Alcohol consumption is strongly linked to premature mortality. This study aims to characterise sudden or unnatural deaths with very high range blood alcohol concentrations that presented to the Department of Forensic Medicine in Sydney between 1997-2011.
Professor Johan Duflou (Dept of Forensic Medicine, Sydney South West Area Health Service; School of Medical Sciences, UNSW; and Dept of Pathology, University of Sydney)
Tatiana Prolov (Sydney West Local Area Health District)
Alcohol consumption is strongly linked to premature mortality. Whilst many studies have examined the proportions of alcohol positive cases associated with cause of death, no study to date has characterised the nature and circumstances of sudden or unnatural deaths presenting with very high alcohol concentrations.
To characterise sudden or unnatural deaths with very high range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1/1/1997-31/12/2011.
Case series of 264 cases of sudden or unnatural death with a BAC of ≥0.300g/100ml.
The mean age of decedents was 46.7yrs and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (34.6%), combined alcohol/other drug toxicity (14.8%), accidents (18.7%),natural disease(13.4%),suicide (11.0%), homicide (6.9%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371g/100ml (range 0.300-0.820g/100ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410g/100ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%), cerebellar atrophy (9.0%).
Darke, S., Duflou, J., Torok, M., Prolov, T. (2013). Toxicology, circumstances and pathology of deaths from acute alcohol toxicity. Journal of Forensic and Legal Medicine, 20(8): 1122-1125. doi: 10.1016/j.jflm.2013.09.002
Darke, S., Duflou, J., Torok, M. and Prolov, T. (2013). Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high-range alcohol concentrations. Addiction, 108: 1411–1417. doi: 10.1111/add.12191.
Unnatural deaths with very high range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle aged males, with long histories of alcohol problems. The provision of treatment, and especially of early treatment, might well have prevented many of these deaths.