Urine/blood ratios of ethanol in deaths attributed to acute alcohol poisoning and chronic alcoholism

• The concentrations of ethanol were determined in femoral venous blood (BAC) and urine (UAC) and the UAC/BAC ratios were evaluated for a large case series of forensic autopsies in which the primary cause of death was either acute alcohol poisoning (N=628) or chronic alcoholism (N=647). In alcohol poisoning deaths both UAC and BAC were higher by about 2g/l compared with chronic alcoholism deaths. In acute alcohol poisoning deaths the minimum BAC was 0.74g/l and the distribution of UAC/BAC ratios agreed well with the shape of a Gaussian curve with mean-standard deviation (S.D.) and median (2.5th and 97.5th centiles) of 1.18-0.182 and 1.18 (0.87 and 1.53), respectively. In alcoholism deaths, when the BAC was above 0.74g/l (N=457) the mean-S.D. and median (2.5th and 97.5th centiles) UAC/BAC ratios were 1.30-0.29 and 1.26 (0.87 and 2.1), respectively. When the BAC was below 0.74g/l (N=190), the mean and median UAC/BAC ratios were considerably higher, being 2.24 and 1.58, respectively. BAC and UAC were highly correlated in acute alcohol poisoning deaths (r=0.84, residual S.D.=0.47g/l) and in chronic alcoholism deaths (r=0.95, residual S.D.=0.41g/l). For both causes of death (N=1275), the correlation between BAC and UAC was r=0.95 and the residual S.D. was 0.46g/l. The lower UAC/BAC ratio observed in acute alcohol poisoning deaths (mean and median 1.18:1) suggests that these individuals died before absorption and distribution of ethanol in all body fluids were complete. The higher UAC/BAC ratio in chronic alcoholism (median 1.30:1) is closer to the value expected for complete absorption and distribution of ethanol in all body fluids.

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