Survival of Very High Blood Alcohol Concentration Without Consequential Damage in a Patient Without a Previous Substance Use Disorder

Intoxications with alcohol may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors such as liver function, tolerance, and comedication. Death may occur due to ethanol‐induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation is occasionally necessary. A case of a 58‐year‐old female patient with depression who demonstrated a very high BAC of 8.68 gm/L (0.868%) following ingestion of large amounts of alcohol with suicidal intent is presented. Intubation and ventilation were life‐saving, and the patient did not develop any physical or consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent, tolerance could be ruled out. This case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large interindividual differences regarding ethanol susceptibility.     

保存犬尸体中自生醇的研究

目的建立组织中自生醇直接进样毛细管柱气相色谱检测方法；建立犬尸体中自生醇研究模型．观察犬尸体中自生醇的产生情况。方法犬经CO2处死，置于室温，分别于死后0、2、4、8、12、24、48、72、96、120h采集样品，样品匀浆后（体液除外）离心去上清，内标溶液1：2（体液为1：4）稀释，直接进样，气相色谱法检测，保留时间定性，内标法定量。结果甲醇、丙酮、乙醇、正丙醇、异丁醇、异丙醇、正丁醇、异戊醇的保留时间分别为（2．77±0．01）、（3．42±0．01）、（3．87±0．01）、（5．92±0．01）、（7．54±0．01）、（7．92±0．01）、（10．33±0．01）、（13．55±0．01）min；大部分组织如心血、下腔静脉血、尿、胆汁、肝、脾、肺和肾在犬死后12h可检出乙醇，肌肉、玻璃体液、和大脑分别在死后48、72、96h检出乙醇；乙醇和正丙醇的生成存在正相关。结论死亡犬体内会产生自生醇，尿中检出乙醇不能判定为生前饮酒，在涉及乙醇的法医学检案中。特别是腐败样品．应注意自生醇对乙醇定性和定量可能造成的影响，应采集不易腐败的组织如玻璃体液、肌肉或大脑，检测乙醇及自生醇含量，并观察与正丙醇的比例关系来进行综合判定。     

Reflections on variability in the blood–breath ratio of ethanol and its importance when evidential breath-alcohol instruments are used in law enforcement

Variability in the blood–breath ratio (BBR) of alcohol is important, because it relates a measurement of the blood-alcohol concentration (BAC) with the co-existing breath-alcohol concentration (BrAC). The BBR is also used to establish the statutory BrAC limit for driving from the existing statutory BAC limits in different countries. The in-vivo BBR depends on a host of analytical, sampling and physiological factors, including subject demographics, time after end of drinking (rising or falling BAC), the nature of the blood draw (whether venous or arterial) and the subject’s breathing pattern prior to exhalation into the breath analyzer. The results from a controlled drinking study involving healthy volunteers (85 men and 15 women) from three ethnic groups (Caucasians, Hispanics and African Americans) were used to evaluate various factors influencing the BBR. Ethanol in breath was determined with a quantitative infrared analyzer (Intoxilyzer 8000) and BAC was determined by headspace gas chromatography (HS-GC). The BAC and BrAC were highly correlated (r = 0.948) and the BBR in the post-absorptive state was 2 382 ± 119 (mean ± SD). The BBR did not depend on gender (female: 2 396 ± 101 and male: 2 380 ± 123, P > 0.05) nor on racial group (Caucasians 2 398 ± 124, African Americans 2 344 ± 119 and Hispanics 2 364 ± 104, P > 0.05). The BBR was lower in subjects with higher breath- and body-temperatures (P < 0.05) and it also decreased with longer exhalation times into the breath-analyzer (P < 0.001). In the post-absorptive state, none of the 100 subjects had a BBR of less than 2 100:1.     

Forensic appraisal of death due to acute alcohol poisoning: three case reports and a literature review

Death due to acute alcohol poisoning lacks specific anatomical characteristics, compared with other deaths due to drug poisoning. We report three forensic cases of death from acute alcohol poisoning due to inhibition of the respiratory centre and eventual asphyxia. Blood alcohol concentrations in the three fatalities were 5.28, 3.33 and 3.78 mg/mL, respectively. Lethal doses and blood alcohol concentrations showed differences between individuals. Detailed auxiliary tests besides autopsy were undertaken. These cases show that forensic scientists should exclude other causes of death, combine the autopsy with auxiliary tests, and then make an appraisal.     

Characteristics of Drug Vendors on the Tor Network: A Cryptomarket Comparison

Abstract

Past research on drug-related vendors on Tor marketplaces indicate that sellers are motivated by the greater anonymity afforded by the Tor Network. Limited research has even posited that some drug-related vendors on cryptomarkets sell to other dealers, adding another dimension to existing literature that highlights the retail nature (dealer-to-customer transactions) of these Tor-based drug markets. Yet these past studies have been largely qualitative in nature. This study conducted a quantitative analysis of vendor accounts on Evolution and Agora to determine characteristics predictive of vendors advertising controlled substances, and to determine whether any statistically significant differences among drug vendor characteristics existed between the two sites.     

Developing Citizens: Missed Opportunities in Health and Social Service Provision? A View From Aotearoa New Zealand

This article is a reflection on an evaluation of multisystemic therapy services in Aotearoa New Zealand, established to treat young people aged 12–16, for alcohol and drug misuse and to decrease unwanted or “antisocial” behaviors. The therapy engaged parents/caregivers in a systems approach and did not require the young person to be directly engaged. This raised three issues. First, because the young people were not active participants, the services missed the opportunity to help the young people develop skills of self management. Second, this lack of engagement created a missed opportunity to engage the young person to re-establish or reconnect relationships that had been harmed. Finally, we reflect on the cultural fit of the service with Māori values. These issues raise a number of questions about the aims of service provision with young people and the assumptions that underpin particular types of service.     

The Contribution of Body Mass and Volume of Distribution to the Estimated Uncertainty Associated with the Widmark Equation

The Widmark equation is used forensically for the determination of the amount of ethanol (alcohol) that may have been consumed and also to determine the blood alcohol concentration (BAC) of an individual at a specific time. It is important to be able to estimate the uncertainty associated with Widmark equations. To date, there has been no detailed determination of contribution to the final uncertainty of Widmark calculations of the volume of distribution of ethanol (V_d), using anthropometric equations, or the contribution of an individual’s body mass. Using published data, published literature, and freedom of information data, we determined that the variability (%CV) associated with V_d was ~10% (Watson et al. and Forrest anthropometric equations) and that the %CV associated with estimated body mass was ~15% compared to ~3% when body mass was directly measured. These data allow an estimation of the overall uncertainty of Widmark calculations using general error propagation. The estimated total uncertainty for BAC calculations increased from ~11% (volume consumed) and ~22% (BAC) to ~19% (volume consumed) and ~37% (BAC) when using measured body mass compared to estimated body mass. These results demonstrate that forensic practitioners should be mindful of the increase in estimated uncertainty in calculated Widmark equation results when estimated body mass is used rather than measured body mass. These data further improve the knowledge around the uncertainty of results calculated with the Widmark equation.     

The Impact of Marital Aggression on Women's Psychological and Marital Functioning in a Newlywed Sample

The impact of husband-to-wife physical aggression on changes in wives' personal and marital well-being was examined in a representative sample of newlywed couples. The sample consisted of couples who completed baseline (time of marriage) and first anniversary assessments as part of the Buffalo Newlywed Study (n = 543). After controlling for sociodemographic variables, initial relationship satisfaction, and verbal aggression, wives who experienced physical aggression from their husbands during the first year of marriage reported increased stress and lower marital satisfaction at the first anniversary. Further, they were more likely to report separation from husbands due to marital problems during the first year of marriage. Experiences of partner physical aggression during the premarital period were associated with greater frequency of heavy drinking episodes among wives, although they were not associated with changes in average daily volume of ethanol consumed. Results suggest that among a community sample, experiences of husband-to-wife physical aggression have negative consequences for both women's psychological well-being and marital functioning.     

血中酒精消除速度与浓度推算关系的研究

目的 研究人血中酒精消除速度与血中酒精浓度的推算关系。方法 用呼气式酒精测定仪测定95位自愿受试者饮酒后一定时间内的血中酒精浓度,对时一浓曲线进行分析。结果 血中酒精的消除符合线性消除规律,消除线性相关系数为-0.989±0.011,最小值为-0.098,最大值-1.000;血中酒精消除速度为-0.140 mg·ml-1·h-1±0.028,最小值为-0.098 mg·ml-1·h-1,最大值-0.230 mg·ml-1·h-1。结论 血中酒精浓度可依据酒精消除速度[-0.10mg·ml-1·h-1]进行回推算。