Alcohol can be implicated in the cause of death by any of multiple mechanisms:
(1) acute ethanol poisoning
(2) co-ingestion of alcohol and a respiratory depressant
(3) co-ingestion of alcohol and a toxic alcohol (methanol, other)
(4) co-ingestion of alcohol with other toxin (acetaminophen, other)
(5) trauma
(6) hypothermia
(7) gastrointestinal or other bleeding
(8) acute pancreatitis
(9) liver failure, acute or chronic
(10) seizures
(11) cardiomyopathy
(12) alcoholic ketoacidosis
(13) pneumonia or other infection
(14) withdrawal
(15) nutritional issues such as Wernicke's encephalopathy and scurvy
The diagnosis of acute ethanol poisoning must consider a number of factors:
(1) blood alcohol concentration (values >= 0.45 g/dL are often fatal, but some chronic alcoholics can tolerate higher levels)
(2) amount and type of alcohol ingested, such as drinking a bottle of hard liquor or binge drinking
(3) ethanol tolerance of the person
The possibility of suicide needs to be considered, and the site investigation should target any evidence of suicidal intent or personal difficulties.
A person who is intoxicated may be subject to assault as well as accidents, so the cause of traumatic injuries should be determined if possible.
