Fatty liver and sudden death. A review

Alcoholism is associated with increased mortality from violent and nonviolent causes. The increase in nonviolent deaths is usually ascribed, at least in part, to "cirrhosis." In the majority of these deaths this implies fatty liver rather than true Laennec's cirrhosis. Studies of sudden nonviolent deaths illustrate the largely unrecognized and frequent occurrence of sudden death with autopsy findings limited solely to fatty liver. The mechanism(s) of these sudden fatty liver deaths is unknown. Several attractive theories attribute such deaths to ethanol withdrawal induced hypoglycemia or hypomagnesemia, pulmonary fat embolization from fatty liver, or other facets of the alcohol withdrawal syndrome, including ethanol dependent maladaptive derangements of neurotransmitters. All the theories of fatty liver death remain essentially untested, however, owing to uncontrolled postmortem conditions and the lack of awareness of fatty liver deaths within the scientific community.