Norwegian Institute of Public Health, Division of forensic toxicology and drug abuse, Pb 4404 Nydalen, Oslo, Norway.
Int J Legal Med. 2010 Mar;124(2):143-8. doi: 10.1007/s00414-009-0393-0. Epub 2009 Nov 25.
In postmortem toxicology, it could be difficult to determine whether a positive blood ethanol concentration reflects antemortem ingestion or postmortem synthesis of alcohol. Measurement of the nonoxidative ethanol metabolite ethyl glucuronide (EtG) has been suggested as a marker of antemortem ingestion of alcohol, but EtG might degrade postmortem which could make interpretation difficult. So far, the published articles concern EtG only. Another nonoxidative metabolite, ethyl sulfate (EtS), which is more stable, has therefore been included in this study. We present a material of 36 deaths where postmortem formation of ethanol was suspected and where both EtG and EtS were measured in blood and urine to assist the interpretation. In 19 cases, EtG and EtS were positive in the body fluids analyzed. The median concentration of EtG and EtS in blood was 0.4 (range 0.1-23.2) and 0.9 mg/L (range 0.04-7.9), respectively. The median concentration of EtG and EtS in urine was 35.9 (range 1.0-182) and 8.5 mg/L (range 0.3-99), respectively. In another 16 cases, there was no trace of EtG or EtS in the specimens analyzed. In one case, there was inconsistency between the results of EtG and EtS; they were both positive in urine, while only EtS was positive in blood. This study showed that, out of 36 cases, antemortem ingestion of alcohol was very likely in 19 and unlikely in 16, according to EtG and EtS results. In the last case, the interpretation was more difficult. One possible explanation would be postmortem degradation of EtG in blood.
在法医毒理学中，很难确定阳性血乙醇浓度是反映生前摄入还是死后酒精合成。测量非氧化乙醇代谢物乙基葡萄糖醛酸苷（EtG）已被提议作为生前摄入酒精的标志物，但 EtG 可能会在死后降解，这可能使解释变得困难。到目前为止，发表的文章仅涉及 EtG。另一种非氧化代谢物，乙基硫酸盐（EtS），更稳定，因此被纳入本研究。我们提供了 36 例死亡案例，这些案例中怀疑死后形成了乙醇，并且在血液和尿液中同时测量了 EtG 和 EtS 以协助解释。在 19 例案例中，体液中检测到 EtG 和 EtS 呈阳性。血液中 EtG 和 EtS 的中位数浓度分别为 0.4（范围 0.1-23.2）和 0.9mg/L（范围 0.04-7.9）。尿液中 EtG 和 EtS 的中位数浓度分别为 35.9（范围 1.0-182）和 8.5mg/L（范围 0.3-99）。在另外 16 例案例中，分析的样本中没有 EtG 或 EtS 的痕迹。在 1 例案例中，EtG 和 EtS 的结果不一致；尿液中均呈阳性，而血液中仅 EtS 呈阳性。本研究表明，在 36 例案例中，根据 EtG 和 EtS 的结果，19 例非常可能是生前摄入酒精，16 例不太可能是生前摄入酒精。在最后 1 例案例中，解释更为困难。一种可能的解释是血液中 EtG 的死后降解。
