Ethanol as a single toxin in non-traumatic deaths--a toxicology perspective

There were 285 autopsy cases in 2010 where ethanol was the only toxin. To try to ascertain the toxicity of ethanol alone, those cases where clinical details stated 'sudden death', 'collapsed', 'brought in dead to hospital', 'found dead at home', 'fell down stairs and dead at end of stairs', 'sudden death in alcoholic' and 'brought in dead and seizures' were extracted. There were 55 males aged from 23 to 76 years and 17 females aged from 41 to 71 years who fulfilled these criteria. Blood ethanol ranged from <50 to 556 mg/dl. The median band in males is 200-249 mg/dl and the 31% of male cases are in the 200s mg/dl range, levels conventionally considered benign. The levels found in females were spread relatively evenly across the range 150-600 mg/dl. The urine/blood ethanol ratios ranged from 0.13 to 2.02. The blood/vitreous ratios in 10 cases ranged from 0.76 to 1.24 with a median value of 1.16. Calculated blood ethanol from vitreous levels showed a negative bias when compared to the measured value but not in all cases. This limits the role of calculated values in legal cases. The threshold for lethal alcohol toxicity is indistinct and likely to be lower than conventionally acknowledged.