Sudden death and hepatic fatty metamorphosis. A North Carolina survey

There is a generally unrecognized epidemic of sudden, nonviolent deaths among alcohol abusers, largely due to fatty liver--related sudden deaths (FLDs). Using data from the North Carolina Office of the Chief Medical Examiner, 411 cases of FLD were identified from 1972 through 1976. The 411 FLD deaths, in view of a low autopsy rate among nonviolent alcohol abuser deaths and the lack of awareness of FLD, suggest a FLD death rate of epidemic proportions. The FLD population characteristics mirror those of the underlying alcohol-abusing population. The increased incidence of low-level (1 to 50 mg/dL) blood ethanol levels among FLD as compared with "control" groups is consistent with several theories linking FLD to some form of acute or hyperacute ethanol withdrawal phenomenon.