PM formation of alcohol

Question 1

Can decomposing tissue produce EToh

Answer 1

Yes
First observed in early 1950s
Ethyl alcohol found as product of putrefaction in several cases
Could not have been from ante-mortem consumption Corry, J
However thought not to exceed 0.05g%

Question 2

Is Pm etOh identical to bevarge

Answer 2

YES

Question 3

Factors that affect rate of putrefaction

Answer 3

Ambient temperature
Humidity
Distribution and type of microorganisms

Question 4

Microorganism

Answer 4

58 species of bacteria
17 species of yeasts
24 species of mold
That can produce ethyl alcohol under a variety of conditions

Question 5

What is the greattedt microoragsims

Answer 5

Originally thought yeast Candida albicans was the primary organism, but the greatest increase observed was the result of Escherichia coli and not yeast

Question 6

When can bacteria pentreate intestinal wall

Answer 6

Distributed through the bloodstream via the hepatic portal vein and intestinal lymph system as long as the
Body temperature exceeds 5 °C

Question 7

How can microbial contamination be prevented

Answer 7

Refrigeration of body within 4 hours of death
Preserve specimens with 1% NaF after autopsy inhibits ethyl alcohol production by most organisms
Except C. albicans

Question 8

what are some endogenous ethyl alcohol production results of microbial activity on

Answer 8

Glucose
Lactate
Glycerol
Amino acids

Question 9

Will all microorganisms form ethyl alcohol

Answer 9

no

Question 10

What is thje primary source of endogenous EtOH

Answer 10

Glucose

Question 11

What tissue is high in glucose storage and the site of the greatest production

Answer 11

Liver
Skeletal muscles
Lungs
Heart

Question 12

What is considered an ideal specimen for alcohol analysis

Answer 12

Vitreous humor

Question 13

Why is vitreous humor ideal

Answer 13

Reflects antemortem ethyl alcohol concentration
Contains no glucose or microorganism
Protected from trauma and putrefaction

Question 14

WHat is a poor medium for microbial ethyl alcohol

Answer 14

Urine except in diabetics

Question 15

Case studies PM formation

Answer 15

12-57% of ethyl alcohol-positive cases was attributed to postmortem synthesis
Majority of cases attributed to postmortem synthesis did not have significant ethyl alcohol concentrations [<0.07 g%]

Question 16

Cases with endogenous ethyl alcohol
ZUnmwalt

Answer 16

Evaluated for the degree of putrefaction
“SMELLBAD”
Skin slippage, mummification, changes in the eyes, marbling, state of rigor mortis [limpness], bloating, purging of fluids [appalling effusions], and discoloration

Question 17

Cases with endogenous ethyl alcohol
Moorgate tube crash

Answer 17

London Northern City Line
Train failed to stop at the line’s end
13 hours to remove injured
42 passengers and motormen died
BAC 80 mg/dL [blood collected from kidney]
“Likely motorman was drinking”
However,
No evidence of drinking

Question 18

Ante vs postmortem

Answer 18

History and scene, histology, blood/tissue distributn, Evaluation of chromatograpm, evaluation of ETOH metab, other volatile cmpds

Question 19

Histroy and scene evidence

Answer 19

DUI and Evidence in car

Question 20

Histology

Answer 20

Gross tissue and histologic evidence
Cirrhotic liver

Question 21

Blood/tissue distribution

Answer 21

EtOH peak
Acetone peak

Question 22

Evaluation of EtOH metabolites

Answer 22

Serotonin metabolites
Other biomarkers

Question 23

Other volatile compounds

Answer 23

Other volatile compounds may be formed during the postmortem interval
Acetaldehyde
Acetone
Isopropanol
Butanol (1, 2, and iso-)
Volatile fatty acids
Gamma hydroxybutyric acid (GHB)

Question 24

Serotonin Metabolite

Answer 24

Davis et al (1967) reported that the ratio of serotonin metabolites was altered by the ingestion of ethyl alcohol – remaining altered for up to 16 hours after cessation of drinking
5-hydroxyindoleacetic acid [5-HIAA]
5-hydroxytryptophol [5-HTOL]
Normally 5-HIAA is ~100 x greater than 5-HTOL
Helander et al )1992) found that when alcohol is consumed the formation of 5-HTOL is favored
Shifting the 5-HIAA:%-HTOL from 100:1 to 60:40
Evaluation of serotonin metabolites in urine will assist in the determination of whether the alcohol was from antemortem consumption or postmortem formation
Absence of alcohol ingestion
Normal HTOL/HITAA below 15 pmol/nmol [some 10 pmol/nmol]

Question 25

1-propanol

Answer 25

Empirical studies have shown that in the absence of antemortem consumption conc of EtOH should be less than 20x that of n(1)-propanol
Liang et al Rat Study – disproved
Concluded < 20 ratio does not allow discrimination between antemortem ingestion and postmortem formation
Threshold conc of 0.104 mg/dL
Sensitivity – 79%
Specificity – 91%
Authors noted PM production w/o signs of decomposition