Postmortem Alcohol Measurements

This topic has recently been reviewed in depth by Pounder and Jones (23). High postmortem alcohol concentrations do not imply that impairment

Top 10 Defense Challenges For Driving Under the Influence of Alcohol

1. Drinking after the offense—the hip flask defense.

2. Laced drinks.

3. Inhalation of ethanol vapors from the work environment.

4. Pathological condition or trauma.

5. Use of skin antiseptics containing ethanol.

6. Alleged mix-up of blood specimens.

7. Postsampling formation of alcohols.

8. Drug-alcohol interactions.

9. Consumption of elixirs or health tonics containing alcohol.

10. Infusion of blood or other liquids during surgical emergency treatment.

was evident during life. Of 32 alcoholics presented at an emergency room for medical treatment, only 23 had apparent behavioral abnormalities, six were confused, and three were drowsy, even though the mean alcohol concentration was 313 mg/100 mL (range 180-450 mg/100 mL) (60). Alcohol can be measured in numerous tissues, but the most accurate picture is usually obtained when multiple sites are sampled (e.g., vitreous, gastric contents, blood, and urine) particularly if ureteral urine is available and the alcohol concentrations compared.

Because the eye is anatomically isolated, putrefaction is delayed, and there is little problem with postmortem redistribution, vitreous measurements can be used to confirm values obtained from whole blood and urine, to distinguish postmortem alcohol production from antemortem ingestion, and to determine whether blood alcohol concentrations were rising or falling at the time of death. Vitreous contains more water than blood so that the blood/ vitreous alcohol ratio is less than 1. Ratios greater than 1 suggest that death occurred before equilibrium had been reached (i.e., blood alcohol was still rising) (61). Vitreous alcohol concentrations can be related to blood concentrations; however, there is so much intraindividual variation that extrapolation in an individual case is probably unwise and unsound scientifically.

As mentioned, serum and plasma contain more water than whole blood, and it follows that the alcohol content of the former will be 10-15% higher than the latter. Because postmortem measurements are made with whole blood and the water content of the cadaver begins to decrease almost immediately after death, estimating antemortem values with any precision is difficult, especially if only blood has been sampled. However, if samples from multiple sites are obtained, and vitreous, blood, and urine (urine as it is being formed contains 1.3 times as much alcohol as whole blood) are all analyzed, it may be possible to make a reasonable estimate of what the alcohol concentration was at the time of death (23).

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