Introduction
Alcohol consumption plays a significant role in modern society and is legal in numerous countries. Nevertheless, careless or excessive drinking or consumption of fake alcoholic beverages can lead to detrimental consequences, such as ethanol poisoning. Distributing such drinks can be considered voluntary or involuntary manslaughter and can lead to fatal outcomes. Thus, forensic toxicology analysis primarily focuses on identifying the levels of ethanol in the system, which can be determined through blood, urine, or breath tests, and on determining the approximate dosage and factors that led to fatal outcomes.
Ethanol Poisoning
When ethanol is used in significant amounts, ethanol poisoning can occur. Alcohol, or ethanol, as well as non-beverage ethanol found in products such as mouthwash, cologne, and respiratory medical care, may trigger this (LaHood & Kok, 2023). The most popular and commonly abused substance, alcohol, is the most prevalent kind of ethanol and is utilized and misused extensively in Western societies (LaHood & Kok, 2023).
Adolescents and young adults are the groups most prone to appearing with acute alcohol intoxication (LaHood & Kok, 2023). Emergency rooms see a disproportionately higher number of these patients than other settings. Delving deeper, alcohol consumption causes central nervous system depression by increasing GABA’s inhibitory neurotransmitter impact on its receptors (Fleming & Amandeep, 2022).
Additionally, it prevents “glutamate” from acting on NMDA receptors, making the user drowsy and careless (Fleming & Amandeep, 2022). Alcohol intoxication can also cause slurred speech, confusion, aberrant movement patterns, and occasionally a state of coma (Fleming & Amandeep, 2022). Therefore, as can be seen, the symptoms of the intoxication are evident and must be treated immediately to avoid fatal outcomes or a coma.
Forensic toxicology analysis of ethanol poisoning involves detecting the amount of ethanol in the human system. Such a procedure is typically performed through breath, blood, or urine (Jones, 2019). Because an individual’s blood or breath alcohol concentration (BAC or BrAC) has legal repercussions, the analytical techniques utilized must be exact, accurate, and appropriate for the task at hand (Jones, 2019). Gas-liquid chromatography with a flame ionization detector is the gold standard method for detecting ethanol in blood and other biological materials; some laboratories also utilize a mass spectrometric detector (Jones, 2019). Therefore, several approaches in forensic toxicology analysis can be applied.
Case Studies
A 19-Year-Old Male Patient
Several case studies can be reviewed to gain a deeper understanding of the intricacies of ethanol poisoning analysis and its various manifestations. After consuming two paper cups of liquor (ethanol content: 36%) and one paper cup of beer (ethanol content: 8%) at a party, a 19-year-old man who had previously been healthy was discovered in an unusual state at around 10 pm (Wang et al., 2019). Each paper cup held around 250 mL (Wang et al., 2019). He was taken to a hospital without a long wait, but attempts to revive him were unsuccessful, and his body was collected and put in a freezer for storage (Wang et al., 2019). After he passed away after 18 days, forensic scientists performed an autopsy (Wang et al., 2019). Therefore, excessive consumption of alcohol contributed to the poisoning.
Next, it is necessary to mention that analysis involves both external and internal examinations. An external examination revealed cyanosis on the lips and fingernails (Wang et al., 2019). His left hand’s dorsum bore a trace of an injection needle (Wang et al., 2019). Some essential signs were found during an internal checkup. Several small hemorrhagic patches were observed on the lower part of the lungs, and the surrounding cut area showed congestion (Wang et al., 2019).
The arteries and veins of the stomach mucosa were discovered to have a significant amount of congestion (Wang et al., 2019). The BAC was found to be 3.78 mg/mL after toxicology testing (Wang et al., 2019). Sedative medications and drugs were not found in his blood, urine, or gastrointestinal contents (Wang et al., 2019). As a result, the conclusion is that acute ethanol intoxication was the likely cause of death.
A 27-Year-Old Female Patient
Another case study involves an older individual, a 27-year-old female. Over the course of one evening, she consumed 450 mL of Hennessy cognac (ethanol content: 40%), and after that, she and several others went to a restaurant where they consumed 150 mL of spirit (ethanol content: 35%) (Wang et al., 2019). The woman was then taken to a hospital after going into a coma (Wang et al., 2019). Therefore, efforts aimed at bringing the patient back to life were unsuccessful due to intoxication.
During an external examination of the back of her left hand, an injection-needle mark had been spotted (Wang et al., 2019). Upon inner inspection, some alveolar cavities contained pale-red edematous liquid (Wang et al., 2019). The BAC was determined by toxicology to be 3.33 mg/mL (Wang et al., 2019). Therefore, when there are no drugs identified in the system, the conclusion is that the cause of death is acute ethanol intoxication.
A Male Student
The last case study involves a younger person as well, more specifically, a male university student. The patient was admitted to the emergency department with a changed mental state and a blood ethanol level greater than 550 mg/dL (Driscoll et al., 2020). He had no relevant medical history, an oral airway was maintained, and he was obtundant, scoring a three on the Glasgow Coma Scale (Driscoll et al., 2020). The man was intubated and transported to the medical critical care unit after experiencing desaturations to the mid-70s.
An arterial blood gas was measured, revealing a pH of 7.14 and a Pco2 of 72 mmHg (Driscoll et al., 2020). Notable laboratory findings included a negative urine toxicological workup, no anion or osmolar gap, and negative readings for methanol or ethylene glycol (Driscoll et al., 2020). Thus, elevated levels of ethanol in the blood can be critical for the health of patients and lead to fatal outcomes.
Conclusion
Hence, identifying the amount of ethanol in the system, which can be done through blood, urine, or breath testing, and determining roughly what dosage and other factors contributed to the deadly consequences are the main goals of forensic toxicological analysis. Ethanol poisoning happens when ethanol is used, typically in large doses. This can be brought on by alcohol, also known as ethanol, as well as non-beverage ethanol, which can be present in mouthwash, cologne, and respiratory medications.
The age groups that are most likely to exhibit acute alcohol intoxication include adolescents and young adults. The most accurate approach for finding ethanol in biological samples, such as blood, is gas-liquid chromatography with a flame ionization detector. It is essential to note that analysis encompasses both external and internal examinations. Atherosclerosis, pale-red liquid in the alveolar cavities, and cyanosis on the lips and fingernails are among the symptoms of ethanol intoxication.
References
Driscoll, D., Bleecker, G., Francis, J., & Jaberi, A. (2020). Acute hemodialysis for treatment of severe ethanol intoxication. Kidney Medicine, 2(6), 793-796.
Fleming, M., & Amandeep, Goyal. (2022). Ethanol. National Library of Medicine.
Jones, A. W. (2019). Alcohol, its analysis in blood and breath for forensic purposes, impairment effects, and acute toxicity. Wiley Interdisciplinary Reviews, 1(6), e1353.
LaHood, A. J., & Kok, S. J. (2023). Ethanol toxicity. National Library of Medicine.
Wang, H., Xu, H., Li, W., Li, B., Shi, Q., Ma, K., Xiao, B., & Chen, L. (2019). Forensic appraisal of death due to acute alcohol poisoning: Three case reports and a literature review. Forensic Sciences Research, 5(4), 341–347.