Endogenous ethanol production in patients with diabetes mellitus as a medicolegal problem

Ethanol which is not ingested but is produced within the body through metabolic processes is known as "endogenous ethanol" (EnEth). The aim of this study was to determine whether there is a significant increase in the blood value of EnEth (BAC) in patients with diabetes mellitus and whether BAC correlates with increased glucose blood levels. In our study the BAC in the group of patients with diabetes mellitus (n=130) was significantly higher (mean value 2.65mg/L) than in the control group (mean value 0.40mg/L) when blood samples were analyzed by headspace gas chromatography method (HS-GC). The BAC levels obtained by semi-quantitative Widmark's method (n=60) were higher, and mean value in the patient group was 27.28mg/L. There was no correlation between the glucose blood levels and BAC, i.e. the auto-production of ethanol does not depend on blood glucose values. The mean value of ethanol in urine in patients with diabetes mellitus was 6.13mg/L measured by HS-GC method and 54.27mg/L when measured using Widmark's method. Even though the BAC in patients with diabetes mellitus was statistically significantly higher (p<0.01) in comparison to the control group, these amounts of EnEth do not increase greatly enough to affect legal proceedings, especially considering the fact that EnEth is measured in mg/mL. Our experimental results as well as data reported in the literature suggest that the cut-off level for the EnEth in blood should be set at BAC<0.1mg/mL for the semi-quantitative method, i.e. the values that appear at the second decimal place cannot be with certainty claimed to arise form the exogenous ethanol. For the HS-GS method cut-off level should be set at BAC<0.01mg/mL for the analytical parameters that were used in our experiments.