median concentration of EtG and EtS in blood was 0.4 (range 0.1-23.2) and 0.9 mg/L (range 0.04-7.9), respectively. The median concentration of EtG and EtS in urine was 35.9 (range 1.0-182) and 8.5 mg/L (range 0.3-99), respectively. In another 16 cases, there was no trace of EtG or EtS in the specimens analyzed. In one case, there was inconsistency between the results of EtG and EtS; they were both positive in urine, while only EtS was positive in blood. This study showed that, out of 36 cases, antemortem ingestion of alcohol was very likely in 19 and unlikely in 16, according to EtG and EtS results. In the last case, the interpretation was more difficult. One possible explanation would be postmortem degradation of EtG in blood.
authors: Norwegian Institute of Public Health, Division of forensic toxicology and drug abuse, Pb 4404 Nydalen, Oslo, Norway. Gudrun.Hoiseth@fhi.no
authors: Gudrun
authors: G
authors: Høiseth
authors: Ritva
authors: R
authors: Karinen
authors: Asbjørg
authors: A
authors: Christophersen
authors: Jørg
authors: J
authors: Mørland
mesh_terms: D000428:Alcohol Drinking; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002851:Chromatography, High Pressure Liquid; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D005965:Glucuronates / Q000097:blood* / Q000652:urine*; D006801:Humans; D011180:Postmortem Changes; D012189:Retrospective Studies; D013463:Sulfuric Acid Esters / Q000097:blood* / Q000652:urine*; D053719:Tandem Mass Spectrometry
chemical_list: D015415:Biomarkers; D005965:Glucuronates; D013463:Sulfuric Acid Esters; C093924:ethyl glucuronide; C011612:diethyl sulfate