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Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high‐range alcohol concentrations
Author(s) -
Darke Shane,
Duflou Johan,
Torok Michelle,
Prolov Tatiania
Publication year - 2013
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12191
Subject(s) - medicine , alcohol , cause of death , autopsy , forensic toxicology , poison control , blood alcohol , physiology , disease , injury prevention , emergency medicine , biology , biochemistry , chemistry , chromatography
Aims To characterize sudden or unnatural deaths with very high‐range blood alcohol concentrations ( BAC s) presenting to the D epartment of F orensic M edicine ( DOFM ) in S ydney between 1 January 1997 and 31 December 2011. Design Case series. Setting S ydney, A ustralia. Cases A total of 263 cases of sudden or unnatural death with a BAC of ≥0.300 g/100 ml. Measurements Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology. Findings The mean age of decedents was 46.7 years and 74.5% were male. Pre‐existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (35.0%), combined alcohol/other drug toxicity (14.8%), accidents (18.6%), natural disease (13.3%), suicide (11.0%), homicide (6.8%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371 g/100 ml (range 0.300–0.820 g/100 ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410 g/100 ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol‐related disease was diagnosed in 62.9% of cases. Alcohol‐related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%) and cerebellar atrophy (9.0%). Conclusions Unnatural deaths with very high‐range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle‐aged males, with long histories of alcohol problems.