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01-01-2021 | Intoxication | Case Report

Putatively lethal ingestion of isopropyl alcohol-related case: interpretation of post mortem isopropyl alcohol and acetone concentrations remains challenging

Authors: Carine Dumollard, Jean-François Wiart, Florian Hakim, Christophe Demarly, Philippe Morbidelli, Delphine Allorge, Jean-Michel Gaulier

Published in: International Journal of Legal Medicine | Issue 1/2021

Abstract

Isopropyl alcohol, or propan-2-ol (IPA), is found in numerous chemicals including alcohol-based hand rubs whose use has been recently widely extended to the general population since the onset of the COVID-19 pandemic. This widespread of IPA use could potentially, but not necessarily, be responsible for an increase in IPA poisoning cases (e.g., in alcoholics and/or for suicide attempt, even more in a lockdown situation). Forensic identification of IPA-related fatalities remains challenging as IPA post mortem detection can also result from antemortem or post mortem production, or post mortem contamination. In order to illustrate this issue, we report the case of a 33-year-old man found dead with a bottle of pure IPA liquid close to him. Toxicological positive results only consisted in IPA (464, 260, 465 and 991 mg/L) and acetone (1560, 2340, 3040 and 1360 mg/L) in blood, vitreous humour, urine and bile, respectively (determinations using headspace gas chromatography with flame ionization detection). These IPA absolute concentrations and IPA-to-acetone ratios appear inferior to those usually reported in the literature (higher than 1000 mg/L and 1.1, respectively) in IPA poisoning cases. In conclusion, this death can be cautiously regarded as an IPA ingestion-related fatality in the hypothesis of a survival time which have promoted IPA metabolism to acetone: this hypothesis is supported by the putative limited IPA-ingested dose. This report emphasizes the fact that post mortem IPA and acetone concentration interpretation involves to take account of (i) results in multiple biological specimens, (ii) complete case history, and (iii) a search of possible IPA presence at the scene of death.

Slaughter RJ, Mason RW, Beasley DMG, Vale JA, Schep LJ (2014) Isopropanol poisoning. Clin Toxicol (Phila) 52(5):470–478. https://doi.org/10.3109/15563650.2014.914527CrossRef

Tavolacci MP, Marini H, Vanheste S, Merle V, Coulon AM, Micaud G, Czernichow P (2007) A voluntary ingestion of alcohol-based hand rub. J Hosp Infect 66(1):86–87. https://doi.org/10.1016/j.jhin.2007.01.008CrossRefPubMed

Skopp G, Gutmann I, Schwarz CS, Schmitt G (2016) An unnatural death by propan-1-ol and propan-2-ol. Int J Legal Med 130(4):975–980. https://doi.org/10.1007/s00414-015-1302-3CrossRefPubMed

Lacouture PG, Wason S, Abrams A, Lovejoy FH (1983) Acute isopropyl alcohol intoxication. Diagnosis and management. Am J Med 75(4):680–686. https://doi.org/10.1016/0002-9343(83)90456-4CrossRefPubMed

Daniel DR, McAnalley BH, Garriott JC (1981) Isopropyl alcohol metabolism after acute intoxication in humans. J Anal Toxicol 5(3):110–112. https://doi.org/10.1093/jat/5.3.110CrossRefPubMed

Henry-Lagarrigue M, Charbonnier M, Bruneel F, Legriel S, Troche G, Ben Mokhtar H, Yehia A, Guezennec P, Merrer J, Palette C, Bedos JP (2010) Severe alcohol hand rub overdose inducing coma, watch after H1N1 pandemic. Neurocrit Care 12(3):400–402. https://doi.org/10.1007/s12028-009-9319-4CrossRefPubMed

Mégarbane B, Villa A (2019) Poisoning with ethanol and 2-propanol-based hand rubs: give Caesar what belongs to Caesar! Neurocrit Care 30(1):226–228. https://doi.org/10.1007/s12028-010-9353-2CrossRefPubMed

Adelson L (1962) Fatal intoxication with isopropyl alcohol (rubbing alcohol). Am J Clin Pathol 38:144–151. https://doi.org/10.1093/ajcp/38.2.144CrossRefPubMed

Alexander CB, McBay AJ, Hudson RP (1982) Isopropanol and isopropanol deaths-ten years’ experience. J Forensic Sci 27(3):541–548. https://doi.org/10.1520/JFS12166JCrossRefPubMed

10.

Honey D, Caylor C, Luthi R, Kerrigan S (2005) Comparative alcohol concentrations in blood and vitreous fluid with illustrative case studies. J Anal Toxicol 29(5):365–369. https://doi.org/10.1093/jat/29.5.365CrossRefPubMed

11.

Jenkins AJ, Merrick TC, Oblock JM (2008) Evaluation of isopropanol concentrations in the presence of acetone in postmortem biological fluids. J Anal Toxicol 32(8):719–720. https://doi.org/10.1093/jat/32.8.719CrossRefPubMed

12.

Molina DK (2010) A characterization of sources of isopropanol detected on postmortem toxicologic analysis. J Forensic Sci 55(4):998–1002. https://doi.org/10.1111/j.1556-4029.2010.01386.xCrossRefPubMed

13.

Gaulier JM, Lamballais F, Yazdani F, Lachâtre G (2011) Isopropyl alcohol concentrations in postmortem tissues to document fatal intoxication. J Anal Toxicol 35(4):254–255. https://doi.org/10.1093/anatox/35.4.254CrossRefPubMed

14.

Petersen TH, Williams T, Nuwayhid N, Harruff R (2012) Postmortem detection of isopropanol in ketoacidosis. J Forensic Sci 57(3):674–678. https://doi.org/10.1111/j.1556-4029.2011.02045.xCrossRefPubMed

15.

Davis PL, Dal Cortivo LA, Maturo J (1984) Endogenous isopropanol: forensic and biochemical implications. J Anal Toxicol 8(5):209–212. https://doi.org/10.1093/jat/8.5.209CrossRefPubMed

16.

Richeval C, Gaulier JM, Romeuf L, Allorge D, Gaillard Y (2019) Case report: relevance of metabolite identification to detect new synthetic opioid intoxications illustrated by U-47700. Int J Legal Med 133(1):133–142. https://doi.org/10.1007/s00414-018-1969-3CrossRefPubMed

17.

Gaulier JM, Richeval C, Phanithavong M, Brault S, Allorge D, Dumestre-Toulet V (2019) A case report of carfentanil-related fatality in France. Toxicol Anal Clin 31(4):323–331. https://doi.org/10.1016/j.toxac.2019.01.002

18.

Lelievre B, Richeval C, Coulon A, Iwanikow D, Brofferio M, Deguigne M, Boels D, Allorge D, Ferec S, Drevin G, Jousset N, Gaulier JM (2020) Case report on two-cathinones abuse: MPHP and N-ethyl-4’methylnorpentedrone, with a fatal outcome. Forensic Toxicol 38:243–254. https://doi.org/10.1007/s11419-019-00486-x

19.

Wiart JF, Hakim F, Andry A, Eiden C, Drevin G, Lelièvre B, Rougé-Maillart C, Decourcelle M, Lemaire-Hurtel AS, Allorge D, Gaulier JM (2020) Pitfalls of toxicological investigations in hair, bones and nails in extensively decomposed bodies: illustration with two cases. Int J Legal Med. https://doi.org/10.1007/s00414-020-02267-3

20.

Pappas AA, Ackerman BH, Olsen KM, Taylor EH (1991) Isopropanol ingestion: a report of six episodes with isopropanol and acetone serum concentration time data. J Toxicol Clin Toxicol 29(1):11–21. https://doi.org/10.3109/15563659109038593CrossRefPubMed

21.

Nordmann R, Ribiere C, Rouach H, Beauge F, Giudicel Y, Nordmann J (1973) Metabolic pathways involved in oxidation of isopropanol into acetone by intact rat. Life Sci 13:919–932. https://doi.org/10.1016/0024-3205(73)90082-9CrossRefPubMed

22.

Dua SL (1974) Letter: peritoneal dialysis for isopropyl alcohol poisoning. JAMA 230(1):35. https://doi.org/10.1001/jama.1974.03240010019008CrossRefPubMed

23.

Gaudet MP, Fraser GL (1989) Isopropanol ingestion: case report with pharmacokinetic analysis. Am J Emerg Med 7(3):297–299. https://doi.org/10.1016/0735-6757(89)90174-5CrossRefPubMed

24.

Mydler TT, Wasserman GS, Watson WA, Knapp JF (1993) Two-week-old infant with isopropanol intoxication. Pediatr Emerg Care 9(3):146–148. https://doi.org/10.1097/00006565-199306000-00007CrossRefPubMed

25.

Blanchet B, Charachon A, Lukat S, Huet E, Hulin A, Astier A (2007) A case of mixed intoxication with isopropyl alcohol and propanol-1 after ingestion of a topical antiseptic solution. Clin Toxicol (Phila) 45(6):701–704. https://doi.org/10.1080/15563650701517285CrossRef

26.

Jerrard D, Verdile V, Yealy D, Krenzelok E, Menegazzi J (1992) Serum determinations in toxic isopropanol ingestion. Am J Emerg Med 10(3):200–202. https://doi.org/10.1016/0735-6757(92)90208-FCrossRefPubMed

27.

Cording CJ, Vallaro GM, Deluca R, Camporese T, Spratt E (2000) A fatality due to accidental PineSol ingestion. J Anal Toxicol 24(7):664–667. https://doi.org/10.1093/jat/24.7.664CrossRefPubMed

28.

Martz W (2010) A lethal ingestion of a household cleaner containing pine oil and isopropanol. J Anal Toxicol 34(1):49–52. https://doi.org/10.1093/jat/34.1.49CrossRefPubMed

29.

Bailey DN (1990) Detection of isopropanol in acetonemic patients not exposed to isopropanol. Clin Toxicol 28:459–466. https://doi.org/10.3109/15563659009038588CrossRef

30.

Platteborze PL, Rainey PM, Baird GS (2011) Ketoacidosis with unexpected serum isopropyl alcohol. Clin Chem 57(10):1361–1344. https://doi.org/10.1373/clinchem.2010.157248CrossRefPubMed

31.

Prevost M, Sun Y, Servilla KS, Massie L, Glew RH, Tzamloukas AH (2012) Repeated intoxication presenting with azotemia, elevated serum osmolal gap, and metabolic acidosis with high anion gap: differential diagnosis, management and prognosis. Int Urol Nephrol 44(1):309–314. https://doi.org/10.1007/s11255-010-9796-6CrossRefPubMed

32.

Palmiere C, Sporkert F, Werner D, Bardy D, Augsburger M, Mangin P (2012) Blood, urine and vitreous isopropyl alcohol as biochemical markers in forensic investigations. Leg Med (Tokyo) 14(1):17–20. https://doi.org/10.1016/j.legalmed.2011.10.005CrossRef

33.

Boumba VA, Ziavrou KS, Vougiouklakis T (2008) Biochemical pathways generating post-mortem volatile compounds co-detected during forensic ethanol analyses. Forensic Sci Int 174(2–3):133–151. https://doi.org/10.1016/j.forsciint.2007.03.018CrossRefPubMed

34.

Boumba VA, Economou V, Kourkoumelis N, Gousia P, Papadopoulou C, Vougiouklakis T (2012) Microbial ethanol production: experimental study and multivariate evaluation. Forensic Sci Int 215(1–3):189–198. https://doi.org/10.1016/j.forsciint.2011.03.003CrossRefPubMed

35.

Kugelberg FC, Jones AW (2007) Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int 165:10–29. https://doi.org/10.1016/j.forsciint.2006.05.004CrossRefPubMed

36.

Brown TL, Gamon S, Tester P, Martin R, Hosking K, Bowkett GC, Gerostamoulos D, Grayson ML (2007) Can alcohol-based hand-rub solutions cause you to lose your driver's license? Comparative cutaneous absorption of various alcohols. Antimicrob Agents Chemother 51(3):1107–1108. https://doi.org/10.1128/AAC.01320-06CrossRefPubMed

37.

Rohsenow DJ, Howland J (2010) The role of beverage congeners in hangover and other residual effects of alcohol intoxication: a review. Curr Drug Abuse Rev 3(2):76–79. https://doi.org/10.2174/1874473711003020076CrossRefPubMed

38.

Teresiński G, Buszewicz G, Madro R (2009) Acetonaemia as an initial criterion of evaluation of a probable cause of sudden death. Leg Med (Tokyo) 11(1):18–24. https://doi.org/10.1016/j.legalmed.2008.08.002CrossRef

Title: Putatively lethal ingestion of isopropyl alcohol-related case: interpretation of post mortem isopropyl alcohol and acetone concentrations remains challenging
Authors: Carine Dumollard
Jean-François Wiart
Florian Hakim
Christophe Demarly
Philippe Morbidelli
Delphine Allorge
Jean-Michel Gaulier
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Intoxication
Ketoacidosis
Published in: International Journal of Legal Medicine / Issue 1/2021
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI: https://doi.org/10.1007/s00414-020-02444-4

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Putatively lethal ingestion of isopropyl alcohol-related case: interpretation of post mortem isopropyl alcohol and acetone concentrations remains challenging

Abstract

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Abstract

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