Drugs and alcohol in hypothermia and hyperthermia related deaths: a retrospective study

Hypothermia and hyperthermia related cases recorded for the period 1973 to 1984 were collected from the files of the Department of Forensic Medicine, University of Oulu, and the necropsy protocols including toxicological results were analyzed. The fact that similar alcohol concentrations were found in both types of fatalities points to the poikilothermic effect of alcohol in humans, as found in animal studies. Both types of deaths seem to be associated with the alcohol elimination phase. Antidepressants and neuroleptics were most often found in the hypothermia cases, but benzodiazepines were also quite frequently present. In spite of the diminished use of barbiturates, these still appear in hypothermia fatalities. Certain other drugs that affect thermoregulation were also noted in solitary cases. Extended toxicological analysis was seldom made in the cases of hyperthermia deaths, and no firm conclusions on the poikilothermic effect of psychotropic drugs could be reached, for example. Therapeutic drug concentrations did not alone predispose the subjects to hypothermia, but appeared in connection with alcohol consumption or chronic diseases.     

Blood alcohol in sudden and unexpected deaths

Blood alcohol concentration was determined in 1672 sudden and unexpected natural and non-natural out-of-hospital deaths. The material covered all medicolegal autopsies in the province of Uusimaa which has a population of approximately 1.1 million inhabitants. In general, the prevalence of cases with alcohol in the blood at the time of death was high but varied considerably according to sex, age, and the cause and manner of death. The blood alcohol result was positive in 36% of the male and in 15% of the female material. In 59% of the alcohol-positive male and in 54% of the alcohol-positive female cases the actual concentrations were at least 1.5%. Acute use of alcohol was regarded as a significant condition contributing to death in 23% of the whole male and in 8% of the whole female material. These gross results and the details presented indicate that the acute use of excess alcohol is a factor contributing to non-natural but also to sudden and unexpected natural deaths to an extent that is not generally known. The results also emphasize that simple blood alcohol determination should be a routine procedure in the autopsy praxis of all sudden and unexpected natural and non-natural out-of-hospital deaths.     

Blood alcohol in fatally injured drivers and the minimum legal drinking age

Although most research on the effect of minimum legal drinking age (LDA) laws on proxies for alcohol-related fatalities find effects of higher LDAs in reducing such fatalities, recent research that supposedly controls for drinking experience claims that higher LDAs have little or no effect. This study examines the actual amount of alcohol in the blood of fatally injured drivers per licensed driver in states where more than 80 percent of such drivers were tested for alcohol and where licensure data were available for the period 1982-1986. The involvement of alcohol in fatal crashes increases with age as the LDA is approached. A higher LDA is associated with fewer alcohol-related crashes among those younger than the LDA. No effect of drinking experience was evident, but this study finds an age-related bias in previously used proxies for alcohol involvement that results in overestimates of alcohol levels in younger drivers.     

Forensic evaluation of the results of chemical and toxicological analysis of blood alcohol level

According to printed research results, the endogenic level of ethanol in blood amounts to 0.001-0.3%, the physiological level amounts to 0.01-0.4% and the lethal level amounts to 3-17.6%. It was established experimentally that the absolute lethal level of ethanol in blood does not exceed 15%. Criteria of incidental contamination of analyzed blood sample with ethanol are described.     

Non-linear kinetics of ethanol elimination in man: Medico-legal applications of the terminal concentration-time data analysis

Research regarding parameters suitable for reporting on the activity of enzymatic systems responsible for ethanol metabolism is of obvious interest in medico-legal practice. Blood ethanol concentration-time curves, following oral administration of ethanol, have been developed for ethylic and non-ethylic subjects. This study has confirmed the non-linear kinetics of ethanol elimination; however, existing non-linear models appear to be inadequate for usual medico-legal practice, because of their complexity. We observed three phases during the elimination of ethanol. The first order terminal phase is characterized by its half-life. This parameter seems adequate as a basis for determining the activity of enzyme systems responsible for the metabolism of ethanol.     

Blood alcohol concentrations of sudden unexpected deaths and non natural deaths.

This study reports on the relationships between the blood alcohol concentration (BAC) and the cause of death - which is of course common knowledge for forensic scientists! Our special aim was to gain unselected data for generalizing conclusions. The blood of 2465 consecutive cases (86% of all 2852 sudden unexpected and unnatural fatalities investigated at the Institute for Legal Medicine in Hamburg during the year 1989) was analysed. The BAC was evaluated according to sex, age, cause of death and place of death. In natural causes of death there were 80% cases under 0.05% BAC. Endocrine and digestive system diseases in particular were associated with positive BAC values. In unnatural death cases the BAC under 0.05% was found in 64% of the suicides, 62% of the accidents, 54% of the homicides and 51% of the drug intoxications. The drowning cases showed higher BAC's than traffic accidents. In suicides middle aged males had high BAC's.     

A study on the combined action of CO and HCN in terms of concentration-time products

Acute toxicity at single and combined exposures of CO and HCN was studied on rats in terms of concentration-time product (ppm . min) necessary to kill animals (lethal CT). The animal was exposed individually to test gas in an animal chamber made of transparent plastics, and test gas was made in gas chamber connected to the animal chamber by a wide and short piece of plastic tube. HCN was produced by addition of NaCN solution to H2SO4 and in case of CO exposure, various amounts of pure CO were introduced. During exposure, gas samples were frequently taken. After exposure, blood sample was withdrawn from the right side of the heart. CO concentrations in the gas and blood were determined gas chromatographically. HCN in the gas sample was measured spectrophotometrically, after being absorbed into NaOH solution in a glass vessel devised by our laboratory. At single exposures, mean lethal CT for CO was 78,000 +/- 22,000 and for HCN was 4,700 +/- 940. In combined exposure, various combinations of CO and HCN were used. A fractional CT, defined as a ratio of CT to lethal CT, multiplied by 100, was calculated for each gas. A linear relationship between fractional CTs of HCN and CO was considered to show a simple additive action between the two gases. The sum of both fractional CTs averaged 100 +/- 26. On the other hand, linear relation was not observed between blood levels of the two toxicants at death.     

Youth alcohol use and dating abuse victimization and perpetration: a test of the relationships at the daily level in a sample of pediatric emergency department patients who use alcohol

Objective: This study retrospectively examined the daily-level associations between youth alcohol use and dating abuse (DA) victimization and perpetration for a 6-month period. Method: Timeline Followback (TLFB) interview data were collected from 397 urban emergency department patients, ages 17 to 21 years. Patients were eligible if they reported past month alcohol use and past year dating. Generalized estimating equation (GEE) analyses estimated the likelihood of DA on a given day as a function of alcohol use or heavy use (≥4 drinks per day for women, ≥5 drinks per day for men), as compared with nonuse. Results: Approximately 52% of men and 61% of women participants reported experiencing DA victimization ≥1 times during the past 6 months, and 45% of men and 55% of women reported perpetrating DA ≥1 times. For both men and women, DA perpetration was more likely on a drinking day as opposed to a nondrinking day (ORs = 1.70 and ORs = 1.69, respectively). DA victimization was also more likely on a drinking day as opposed to a nondrinking day for both men and women (ORs = 1.23 and ORs = 1.34, respectively). DA perpetration and DA victimization were both more likely on heavy drinking days as opposed to nondrinking days (2.04 and 2.03 for men's and women's perpetration, respectively, and 1.41 and 1.43 for men's and women's victimization, respectively). Conclusions: This study found that alcohol use was associated with increased risk for same day DA perpetration and victimization, for both male and female youth. We conclude that for youth who use alcohol, alcohol use is a potential risk factor for DA victimization and perpetration.     

Blood alcohol concentration determined from urine samples as a practical equivalent or alternative to blood and breath alcohol tests

The value of urine tests for determining an equivalent blood alcohol concentration in driving under the influence (DUI) enforcement cases is reviewed from a historical, theoretical, and practical perspective. The limits of precision and accuracy that can be ascribed to urine alcohol results are demonstrated through an evaluation of actual case results wherein both a first void and a subsequent urine sample were analyzed and converted to an equivalent blood alcohol concentration (BAC) using a urine to blood conversion factor of 1.3:1.     

A retrospective analysis of alcohol in medicolegal postmortems over a period of five years.

Violence and violent death are everyday events in present-day South Africa. Although this phenomenon may be attributed in great part to the sociopolitical environment, the single most important underlying common factor is the presence of alcohol in both the perpetrators of violence and their victims. We retrospectively studied 948 cases of 2,980 medicolegal autopsies done over a 5-year period. We found that 52.5% of cases tested positively for alcohol, with blood alcohol concentration varying from 0.008 to 0.048 g% (mean = 0.18). Male patients were more common and more likely to be positive than female patients. Breakdown of the cases into various modes of death showed that homicides, vehicular accidents, and suicides predominated. The results are in agreement with earlier studies done locally and elsewhere.     

Post-mortem estimation of gamma-glutamyl transferase in vitreous humor and its association with chronic abuse of alcohol and road-traffic deaths

A small survey was undertaken to assess the usefulness of measuring gamma-glutamyl transferase in vitreous. The results show that this enzyme may not be a sensitive test to predict the mortality due to chronic abuse of alcohol in road traffic deaths.     

Asphyxial deaths: a retrospective study and review of the literature

An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths.During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases.The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.