Öz
Aim: In the postmortem period, endogenous ethanol can be produced from a variety of substrates, including decomposed corpses, a variety of bacteria, yeasts, and molds. Many factors can influence postmortem ethanol synthesis, including the time between death and autopsy, environmental temperature and humidity and microorganisms present in the body at the time of death or in the deceased's environment. It's crucial to determine whether ethyl alcohol, which is found in body fluids like putrefaction fluid, vitreous humor, and blood, was consumed prior to death or formed endogenously after death. Non-oxidative minor metabolites of ethanol, ethyl glucuronide, and ethyl sulfate, are commonly used biomarkers to confirm antemortem alcohol intake.
The aim of this study was to determine postmortem endogenous origin ethyl alcohol levels and to evaluate ethyl alcohol and its metabolites determined as a result of the toxicological examination in body fluids obtained from autopsies of decomposed cases.
Materials And Methods: Autopsy reports on decomposed bodies performed in XXX Branch of Forensic Medicine between 2013 and 2020 were reviewed retrospectively. The presence of ethyl alcohol in putrefaction fluid and vitreous humor, as well as the search status and results for its metabolites, were all recorded.
Results: Between 2013 and 2020, 294 (8.4%) of 3418 autopsies revealed evidence of decomposition. Males made up 83.3 % (n:245) and females made up %16,7’si (n:49) of the cases with signs of putrefaction. Ethyl alcohol was discovered in the putrefaction fluid of 174 (59,2%) patients and the vitreous humor of 15 (5.1%) patients.
In 48 (27,6 percent) of the cases where ethyl alcohol was detected in the putrefaction fluid, metabolites such as ethyl sulfate and ethyl glucuronide were searched, but no metabolites were found in 30 of them. In 17 of the cases where no ethyl alcohol metabolite was detected in the putrefaction fluid, the ethyl alcohol level was below 50 mg/dl, between 51 and 100 mg/dl in 11, and above 100 mg/dl in 2 of them.
In cases with no metabolites, the highest ethanol level was 159 mg/dl in the putrefaction fluid.
Conclusion: It was concluded that in all decomposed cases where ethyl alcohol is detected, it is crucial to look for metabolites.
Anahtar Kelimeler
Forensic Medicine Putrefaction Ethanol Ethyl Glucuronide Ethyl Sulphate
Kaynakça
- Battal D. Postmortem kan-vitröz sıvı etanol düzeylerinin saptanması ve adli tıpta önemi [Master’s Thesis]. Sağlık Bilimleri Enstitüsü; 2004.
- O’Neal CL, Poklis A. Postmortem production of ethanol and factors that influence interpretation: a critical review. The American journal of forensic medicine and pathology. 1996;17(1):8-20.
- Aşicioğlu F, Mutlu E, Belce A. Adli Vakalarda Etil Glukuronid ve Etil Sülfat Analizinin Önemi: Olgu Bildirileri: The Importance of Ethyl Glucuronide and Ethyl Sulphate Analysis in Forensic Cases. Turkiye Klinikleri Journal of Forensic Medicine & Forensic Sciences. Ocak 2019;16(1):64-9.
- Høiseth G, Morini L, Polettini A, Christophersen A, Mørland J. Blood kinetics of ethyl glucuronide and ethyl sulphate in heavy drinkers during alcohol detoxification. Forensic Science International. 2009;188(1-3):52-6.
- Høiseth G, Karinen R, Christophersen A, Mørland J. Practical use of ethyl glucuronide and ethyl sulfate in postmortem cases as markers of antemortem alcohol ingestion. International Journal of Legal Medicine. 2010;124:143-8.
- Baduroğlu E, Durak D. Alkol ile ilgili adli tıp sorunları. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2010;36(2):65-71.
- Dokgöz H. Ölüm ve Postmortem Değişimler. İçinde: Adli Tıp & Adli Bilimler. 2. bs 2019. s. 678.
- Logan BK, Jones AW. Endogenous ethanol production in a child with short gut syndrome. Journal of pediatric gastroenterology and nutrition. 2003;36(3):419-20.
- Al-Asmari AI, Anderson RA, Appelblad P. Direct determination of ethyl glucuronide and ethyl sulfate in
- postmortem urine specimens using hydrophilic interaction liquid chromatography-electrospray ionization- tandem mass spectrometry. Journal of analytical toxicology. 2010;34(5):261-72.
- Lewis RJ, Johnson RD, Angier MK, Vu NT. Ethanol formation in unadulterated postmortem tissues. Forensic science international. 2004;146(1):17-24.
- Karayolları Trafik Kanunu [İnternet]. Erişim adresi: https://www.mevzuat.gov.tr/mevzuatmetin/1.5.2918.pdf
- TCK Yaralanma Rehberi [İnternet]. Erişim adresi: https://www.atk.gov.tr/tckyaralama24-06-19.pdf
- Aşırdizer M, Etli Y, Gümüş O, Kartal E, Hekimoğlu Y. Biomarkers Used to Determine Antemortem and Postmortem Ethyl Alcohol Level in Body Fluids. Turkish Journal of Forensic Medicine. 30(2):153-61.
- Wagner K. Über die Veränderlichkeit des Alkoholgehaltes von Leichenblut und nicht steril aufbewahrten Blutproben. Deutsche Zeitschrift für die gesamte gerichtliche Medizin. 1936;26:276-92.
- Ceciliason AS, Andersson MG, Lundin E, Sandler H. Microbial neoformation of volatiles: implications for the estimation of post-mortem interval in decomposed human remains in an indoor setting. International Journal of Legal Medicine. 2021;135:223-33.
- Lin Z, Wang H, Jones AW, Wang F, Zhang Y, Rao Y. Evaluation and review of ways to differentiate sources of ethanol in postmortem blood. International journal of legal medicine. 2020;134:2081-93.
- Simic M, Ajdukovic N, Veselinovic I, Mitrovic M, Djurendic-Brenesel M. Endogenous ethanol production in patients with diabetes mellitus as a medicolegal problem. Forensic science international. 2012;216(1-3):97- 100.
- Monteiro C, Castilho M, Real FC, Proença P. Ethanol and putrefaction: Medicolegal relevance of the study of different biological samples. Toxicologie analytique et clinique. 2022;34(3):S145.
- Kugelberg FC, Jones AW. Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic science international. 2007;165(1):10-29.
- Høiseth G, Karinen R, Christophersen AS, Olsen L, Normann PT, Mørland J. A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol. Forensic Science International. 2007;165(1):41-5.
- Politi L, Morini L, Mari F, Groppi A, Bertol E. Ethyl glucuronide and ethyl sulfate in autopsy samples 27 years after death. International journal of legal medicine. 2008;122:507-9.
- Vural N, Sayın H. Kan Alkol Düzeyini Etkileyen Faktörlerin Adli Tıp Açısından Değerlendirilmesi. 1996;1(2):74-81.
- Caplan YH, Levine B. Vitreous humor in the evaluation of postmortem blood ethanol concentrations. Journal of analytical toxicology. 1990;14(5):305-7.
- de Lima IV, Midio AF. Origin of blood ethanol in decomposed bodies. Forensic science international. 1999;106(3):157-62.
- Pajunen T, Vuori E, Lunetta P. Epidemiology of alcohol-related unintentional drowning: is post-mortem ethanol production a real challenge? Injury epidemiology. 2018;5:1-5.
- Maghdy M. S, Ramy M. EN, Yousef S, Ismail I. H, Ola A. H, Ayman A. ES. Postmortem endogenous production of ethanol in albino rabbit. 1998;1(4):57-73.
- Ziavrou K, Boumba VA, Vougiouklakis TG. Insights into the origin of postmortem ethanol. International journal of toxicology. 2005;24(2):69-77.
- Al-Asmari AI, Altowairgi MM, Al-Amoudi DH. Effects of postmortem interval, putrefaction, diabetes, and location of death on the analysis of ethyl glucuronide and ethyl sulfate as ethanol biomarkers of antemortem alcohol consumption. Forensic Science International. 2022;335:111280.
- Høiseth G, Karinen R, Johnsen L, Normann PT, Christophersen AS, Mørland J. Disappearance of ethyl glucuronide during heavy putrefaction. Forensic Science International. 2008;176(2-3):147-51.
Öz
Amaç: Çürümüş cesetlerde, postmortem dönemde birçok bakteri, maya ve küf türü, çeşitli substratlardan endojen etanol üretilebilir. Ölüm ile otopsinin yapıldığı zaman arasındaki süre, çevre ısısı ve nem düzeyi, ölüm anında vücutta bulunan veya ölenin bulunduğu ortamdaki mikroorganizmalar gibi pek çok değişken postmortem etanol sentezini etkileyebilir. Çürümüş olgularda, vücut sıvılarında saptanan etil alkolün ölümden önce mi tüketildiği, yoksa ölümden sonra endojen mi oluştuğunun ayırt edilmesi önemlidir. Etanolün non-oksidatif minor metabolitlerinden etil glukuronid ve etil sülfat, antemortem alkol alımını doğrulamak amacıyla sıklıkla kullanılan biyobelirteçlerdir.
Bu çalışmada otopsi yapılan çürümüş olguların vücut sıvılarında yapılan toksikolojik incelemeler sonucunda saptanan etil alkol ve metabolitlerinin değerlendirilmesi, postmortem endojen kaynaklı etil alkol düzeylerinin belirlenmesi amaçlanmıştır.
Gereç Ve Yöntem: XXX Adli Tıp Şube Müdürlüğünde 2013-2020 yılları arasında çürümüş cesetlere yapılan otopsi raporları retrospektif dosya taraması şeklinde incelenmiştir. Çürüme sıvısı ve göz içi sıvısında etil alkol saptanma durumu, metabolitlerinin aranma durumu ve sonuçları kaydedilmiştir.
Bulgular: 2013-2020 yılları arasında yapılan toplam 3418 otopsinin 294’ünde (%8.4) çürüme bulguları saptanmıştır. Çürüme bulguları saptanan olguların %83.3’ü (n:245) erkektir. Çürümüş olguların 174’ünde (%59,2) çürüme sıvısında, 15’inde (%5,1) göz içi sıvısında etil alkol saptanmıştır.
Çürüme sıvısında etil alkol saptanan olguların 48’inde (%27,6) etil alkol metabolitleri olan etil sülfat ve etil glukuronid aranmış, bunların 30’unda metabolit saptanmamıştır. Çürüme sıvısında etil alkol metaboliti saptanmayan olguların 17’sinde etil alkol düzeyi 50 mg/dl’nin altında, 11'inde 51-100 mg/dl arasında, 2’sinde 100 mg/dl’nin üzerindedir.
Metabolit saptanmayan olgulardaki en yüksek etanol düzeyi, çürüme sıvısında 159 mg/dl’dir.
Sonuç: Etil alkol saptanan tüm çürümüş olgularda mutlaka metabolitlerin de aranmasının önemli olduğu sonucuna varılmıştır.
Anahtar Kelimeler
Teşekkür
Bu araştırmanın yapılması için onay vererek çalışmamızı kolaylaştıran Adli Tıp Kurumu Başkanlığına teşekkür ederiz.
Kaynakça
- Battal D. Postmortem kan-vitröz sıvı etanol düzeylerinin saptanması ve adli tıpta önemi [Master’s Thesis]. Sağlık Bilimleri Enstitüsü; 2004.
- O’Neal CL, Poklis A. Postmortem production of ethanol and factors that influence interpretation: a critical review. The American journal of forensic medicine and pathology. 1996;17(1):8-20.
- Aşicioğlu F, Mutlu E, Belce A. Adli Vakalarda Etil Glukuronid ve Etil Sülfat Analizinin Önemi: Olgu Bildirileri: The Importance of Ethyl Glucuronide and Ethyl Sulphate Analysis in Forensic Cases. Turkiye Klinikleri Journal of Forensic Medicine & Forensic Sciences. Ocak 2019;16(1):64-9.
- Høiseth G, Morini L, Polettini A, Christophersen A, Mørland J. Blood kinetics of ethyl glucuronide and ethyl sulphate in heavy drinkers during alcohol detoxification. Forensic Science International. 2009;188(1-3):52-6.
- Høiseth G, Karinen R, Christophersen A, Mørland J. Practical use of ethyl glucuronide and ethyl sulfate in postmortem cases as markers of antemortem alcohol ingestion. International Journal of Legal Medicine. 2010;124:143-8.
- Baduroğlu E, Durak D. Alkol ile ilgili adli tıp sorunları. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2010;36(2):65-71.
- Dokgöz H. Ölüm ve Postmortem Değişimler. İçinde: Adli Tıp & Adli Bilimler. 2. bs 2019. s. 678.
- Logan BK, Jones AW. Endogenous ethanol production in a child with short gut syndrome. Journal of pediatric gastroenterology and nutrition. 2003;36(3):419-20.
- Al-Asmari AI, Anderson RA, Appelblad P. Direct determination of ethyl glucuronide and ethyl sulfate in
- postmortem urine specimens using hydrophilic interaction liquid chromatography-electrospray ionization- tandem mass spectrometry. Journal of analytical toxicology. 2010;34(5):261-72.
- Lewis RJ, Johnson RD, Angier MK, Vu NT. Ethanol formation in unadulterated postmortem tissues. Forensic science international. 2004;146(1):17-24.
- Karayolları Trafik Kanunu [İnternet]. Erişim adresi: https://www.mevzuat.gov.tr/mevzuatmetin/1.5.2918.pdf
- TCK Yaralanma Rehberi [İnternet]. Erişim adresi: https://www.atk.gov.tr/tckyaralama24-06-19.pdf
- Aşırdizer M, Etli Y, Gümüş O, Kartal E, Hekimoğlu Y. Biomarkers Used to Determine Antemortem and Postmortem Ethyl Alcohol Level in Body Fluids. Turkish Journal of Forensic Medicine. 30(2):153-61.
- Wagner K. Über die Veränderlichkeit des Alkoholgehaltes von Leichenblut und nicht steril aufbewahrten Blutproben. Deutsche Zeitschrift für die gesamte gerichtliche Medizin. 1936;26:276-92.
- Ceciliason AS, Andersson MG, Lundin E, Sandler H. Microbial neoformation of volatiles: implications for the estimation of post-mortem interval in decomposed human remains in an indoor setting. International Journal of Legal Medicine. 2021;135:223-33.
- Lin Z, Wang H, Jones AW, Wang F, Zhang Y, Rao Y. Evaluation and review of ways to differentiate sources of ethanol in postmortem blood. International journal of legal medicine. 2020;134:2081-93.
- Simic M, Ajdukovic N, Veselinovic I, Mitrovic M, Djurendic-Brenesel M. Endogenous ethanol production in patients with diabetes mellitus as a medicolegal problem. Forensic science international. 2012;216(1-3):97- 100.
- Monteiro C, Castilho M, Real FC, Proença P. Ethanol and putrefaction: Medicolegal relevance of the study of different biological samples. Toxicologie analytique et clinique. 2022;34(3):S145.
- Kugelberg FC, Jones AW. Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic science international. 2007;165(1):10-29.
- Høiseth G, Karinen R, Christophersen AS, Olsen L, Normann PT, Mørland J. A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol. Forensic Science International. 2007;165(1):41-5.
- Politi L, Morini L, Mari F, Groppi A, Bertol E. Ethyl glucuronide and ethyl sulfate in autopsy samples 27 years after death. International journal of legal medicine. 2008;122:507-9.
- Vural N, Sayın H. Kan Alkol Düzeyini Etkileyen Faktörlerin Adli Tıp Açısından Değerlendirilmesi. 1996;1(2):74-81.
- Caplan YH, Levine B. Vitreous humor in the evaluation of postmortem blood ethanol concentrations. Journal of analytical toxicology. 1990;14(5):305-7.
- de Lima IV, Midio AF. Origin of blood ethanol in decomposed bodies. Forensic science international. 1999;106(3):157-62.
- Pajunen T, Vuori E, Lunetta P. Epidemiology of alcohol-related unintentional drowning: is post-mortem ethanol production a real challenge? Injury epidemiology. 2018;5:1-5.
- Maghdy M. S, Ramy M. EN, Yousef S, Ismail I. H, Ola A. H, Ayman A. ES. Postmortem endogenous production of ethanol in albino rabbit. 1998;1(4):57-73.
- Ziavrou K, Boumba VA, Vougiouklakis TG. Insights into the origin of postmortem ethanol. International journal of toxicology. 2005;24(2):69-77.
- Al-Asmari AI, Altowairgi MM, Al-Amoudi DH. Effects of postmortem interval, putrefaction, diabetes, and location of death on the analysis of ethyl glucuronide and ethyl sulfate as ethanol biomarkers of antemortem alcohol consumption. Forensic Science International. 2022;335:111280.
- Høiseth G, Karinen R, Johnsen L, Normann PT, Christophersen AS, Mørland J. Disappearance of ethyl glucuronide during heavy putrefaction. Forensic Science International. 2008;176(2-3):147-51.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2024 |
| Gönderilme Tarihi | 7 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2024Cilt: 63 Sayı: 1 |
