Assistance of ethyl glucuronide and ethyl sulfate in the interpretation of postmortem ethanol findings.

Postmortem ethanol formation is a well-known problem in forensic toxicology. The aim of this study was to interpret findings of ethanol in blood, in a large collection of forensic autopsy cases, by use of the nonoxidative ethanol metabolites, ethyl glucuronide (EtG), and ethyl sulfate (EtS). In this study, according to previously published literature, antemortem ethanol ingestion was excluded in EtS-negative cases. Among 493 ethanol-positive forensic autopsy cases, collected during the study period, EtS was not detected in 60 (12 %) of the cases. Among cases with a blood alcohol concentration (BAC) of ≤ 0.54 g/kg, antemortem ethanol ingestion was excluded in 38 % of the cases, while among cases with a BAC of ≥ 0.55 g/kg, antemortem ethanol ingestion was excluded in 2.2 % of the cases. For all cases where ethanol was measured at a concentration >1.0 g/kg, EtS was detected. The highest blood ethanol concentration in which EtS was not detected was 1.0 g/kg. The median concentrations of EtG and EtS in blood were 9.5 μmol/L (range: not detected (n.d.) 618.1) and 9.2 μmol/L (range: n.d. 182.5), respectively. There was a statistically significant positive correlation between concentration levels of ethanol and of EtG (Spearman's rho=0.671, p<0.001) and EtS (Spearman's rho=0.670, p<0.001), respectively. In conclusion, this study showed that in a large number of ethanol-positive forensic autopsy cases, ethanol was not ingested before the time of death, particularly among cases where ethanol was present in lower blood concentrations. Routine measurement of EtG and EtS should therefore be recommended, especially in cases with BAC below 1 g/kg.