Postmortem Ethanol Concentrations and Postmortem Ethanol Production

Abstract

A review of the literature was conducted in reference to postmortem blood ethanol concentrations and the issue of postmortem production of ethanol. Ethanol in postmortem specimens may occur as a result of antemortem consumption (most common), postmortem production in the body or in vitro by microorganisms (less common), and endogenous production by microorganisms during life (rare). The portion of ethanol-positive postmortem cases in which postmortem production of ethanol is thought to have occurred is small, as is the portion of cases in which postmortem production of ethanol is a potentially important issue. It is unusual for postmortem production of ethanol to account for more than a 70 mg/dL concentration, but cases with higher concentrations occasionally occur. Cases in which blood ethanol is positive but vitreous ethanol concentration is much lower or negative, and/or in which the urine: blood ethanol concentration ratio is less than one are supportive of postmortem ethanol production. The presence of other alcohols such as n-propanol and/or n-butanol is suggestive of postmortem microbial production of ethanol. The ratio of serotonin metabolites in urine may be helpful in distinguishing postmortem production of ethanol from antemortem consumption, as may the concentration of ethyl glucuronide in blood. Candida and some other species may produce ethanol in urine antemortem and postmortem. In rare instances such as infections, endogenous ethanol production may occur in a living person. Recommendations are made concerning samples to collect and tests that may be helpful in distinguishing antemortem ethanol consumption from postmortem production of ethanol.

Ethanol and Higher Alcohols’ Production in Fungal and Bacterial Laboratory Cultures and Significance for Forensic Samples

“…The EC models were the most successful of the tested models in all manner of death cases (Figure 2), showing that the latter is not an indicative factor of postmortem ethanol production. The bacterial models were more successful in cases with putrefaction (Figure 3), as expected, since putrefaction is a well-recognized indicator of microbial ethanol production at the postmortem [5,6,8,22,24].…”

“…Particularly in postmortem cases, BAC is determined as part of the death investigation process since it might be a causal or a contributory factor [ 3 , 4 ]. In such cases, the interpretation of relative results may present limitations and complexities mainly due to the postmortem ethanol neo-formation (which is actually microbial ethanol production) [ 5 , 6 , 7 , 8 , 9 ] at the interval from death up to the analysis of the sample. To achieve a feasible accuracy in interpreting the postmortem ethanol analysis results and in defining the origin (whether it is a result of antemortem consumption or postmortem microbial production or both) of the measured ethanol, various factors have been evaluated [ 5 , 10 , 11 ], such as the putrefaction state of the cadaver at autopsy, the clinical history of the deceased, the determination of non-oxidative metabolites of ethanol, the identification of microbes in the analyzed sample, and the evaluation of the discrepancies between ethanol concentration from various sampling sites and from different specimens [ 5 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Impact of Trauma, Massive Blood Loss and Administration of Resuscitation Fluids on a Person's Blood-Alcohol Concentration and Rate of Ethanol Metabolism

“…In trauma-related deaths, other factors deserve consideration, including decomposition and possible postmortem synthesis of ethanol from fermentation of glucose or other substrates (65). When government agencies and legislators introduced a statutory BAC for driving, they were considering blood samples taken under sterile conditions from living subjects and not blood from dead bodies taken during an autopsy (66).…”