How Alcohol Kills: Alcohol-Attributable and Alcohol-Associated Deaths in a Medical Examiner Population

Forensic pathologists frequently encounter the myriad effects of acute and chronic ethanolism and the many ways that alcohol contributes to sudden natural and unnatural deaths. Alcohol may act as risk factor for sudden death or directly participate as a cause of sudden death through its acute and chronic toxic effects. This retrospective descriptive study examines the causes and manner of deaths potentially attributable to alcohol and the results of postmortem toxicology testing for ethanol in unnatural deaths and alcohol-attributable natural deaths over a five-year period in a large medical examiner's office. Ethanol was detected in all types of unnatural deaths as well as alcohol-attributable natural deaths due to the complications of chronic ethanol abuse with a wide range of overlapping concentrations. Of the unnatural deaths involving individuals with a detectable ethanol concentration, 61% were accidents, 25% suicides, and 14% were homicides; ethanol was detected in 40.2% of accidents, 42.0% of suicides, and 53.1% of homicides. Ethanol was also detected in 41% of deaths due to chronic alcoholism. For the unnatural deaths involving intoxicated individuals and deaths due to chronic alcoholism, the deaths were certified as a wide variety of causes. In general, the results are similar to those in the existing literature. Forensic pathologists need to be well-versed in interpreting postmortem ethanol concentrations and determining the role of acute and/or chronic ethanolism in sudden deaths.