Ethyl and isopropyl alcohol poisonings: Standardised approach for post-mortem evaluation of the toxic interaction

Abstract

Evaluation and reporting of the combined toxic effects of ethyl and isopropyl alcohols is inconsistent, thus presenting both professional and legal challenges in forensic practice. We screened 5257 post-mortem examination reports for presence of isopropyl alcohol (IP) in deceased person‘s blood. 174 cases such cases where identified and included in the study. In 61 of those established cause of death was attributed to a toxic lethal effect of ethyl and isopropyl alcohols and in remaining 113 cases toxins detected in urine and blood were not linked to the cause of death. The first group was assessed for potential of hyper-diagnosis and the second group for hypo-diagnosis. In this study we have introduced the concept of Theoretical Ethanol Toxicity Equivalent (TETE), which offers a standardised method of assessing and reporting cumulative toxic effects of both substances. TETE concept is based on the previously published data on the individual toxicity of ethyl and isopropyl alcohols. Application of TETE method identified 13% incidence of potential hyper-diagnosis in the first group and 9% incidence of potential hypo-diagnosis in the second group. Our data suggests that there is marked variation in the way combined toxic effects are reported and interpreted, therefore standardised approach is needed. Routine use of TETE method could increase the accuracy and consistency of the post-mortem examination conclusions.