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Effects of perimortem physical factors associated with death on exogenous ethanol concentrations in cardiac blood
Fumio Moriya1, Yoshiaki Hashimoto, Junichi Furumiya
1Department of Legal Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan. moriyaf@med.kochi-u.ac.jp
Insights
Perimortem factors like blood loss and CPR can alter cardiac blood ethanol concentrations. Femoral venous blood ethanol levels are reliable indicators of blood alcohol at death, except in cases of massive bleeding and CPR.
Area of Science:
- Forensic Toxicology
- Postmortem Medicine
Background:
- Accurate postmortem blood ethanol concentration is crucial for forensic investigations.
- Perimortem events can potentially influence the distribution of ethanol in blood.
- Understanding these influences is vital for interpreting toxicological findings.
Purpose of the Study:
- To investigate the impact of perimortem physical factors on cardiac blood ethanol concentrations.
- To assess the reliability of cardiac blood ethanol measurements in various death scenarios.
- To identify specific conditions that may lead to discrepancies in postmortem ethanol levels.
Main Methods:
- Analysis of cardiac and femoral venous blood ethanol concentrations from 41 deceased individuals.
- Inclusion of cases with varying causes of death, including fire victims, drowned persons, and those undergoing cardiopulmonary resuscitation (CPR).
- Comparison of ethanol levels between cardiac chambers and correlation with femoral venous blood ethanol.
Main Results:
- A strong correlation (r²=0.990) was found between right cardiac and femoral venous blood ethanol concentrations.
- Significantly lower left-to-right cardiac chamber ethanol ratios were observed in decedents with massive blood loss and CPR (0.71±0.13).
- Blood loss and prolonged chest compression during CPR may decrease left cardiac chamber ethanol concentrations.
Conclusions:
- Postmortem cardiac and femoral venous blood ethanol concentrations generally reflect antemortem levels when putrefaction is minimal.
- Massive blood loss combined with CPR necessitates careful interpretation of left cardiac blood ethanol results.
- Femoral venous blood ethanol is a reliable indicator, but specific circumstances require specialized consideration in forensic toxicology.
Abstract:
The purpose of this study was to determine whether perimortem physical factors associated with death affect exogenous ethanol concentrations in cardiac blood. Forty-one autopsies of alcohol-intoxicated decedents with no or little putrefaction were involved. Postmortem intervals ranged from 6 to 96 h at the time of autopsy. Our 41 cases consisted of 17 fire victims, 8 drowned persons, 3 blood-loss patients who underwent unsuccessful cardiopulmonary resuscitation (CPR) for 30-50 min, 3 blood-loss persons without CPR, three non-blood-loss patients who underwent unsuccessful CPR for 5-60 min, and seven people who died of other causes. Ethanol concentrations in right cardiac chamber blood ranged from 0.12 to 4.40 mg/g (mean 1.39 mg/g) in all cases. An excellent correlation was observed between ethanol concentrations in right cardiac chamber blood and femoral venous blood (y=1.01x-0.087, n=38, r2=0.990). The ratios of blood ethanol concentrations in the left to right cardiac chambers were significantly lower in blood-loss decedents with CPR (0.71+/-0.13) than other decedents (0.92+/-0.07-1.06+/-0.06). Two factors, blood-loss and prolonged chest compression under ventilation, might have caused a decrease in blood ethanol concentration in the left cardiac chambers. Postmortem cardiac blood ethanol concentration as well as postmortem femoral venous blood ethanol concentration may usually reflect blood ethanol levels at the time of death when putrefaction is not evident. However, special attention is required for cases that received CPR after massive bleeding.
