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.