Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high-range alcohol concentrations
Article first published online: 9 MAY 2013
© 2013 Society for the Study of Addiction
Volume 108, Issue 8, pages 1411–1417, August 2013
How to Cite
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
- Issue published online: 11 JUL 2013
- Article first published online: 9 MAY 2013
- Accepted manuscript online: 8 APR 2013 04:10AM EST
- Manuscript Accepted: 12 MAR 2013
- Manuscript Revised: 24 JAN 2013
- Manuscript Received: 27 AUG 2012
- Australian Government Department of Health and Ageing
- NSW Health Department
To characterize sudden or unnatural deaths with very high-range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1 January 1997 and 31 December 2011.
A total of 263 cases of sudden or unnatural death with a BAC of ≥0.300 g/100 ml.
Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology.
The mean age of decedents was 46.7 years and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (35.0%), combined alcohol/other drug toxicity (14.8%), accidents (18.6%), natural disease (13.3%), suicide (11.0%), homicide (6.8%) 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 0.371 g/100 ml (range 0.300–0.820 g/100 ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410 g/100 ml). 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%) and cerebellar atrophy (9.0%).
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.