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Dinis-Oliveira RJ. "Not everything that can be counted counts" in ethanol toxicological results: an antemortem and postmortem technical interpretation focusing on driving under the influence. Forensic Sci Res 2024; 9:owae023. [PMID: 39006154 PMCID: PMC11240237 DOI: 10.1093/fsr/owae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/29/2024] [Indexed: 07/16/2024] Open
Abstract
Ethanol blood analysis is the most common request in forensic toxicology, and some studies point to positive results in approximately one-third of all unnatural deaths. However, distinguishing sober deaths from drunk deaths is not as simple as it may seem. This technical, clinical, and forensic interpretation is proposed to interpret the ethanol toxicological results, discussing several artefacts and pitfalls that must be considered, namely focusing on driving under the influence. This work is presented with a practical and objective approach, aiming to alleviate the complexities associated with clinical, physiological, pathophysiological, and toxicological aspects to enhance comprehension, practicality, and applicability of its content, especially to courts. Particularly the physical integrity of the body, the postmortem interval, putrefactive signs, anatomic place of blood collection, alternative samples such as vitreous humour and urine, the possibility of postmortem redistribution, the inclusion of preservatives in containers, and optimal temperature conditions of shipment are among some of the aspects to pay attention. Although several biomarkers related to postmortem microbial ethanol production have been proposed, their translation into forensic routine is slow to be implemented due to the uncertainties of their application and analytical difficulties. Specifically, in the interpretation of ethanol toxicological results, "not everything that can be counted counts and not everything that counts can be counted" (attributed to Albert Einstein).
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Research Unit on Applied Molecular Biosciences, Translational Toxicology Research Laboratory, University Institute of Health Sciences 1H-TOXRUN, IUCS-CESPU, Gandra, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- FOREN – Forensic Science Experts, Lisbon, Portugal
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Ialongo C. Blood alcohol concentration in the clinical laboratory: a narrative review of the preanalytical phase in diagnostic and forensic testing. Biochem Med (Zagreb) 2024; 34:010501. [PMID: 38107001 PMCID: PMC10564119 DOI: 10.11613/bm.2024.010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/20/2023] [Indexed: 12/19/2023] Open
Abstract
The analysis of blood alcohol concentration (BAC), a pivotal toxicological test, concerns acute alcohol intoxication (AAI) and driving under the influence (DUI). As such, BAC presents an organizational challenge for clinical laboratories, with unique complexities due to the need for forensic defensibility as part of the diagnostic process. Unfortunately, a significant number of scientific investigations dealing with the subject present discrepancies that make it difficult to identify optimal practices in sample collection, transportation, handling, and preparation. This review provides a systematic analysis of the preanalytical phase of BAC that aims to identify and explain the chemical, physiological, and pharmacological mechanisms underlying controllable operational factors. Nevertheless, it seeks evidence for the necessity to separate preanalytical processes for diagnostic and forensic BAC testing. In this regard, the main finding of this review is that no literature evidence supports the necessity to differentiate preanalytical procedures for AAI and DUI, except for the traceability throughout the chain of custody. In fact, adhering to correct preanalytical procedures provided by official bodies such as European federation of clinical chemistry and laboratory medicine for routine phlebotomy ensures both diagnostic accuracy and forensic defensibility of BAC. This is shown to depend on the capability of modern pre-evacuated sterile collection tubes to control major factors influencing BAC, namely non-enzymatic oxidation and microbial contamination. While certain restrictions become obsolete with such devices, as the use of sodium fluoride (NaF) for specific preservation of forensic BAC, this review reinforces the recommendation to use non-alcoholic disinfectants as a means to achieve "error-proof" procedures in challenging operational environments like the emergency department.
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Affiliation(s)
- Cristiano Ialongo
- Department of Experimental Medicine, Policlinico Umberto I, ‘Sapienza’ University, Rome, Italy
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Olds ML. Comparisons of blood alcohol concentrations between initial testing and reanalysis from unopened tubes preserved with 0.25% NaF following refrigerated storage up to 3.93 years. J Anal Toxicol 2023; 47:636-639. [PMID: 37561959 DOI: 10.1093/jat/bkad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
Few studies support the usage of <1% nominal sodium fluoride (NaF) to preserve ethanol in antemortem blood. Of these studies, several are limited by short study durations of 90 days or less, and there is limited research of authentic samples preserved with <1% NaF. In this retrospective analysis, data from initial and reanalysis testing of blood alcohol concentration (BAC) in antemortem blood collected in 6 mL gray-top tubes (providing 0.25% nominal NaF) has been compiled, to evaluate changes in ethanol concentration that occurred after periods of refrigerated storage. The time between initial and reanalysis was determined by court request(s), and ranged 0.30-3.93 years. In each case, a previously unopened tube was selected for reanalysis testing. Comparable BAC values were found from initial testing, with BACs ranging from 0.025 to 0.394 g/100 mL, and reanalysis testing, with BACs ranging from 0.021 to 0.393 g/100 mL. Ethanol changes ranged from -0.013 g/100 mL (decrease) to 0.008 g/100 mL (increase). BAC reanalysis values that increased (n = 6) were within the uncertainty of measurement (UM) from the initial BAC test, that is, were not statistically or analytically significant. For BAC decreases (n = 29), four test values exceeded the UM of the original test, with BAC losses ranging from 0.004 to 0.011 g/100 mL (relative percent changes 6.5-16.0% loss). The average ethanol change was -0.004 g/100 mL, which is comparable to or less than ethanol losses from studies using 1% NaF preservative of varying temperature and storage duration.
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Affiliation(s)
- Maria L Olds
- Fort Worth Police Department Crime Laboratory, 3616 East Lancaster Ave., Fort Worth, TX 76103, USA
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Cheng JYK, Hui JWS, Chan WS, So MH, Hong YH, Leung WT, Ku KW, Yeung HS, Lo KM, Fung KM, Ip CY, Dao KL, Cheung BKK. Interpol review of toxicology 2019-2022. Forensic Sci Int Synerg 2022; 6:100303. [PMID: 36597440 PMCID: PMC9799715 DOI: 10.1016/j.fsisyn.2022.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jack Yuk-ki Cheng
- Government Laboratory, Hong Kong Special Administrative Region of China
| | | | - Wing-sum Chan
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Man-ho So
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Yau-hin Hong
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Wai-tung Leung
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Ka-wai Ku
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Hoi-sze Yeung
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Kam-moon Lo
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Kit-mai Fung
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Chi-yuen Ip
- Government Laboratory, Hong Kong Special Administrative Region of China
| | - Kwok-leung Dao
- Government Laboratory, Hong Kong Special Administrative Region of China
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Almofti N, Ballesteros-Gómez A, Rubio S, Girela-López E. Analysis of conventional and nonconventional forensic specimens in drug-facilitated sexual assault by liquid chromatography and tandem mass spectrometry. Talanta 2022; 250:123713. [PMID: 35779361 DOI: 10.1016/j.talanta.2022.123713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/22/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
The incidence of drug-facilitated sexual assault (DFSA) has dramatically increased in the last decades. Forensic analytical scientists continuously seek new methods and specimens to prove the incidence of intoxication for the judiciary system. Factors influencing sample selection include the ease of obtaining the samples and the window of detection of the drugs, among others. Both conventional (blood, urine) and non-conventional specimens (hair, nails, fluids) have been proposed as suitable in DFSA cases. Reported sample treatments include a variety of liquid-liquid and solid-phase extraction as well as dilute-and-shoot procedures and microextraction techniques. Regarding analysis, liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) has emerged as the preferred confirmatory technique, due to its sensitivity, selectivity, and wide-scope applicability. In this review, we critically discuss the most common specimens and sample treatments/analysis procedures (related to LC-MS/MS) that have been reported during the last ten years. As a final goal, we intend to provide a critical overview and suggest analytical recommendations for the establishment of suitable analytical strategies in DFSA cases.
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Affiliation(s)
- N Almofti
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Marie Curie Annex Building, Campus of Rabanales, University of Córdoba, 14071, Córdoba, Spain; Section of Forensic and Legal Medicine, Department of Morphological and Sociosanitary Sciences, Faculty of Medicine and Nursing, University of Córdoba, 14071, Córdoba, Spain
| | - A Ballesteros-Gómez
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Marie Curie Annex Building, Campus of Rabanales, University of Córdoba, 14071, Córdoba, Spain.
| | - S Rubio
- Department of Analytical Chemistry, Institute of Fine Chemistry and Nanochemistry, Marie Curie Annex Building, Campus of Rabanales, University of Córdoba, 14071, Córdoba, Spain
| | - E Girela-López
- Section of Forensic and Legal Medicine, Department of Morphological and Sociosanitary Sciences, Faculty of Medicine and Nursing, University of Córdoba, 14071, Córdoba, Spain
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Kosecki PA, Autret A, Abbott L, Keller-Brooke K. Isobutylene contamination of blood collected in 10-ml evacuated blood collection tubes with gray conventional rubber stoppers. J Forensic Sci 2021; 66:2484-2492. [PMID: 34250598 DOI: 10.1111/1556-4029.14792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
Dual-column headspace gas chromatographic analysis with two flame-ionization detectors is a commonly used analytical technique for forensic blood ethanol quantitation. This technique is also applicable to the identification and quantitation of other volatile organic compounds such as methanol in biological samples. Compound identification by retention time is limited to those compounds with known retention times programmed into the instrument method. Historically, an early-eluting peak from an unidentified compound has been observed in both chromatograms from antemortem blood samples analyzed for ethanol concentration with this technique. The unidentified compound's retention time matches that of methanol on one column but not on the second column. This previously unidentified compound has been identified as isobutylene. The proposed source of the isobutylene contamination historically observed in antemortem blood samples collected in 10-ml gray-top blood collection tubes is the conventional rubber stopper. Isobutylene was detected in deionized water stored in each of the seven lots of 10-ml blood tubes tested; the expiration dates of the tubes tested spanned the years 2002-2022. Misidentification of isobutylene as methanol is possible when using a single-column gas chromatographic system. The presence of isobutylene in blood collected in a gray-top collection tube does not represent laboratory contamination, is not an interferent with blood ethanol quantitation, and does not affect the ethanol concentration in the blood. A 0.150 g/dl aqueous ethanol standard was stored in a gray-top tube to evaluate the potential impact of isobutylene on ethanol quantitation. The solution's average ethanol concentration measured after storage was 0.150 g/dl.
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Affiliation(s)
| | - Amy Autret
- Tucson Police Department Crime Laboratory, Tucson, AZ, USA
| | - Lori Abbott
- Scottsdale Police Department Crime Laboratory, Scottsdale, AZ, USA
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