King Abdulaziz Hospital, Laboratory Department,، Jeddah, Saudi Arabia, P.O. Box 6470, Jeddah 21442, Saudi Arabia.
Poison Control and Forensic Medical Chemistry Center, Jeddah, Saudi Arabia.
Forensic Sci Int. 2022 Jun;335:111280. doi: 10.1016/j.forsciint.2022.111280. Epub 2022 Mar 29.
This study evaluated the forensic value of ethanol biomarkers ethyl glucuronide (EtG) and ethyl sulfate (EtS) under different conditions, including diabetes mellitus, drug abuse, and advanced decomposition. In addition, we explored whether ethanol, EtG, or EtS formation occurred in patients who died as a result of diabetes mellitus. Fifty-two routine postmortem cases were divided into three groups. Group 1 included only the post-mortem cases in which at least blood samples were available (n=47). Group 2 included all cases with positive BAC (n=28). Group 3 included the cases with negative BAC while information surrounding the cases suspected antemortem alcohol consumption and cases that tested negative for ethanol but positive for EtG and EtS. We analyzed multiple bodily fluid specimens, including the vitreous humor, for ethanol biomarker analysis and accurately identified antemortem ethanol consumption or postmortem ethanol synthesis. We also determined the utility of urine samples for analyzing ethanol and its metabolites in putrefaction cases. If no urine sample was available at autopsy due to urination before death or diabetes-associated glucosuria, vitreous humor samples were an appropriate alternative for ethanol biomarker testing. We observed postmortem ethanol synthesis in diabetic individuals even with a short postmortem interval (PMI), however, glucose did not increase postmortem ethanol production in individuals with diabetes under appropriate preservation. The shorter the PMI, the better the ethanol source can be determined. Postmortem ethanol production occurred in all body fluid specimens analyzed herein, including the vitreous humor. EtG and EtS levels were stable and provided accurate insight into ethanol sources, even in cases of postmortem ethanol production. While the present study focused on the use of vitreous humor for the analysis, it is expected such samples may not be available in cases of advanced decay. In cases where no other bodily fluid specimens are available, solid tissue specimens are highly preferred.
本研究评估了乙醇生物标志物乙基葡萄糖醛酸苷（EtG）和乙基硫酸盐（EtS）在不同条件下的法医学价值，包括糖尿病、药物滥用和高度腐败。此外，我们还探讨了是否有乙醇、EtG 或 EtS 形成于因糖尿病而死亡的患者体内。52 例常规尸检病例分为三组。第 1 组仅包括至少有血液样本的尸检病例（n=47）。第 2 组包括所有 BAC 阳性的病例（n=28）。第 3 组包括 BAC 阴性的病例，但这些病例存在生前酒精摄入的可疑情况，以及乙醇检测为阴性但 EtG 和 EtS 检测为阳性的病例。我们分析了多种体液标本，包括玻璃体液，用于乙醇生物标志物分析，并准确识别生前乙醇摄入或死后乙醇合成。我们还确定了尿液样本在腐败案例中分析乙醇及其代谢物的实用性。如果由于死前排尿或糖尿病相关糖尿，尸检时没有尿液样本，玻璃体液样本是进行乙醇生物标志物测试的合适替代样本。我们观察到糖尿病患者即使在死后间隔时间（PMI）较短的情况下也会发生死后乙醇合成，但在适当保存的情况下，葡萄糖不会增加糖尿病患者死后乙醇的产生。PMI 越短，越能更好地确定乙醇的来源。死后乙醇的产生发生在本文分析的所有体液标本中，包括玻璃体液。EtG 和 EtS 水平稳定，即使在死后乙醇产生的情况下，也能提供准确的乙醇来源信息。虽然本研究侧重于玻璃体液的分析，但预计在高度腐败的情况下，可能无法获得此类样本。在没有其他体液标本的情况下，固体组织标本是高度首选的。
