title: Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high-range alcohol concentrations.
abstract: OBJECTIVE
  To characterize sudden or unnatural deaths with very high-range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1 January 1997 and 31 December 2011.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Sydney, Australia.
  
  
  METHODS
  A total of 263 cases of sudden or unnatural death with a BAC of ≥0.300 g/100 ml.
  
  
  METHODS
  Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology.
  
  
  RESULTS
  The mean age of decedents was 46.7 years and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (35.0%), combined alcohol/other drug toxicity (14.8%), accidents (18.6%), natural disease (13.3%), suicide (11.0%), homicide (6.8%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371 g/100 ml (range 0.300-0.820 g/100 ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410 g/100 ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%) and cerebellar atrophy (9.0%).
  
  
  CONCLUSIONS
  Unnatural deaths with very high-range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle-aged males, with long histories of alcohol problems.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW 2052, Australia. s.darke@unsw.edu.au
authors.forename: Shane
authors.initials: S
authors.lastname: Darke
authors.forename: Johan
authors.initials: J
authors.lastname: Duflou
authors.forename: Michelle
authors.initials: M
authors.lastname: Torok
authors.forename: Tatiania
authors.initials: T
authors.lastname: Prolov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000401:mortality*; D001344:Autopsy; D016022:Case-Control Studies; D002423:Cause of Death; D003645:Death, Sudden / Q000453:epidemiology*; D000431:Ethanol / Q000097:blood / Q000506:poisoning*; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000401:mortality
chemical_list: D000431:Ethanol
keywords: Alcohol; mortality; toxicology