Cause and manner of death and phase of the blood alcohol curve

Lahti, R.A; Pitkäniemi, J.; Jones, Alan Wayne; Sajantila, Antti; Poikolainen, Kari; Vuori, Erkki

doi:10.1016/j.forsciint.2014.09.015

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Although simulated driving tasks are not perfectly analogous to real-world motoring, they do provide a derivative of the skill set required for driving, which can be tested under laboratory conditions (Irwin, Iudakhina, Desbrow, & McCartney, 2017). Autopsy data, which included measures of alcohol pharmacokinetics, have shown that fatal road accidents are far more common during the descending limb of the BAC curve in which acute behavioral tolerance is most evident (Lahti et al, 2014; Levine & Smialek, 2000). Approaches for dealing with drinking and driving and alcohol-related road accidents need to consider the influence that changes in the dose effect could be having, especially the difference in recovery between subjective intoxication and other domains of behavior.…”

Section: Discussionmentioning

confidence: 99%

Acute behavioral tolerance to alcohol.

Comley

Dry

2020

Experimental and Clinical Psychopharmacology

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Although the strength of the effect produced by alcohol is generally dose dependent, its effect on behavior cannot be reliably predicted by the dose alone because the dose effect has been shown to vary. Acute behavioral tolerance is a rapid decrease in the dose effect of alcohol, seen to occur within the duration of a single dose. Numerous research paradigms have been used to examine acute behavioral tolerance, across an array of different behavioral measures. We have reviewed studies that used a research paradigm appropriate to test for acute behavioral tolerance. The primary aim was to examine the different paradigms that have been used to identify what empirical evidence of the effect has been found. The additional aims were to identify domains of behavior in which acute tolerance has been shown to occur and ascertain which conditions have been shown to influence it. Findings of acute tolerance were prevalent. Seven different research paradigms were identified, and each found evidence of acute behavioral tolerance in at least 1 study. The effect was not uniform across all behavioral measures. Subjective measures reliably showed the effect, but objective measures of behavior were less reliable, providing evidence that particular aspects of task performance are more sensitive to acute tolerance than others. The dose effect of alcohol for behavioral measures is often shown to decrease within the duration of a single dose. Investigations into, and considerations of, the effects of alcohol on behavior need to consider temporal changes in the dose effect.

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Section: Discussionmentioning

confidence: 99%

Acute behavioral tolerance to alcohol.

Comley

Dry

2020

Experimental and Clinical Psychopharmacology

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“…Studies testing acute tolerance in driving simulator performance have not found that impairment at a given BAC diminished during the dose (Gengo et al, 1990; Marczinski & Fillmore, 2009; Starkey & Charlton, 2014; Weafer & Fillmore, 2012). Also, autopsy data show that road accidents are more prevalent when victims are on the descending limb of the BAC curve (Lahti et al, 2014). This suggests that although cognitive performance in domains such as information processing speed may show statistically significant recovery from alcohol, it is unlikely to be clinically or ecologically significant to the degree that driving with an elevated BAC becomes safe.…”

Section: Discussionmentioning

confidence: 99%

Acute tolerance to alcohol-induced impairment in cognitive performance.

Comley¹,

Dry²

2020

Experimental and Clinical Psychopharmacology

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Acute tolerance is a rapid decrease in the effect of alcohol relative to the blood alcohol concentration (BAC) occurring within the duration of a single dose of alcohol. It remains uncertain which cognitive domains are susceptible to acute tolerance, because findings vary between tasks used to measure the effect of alcohol. This study examined acute tolerance in subjective intoxication and in 2 cognitive domains: information processing, measured using the Inspection Time Task (ITT), and response inhibition, measured with the Sustained Attention to Response Task (SART). Forty participants were allocated to either an alcohol or placebo group. After baseline measures, the alcohol group were given an active dose to produce a peak BAC of 0.07%, whereas the placebo group received a placebo beverage. ITT and SART performance were measured at a BAC of 0.05% twice during the course of the dose, once when BAC was ascending and again when descending. The placebo group was tested at equivalent times. When BAC was ascending, the alcohol group showed increased ratings of subjective intoxication and impaired performance on the ITT. Consistent with an acute tolerance effect, ratings of subjective intoxication and impairment on the ITT in the alcohol group were lower when BAC was descending. Performance on the SART was not found to be affected by alcohol. The findings suggest information processing is a domain of behavior that shows acute tolerance to alcohol and that the subjective intoxication felt at a BAC of 0.05% can decrease substantially within the duration of a single dose.

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“…In addition, the stage of alcohol intoxication at the time of death was estimated based on the ratio of postmortem blood alcohol concentration (BAC) and urine alcohol concentration (UAC). In general, the accepted average UAC to BAC ratio is approximately 1.3:1 and vitreous humor alcohol concentration (VHAC) to BAC ratio is 1.2:1 . We defined the deaths in the likely absorptive phase of the blood curve when peripheral BAC was more than UAC; deaths in the likely peak of the blood curve when UAC to BAC ratio was from 1:1 to 1.3:1; and deaths in the likely postabsorptive phase when UAC to BAC ratio was >1.3:1.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Acute Alcohol Intoxication as the Primary Cause of Death: A Diagnostic Challenge for Forensic Pathologists

et al. 2017

Journal of Forensic Sciences

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Deaths caused by acute alcohol intoxication (AAI) remain a major public health issue. This study is retrospective and descriptive: an 8-year case analysis of deaths due to AAI in Maryland. Study showed that of 150 AAI deaths, the death rate among Hispanics (10.41/100,000 population) was significantly higher than all the non-Hispanics combined (1.88/100,000 population). The majority of individuals were young adults, overweight, and binge drinkers. The obese group showed significantly lower mean heart and peripheral blood alcohol concentration (BAC) (0.36%, 0.37%) than the normal weight group (0.45%, 0.42%). Based on the PBAC and urine AC ratio, 49.6% deaths likely occurred close to peak phase, followed by postabsorptive phase (31.6%) and absorptive phase (18.8%). Our results indicate that forensic pathologists should evaluate postmortem BAC in the light of individual's age, drinking history, body weight, possible phase of alcohol intoxication, and other autopsy findings when certifying AAI as primary cause of death.

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Cause and manner of death and phase of the blood alcohol curve

Cited by 8 publications

References 26 publications

Acute behavioral tolerance to alcohol.

Acute behavioral tolerance to alcohol.

Acute tolerance to alcohol-induced impairment in cognitive performance.

Evaluation of Acute Alcohol Intoxication as the Primary Cause of Death: A Diagnostic Challenge for Forensic Pathologists

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