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Andy PhD DABT
Andy PhD DABT, Toxicologist
Category: Health
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Experience:  Board certified with 20 years in research or consulting
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What is considered a lethal brain Ethanol level?

Resolved Question:

What is considered a lethal brain Ethanol level?
Submitted: 2 years ago.
Category: Health
Expert:  DrThomasMd replied 2 years ago.
Hello
We do not test brain alcohol
Please clarify your question?
Customer: replied 2 years ago.
The result I am reading is from an autopsy that measured Blood, urine, Vitreous and brain ethanol.
Expert:  DrThomasMd replied 2 years ago.
let me have an expert that is online that I think can help you answer that

Expert:  Andy PhD DABT replied 2 years ago.
Hello,

I am a toxicologist and I would be happy to help you with your question. The most common measure of alcohol level is in the blood as DrThomas stated and the brain is not often used if blood levels are already obtained. Are you trying to find out if the person was intoxicated when they died? If so, I need to have some more information.

-How long was the body dead before it was found?

-Where and in what environment was the body found, i.e. inside, outside, while it was hot or cold?

-What were the alcohol levels in the blood, vitreous, and brain (urine levels are useless)?

-Where did the blood sample come from, was it femoral blood, or cardiac blood?

-Do you know the circumstances of the death, i.e. was the person seen before they died and had they been drinking?


I can get a better answer to you if I can take a look at the autopsy report. If you would like, you can send it to me by creating an account at www.mediafire.com (for free), and up-load the document onto the site, then just copy and paste the web address for that document into the JustAnswer question box. Realize though that it would then become open to the public to see, so I would black out any personal information first then scan it in. Seeing the autopsy report would be best so I can see what else it says.

Take care,
Andy
Customer: replied 2 years ago.
Yes, he was drinking and died in a car accident. His time of death was 2318 hrs and the autopsy was performed the next day at 1320 hours. It was a cold night, but he was immediately transported to the hospital and was pronounced dead at the scene. I am not sure if the blood was taken from the femoral artery or heart. He died of hemorrghagic and traumatic shock, and multiple devastating injuries. His brain ethanol was 0.276, Vitreous 0.224 and blood .248. I know the legal limit is .08. But what is considered a toxic level? In addition, I have one last question. There was many microscopic diagnosis. Eight in total, but and confused with one of them as noted: Glandular and stromal hyperplasia of prostate with focal, low-grade, prostatic, intraepithelial neoplasia. Thank you.
Expert:  replied 2 years ago.
Hello,

I'm sorry for your loss, was this your father? There are four things to consider here. First is when ever you are talking about alcohol (ethanol) in a deceased body you have to determine if the alcohol was caused by bacteria and other microbes growing and fermenting in the body after death. If there is a long delay in when the person died and when they are taken to the medical examiner and their body was in a warm environment, then the microbes can grow and produce ethanol which would look like the person was drinking when in fact they may not have been. However, in this case, there is less than 24 hours between death and getting to the medical examiner and it was during a cold night, so what ever ethanol was found in the body was from drinking.

The next thing is how much ethanol did he have in his body. Blood is the best tissue to take to determine the amount of ethanol, but the blood must be taken from the femoral artery to be accurate. This is because the blood from there (in the leg) is separated from the intestine. Ethanol still in the intestine has not yet been absorbed into the blood at the time of death and so would not contribute to causing someone to become drunk. After death the ethanol in the intestine can diffuse out into the rest of the body, so if blood was taken from a place near the intestines then it could have higher levels of ethanol than were present at the time of death. By taking blood from the leg, it is far away from the intestine separated by dense muscle tissue and so is not affected by it. So I will assume the blood sample was from the femoral artery. You asked what the toxic level is and actually toxic can mean different things. The level of 0.08 is considered toxic since it can impair judgment and increase the risk of getting into a car accident. However I realize that is not what you are asking. More specifically, at 0.248% the person would have been quite drunk and would be getting sleepy and could be staggering when they walk. At 0.3% some people can pass out, while 0.4% usually will cause someone to go into a coma and can cause death in some people. So death is seen at levels of 0.4% or higher. So he was not to the point where he could have died from alcohol poisoning, but he was very impaired and not able to drive a car very well. Now these numbers are good for the average person, someone who is not an alcoholic or who does not drink often. Some alcoholics have been found with blood levels as high as 0.7% when they died. So if he was an alcoholic than depending on how much he drank death would not be expected until somewhere between 0.5 to 0.7%.

Now for the third component. The vitreous is the jelly like fluid that fills the eye ball. It gets exposed to blood and will take up ethanol to a concentration of about 120% of that found in the blood when it is at equilibrium, i.e. when the rate of ethanol going into the vitreous equals the rate of it leaving. However, when someone first starts drinking the ethanol enters their intestines, it then goes into their blood and gets distributed throughout their body and this can take 20 minutes to occur. As the ethanol is absorbing into the blood from the intestine the blood ethanol levels start to rise and will finish absorbing about an hour or so later which will be the time at which the level in the blood is the highest, as metabolism and excretion continue to remove the ethanol from the blood and bring down the blood ethanol level. As the ethanol in the blood starts to rise it comes in contact with the vitreous and starts to get absorbed into it. As the level in the blood continues to rise so does the level in the vitreous, however there is a 1 to 2 hour delay in it absorbing into the vitreous. So this means that during the absorptive phase of drinking the ethanol levels are still rising and the vitreous level will lag behind the blood and will have lower levels of ethanol than the blood. Once drinking stops and the blood levels stop rising the blood and vitreous levels reach equilibrium and are close to being equal, with the level in the vitreous being 120% that of the blood, i.e. higher in vitreous than blood, by 20%. Then as time goes on, the ethanol in the blood, but not the vitreous, is metabolized and will decrease, but again there is a lag in the change of the ethanol level in the vitreous, so as the ethanol levels decrease in the blood the level in the vitreous will be more than 20% higher than that in the blood. So this means that if the ethanol levels in the vitreous are lower than the blood (as they are in this case) then the person was still actively drinking when they died. If the vitreous levels were higher then in the blood, they had stopped drinking for some time before they died.

So this means that the person was actively drinking when they died and was almost drunk enough to have passed out, but not enough to have died.

The forth component to your question is the hyperplasia and neoplasia of the prostate. Prostate cancer is a very slowly progressing cancer in which it may develop in a person and not cause any problems for many years. Because of this many people have prostate cancer and don't even know it and many people die from something else and are found at autopsy to have also had prostate cancer. In fact most men who die of "old age" have prostate cancer, so it is very common in older men. It is from this that I assumed you are talking about your father (you have the autopsy report, so you are probably a relative; you said "he" so the person is a male; they have prostate cancer and so are old, maybe 60 or older, but you are 27, so it is not a brother and likely your father or grandfather). Since most men eventually have prostate cancer, but die from something else, his prostate cancer does not mean that you necessarily are at high risk for it, it is nothing to worry about.

I hope I have answered your question, if you need clarification or I am missing anything please let me know and I will make it clear for you.

Take care,
Andy
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 110
Experience: Board certified with 20 years in research or consulting
Andy PhD DABT and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Dear XXXXX,
It was my twin brother who died at 27. Interesting about your last statement about the prostate cancer. At around the age of 60 I requested that his doctor to a PSA and a quaic test. Both came back positive. The doctor was almost reluctant to do the PSA because all of his digital exams were normal and I know there can be some false positives, but the biopsy confirmed prostate cancer and he was treated with Casadex, Lupron and radiation seeds and did very well. He then underwent a colonoscopy and they found pre-cancerous polyps (adenoma?) and they were removed. My father died at the age of 71 of a massive heart attack and had a abnormal stress on Thurs, reporr read as abnormal and died on Sun. He complained of chest pain to me, but then would say it went away. He had a catherization five years prior which showed a myocardial bridge and because of this, he often would have intermittant chest pain. Luckily, I was there and was able to do CPR, but it was to no avail. Thank you for you condolences. My life without my twin will never be the same. Thank you for all the information.
Expert:  Andy PhD DABT replied 2 years ago.
Hello,

I am so sorry, I can't imagine how hard it must be to lose a twin, that is a strong connection. Was he an identical twin?

I am a little confused by your response. Are you saying that your twin brother died at 27 years old in this car crash and you are currently 27 years old as well? So who was it who had prostate cancer at age 60 and then got treatment? Was that your father? If your brother was 27 when he died and prostate cancer was found in him, then I would be a little concerned, especially if your brother was an identical twin. It would be a good idea to talk to your doctor about getting a PSA test for you, if nothing else to get a background level. Seeing prostate cancer at age 27 is not so common.

Take care,
Andy
Customer: replied 2 years ago.
Hi Andy,
No, we are fraternal twins and I lost him at the age of 27. I am not 47 and still have not gotten over his death and even tried to take my own life shortly after his death as I could not deal with it. I used to belong to an organization called "Twinless Twins" as only another twin could understand. Even my older sisters agreed and said, "We are grieving, but know it is nothing compared to what you are going through". I used to work for a dermatologist and a patient came in and was dx with melanoma. He asked if he had an siblings and he responded that he had an identical twin. He said, "Bring him in immediatel". He also had melanoma, but was further advanced. They both passed away from it, but the one the twin who was forced to come into the office for the examination, died earlier. My twin brother has a son that is now 22 years old. I am assuming I should share this information with him. When I was in nursing school, we had one male nursing student who was 28 when he went for a physical. He was ready to have his blood work done and the technician left the room. When she did, he circled PSA. Well, the doctor was a little taken back when he saw the elevated number considering he did not even order the test. He decided to put him on a course of antibiotics to see if it was just elevated due to prostatitis. Well, it was still elevated and he indeed had prostate cancer at the age of 28. Thank you for your concern, Diane, Twin to David
PS: My mom wanted to have a boy so bad as she already had two girls and she had only gained 14 1/2 lbs with us. She kept telling the doctor she was having either one very large baby or twins. He of course told her no. But on delivery said, "Well, you have another girl... But wait, you have a boy too!!!!" My twin almost died at birth from neonatal nercosis. Very odd in fraternal twins. I knew the minute he had died. I was ina soud sleep and woke up suddenly and just knew something was wrong. I went downstairs and my dad was still up, but I didn't know what to say to him, so just went back upstairs. I pulled my phone off of my dresser and put it next to my pillow. Within 15 minutes, I got the call that my brother had passed. I went to the morgue the next morning and they said I could not see him because I was NOT next of kin. I said, "But I am his twiin". His son was only two years old. How were we going to tell him? He would find a picture of his dad and pull it off the dresser and hold it to his heart and cry, :My daddy, My daddy". I went to his car and could not believe what I saw. I would just scream thinking of his dead in the car. I found a Christmas card from his son that read, "From Your Little Guy" and found a book on baby massage. My brother was in a horrible accident shortly after the birth of his son. He was rear-ended and his face went through the back window of his pick-up truck. He was such a handsome man, now left with such horrible facial scares. That is when he started drinking, not only from the facial scars, but the pain he was left in from the accident. His nose was almost compleletly severered off and the laceration on his cheek cut through the parotid gland and he had to have some procedures to help the gland drain. Year of not having a father he told his mother, "If you can't find me a daddy, then just buy me one". She was fortunate to remarry. Well, once again thank you for your concern and for reading my story. Sincerely, XXXXX XXXXX to David
Expert:  replied 2 years ago.
Hi Diane,

Wow, I can't even imagine, that is so sad. I will make sure to give my daughters a hug when they get back from the store. It certainly makes me thankful to be alive, thank you for sharing that.

I understand this better now, so you filled out the information as if it was your brother at the time he died, I thought you were a 27 year old male. So you obviously do not have to worry about prostate cancer, but yes you are right I do think you should let David's son know that he is at risk and should probably get a PSA test.

Take care Diane,
Andy
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 110
Experience: Board certified with 20 years in research or consulting
Andy PhD DABT and 5 other Health Specialists are ready to help you

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Andy PhD DABT
Andy PhD DABT
Board Certified Toxicologist
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Board certified with 20 years in research or consulting