Forensic Sciences Research, Volume. 9, Issue 3, owae023(2024)

“Not everything that can be counted counts” in ethanol toxicological results: an antemortem and postmortem technical interpretation focusing on driving under the influence

Ricardo Jorge Dinis-Oliveira1,2,3,4、*
Author Affiliations
  • 1Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
  • 2UCIBIO - Research Unit on Applied Molecular Biosciences, Translational Toxicology Research Laboratory, University Institute of Health Sciences 1H-TOXRUN, IUCS-CESPU, Gandra, Portugal
  • 3Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
  • 4FOREN – Forensic Science Experts, Lisbon, Portugal
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    References(128)

    [2] CP Salas-Wright, AH Hai, MG Vaughn et al. Driving under the influence of cannabis and alcohol: evidence from a national sample of young drivers. Addict Behav, 147(2023).

    [3] FC Kugelberg, AW Jones. Interpreting results of ethanol analysis in postmortem specimens: a review of the literature. Forensic Sci Int, 165, 10-29(2007).

    [4] K Oshaug, R Kronstrand, FC Kugelberg et al. Frequency of postmortem ethanol formation in blood, urine and vitreous humor—improving diagnostic accuracy with the use of ethylsulphate and putrefactive alcohols. Forensic Sci Int, 331(2022).

    [5] RJ Dinis-Oliveira, T Magalhães. Driving under the influence of psychotropic substances: a technical interpretation. Psychoactives, 1, 7-15(2022).

    [6] KJ Anstey, J Wood, S Lord et al. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev, 25, 45-65(2005).

    [7] TL Martin, PAM Solbeck, DJ Mayers et al. A review of alcohol-impaired driving: the role of blood alcohol concentration and complexity of the driving task. J Forensic Sci, 58, 1238-1250(2013).

    [8] KN Olson, SW Smith, JS Kloss et al. Relationship between blood alcohol concentration and observable symptoms of intoxication in patients presenting to an emergency department. Alcohol Alcohol, 48, 386-389(2013).

    [9] T Brumback, D Cao, A King. Effects of alcohol on psychomotor performance and perceived impairment in heavy binge social drinkers. Drug Alcohol Depend, 91, 10-17(2007).

    [10] RD Blomberg, RC Peck, H Moskowitz et al. The Long Beach/Fort Lauderdale relative risk study. J Safety Res, 40, 285-292(2009).

    [11] MT Gómez-Talegón, FJ Alvarez. Road traffic accidents among alcohol-dependent patients: the effect of treatment. Accid Anal Prev, 38, 201-207(2006).

    [12] PL Zador, SA Krawchuk, RB Voas. Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data. J Stud Alcohol, 61, 387-395(2000).

    [13] NM Porpiglia, F Tagliaro, R Micciolo et al. New evidence of high association between carbohydrate deficient transferrin (CDT) and alcohol-related road traffic accidents. A retrospective study on 929 injured drivers. Forensic Sci Int, 340(2022).

    [14] F Bortolotti, R Micciolo, L Canal et al. First objective association between elevated carbohydrate-deficient transferrin concentrations and alcohol-related traffic accidents. Alcohol Clin Exp Res, 39, 2108-2114(2015).

    [15] CD Klaassen. Casarett & Doull's Toxicology: The Basic Science of Poisons(2019).

    [16] RJ Dinis-Oliveira. Oxidative and non-oxidative metabolomics of ethanol. Curr Drug Metab, 17, 327-335(2016).

    [17] RJ Dinis-Oliveira, T Magalhães. Abuse of licit and illicit psychoactive substances in the workplace: medical, toxicological, and forensic aspects. J Clin Med, 9, 770(2020).

    [18] RJ Dinis-Oliveira, F Carvalho, ML Bastos. Toxicologia Forense [Forensic Toxicology](2015).

    [19] GR Jang, RZ Harris. Drug interactions involving ethanol and alcoholic beverages. Expert Opin Drug Metab Toxicol, 3, 719-731(2007).

    [20] LN Chan, GD Anderson. Pharmacokinetic and pharmacodynamic drug interactions with ethanol (alcohol). Clin Pharmacokinet, 53, 1115-1136(2014).

    [21] NJ Langford, RE Ferner. The medico-legal significance of pharmacokinetic interactions with ethanol. Med Sci Law, 53, 1-5(2013).

    [22] C Simsek, T Kojima, M Dogru et al. The early effects of alcohol consumption on functional visual acuity, tear functions, and the ocular surface. Eye Contact Lens, 47, 20-26(2021).

    [23] F Martino, JJ Castro-Torres, M Casares-López et al. Effects of alcohol consumption on driving performance in the presence of interocular differences simulated by filters. Sci Rep, 13, 17694(2023).

    [24] H Garrisson, A Scholey, E Ogden et al. The effects of alcohol intoxication on cognitive functions critical for driving: a systematic review. Accid Anal Prev, 154(2021).

    [25] RJ Dinis-Oliveira, F Carvalho, JA Duarte et al. Collection of biological samples in forensic toxicology. Toxicol Mech Methods, 20, 363-414(2010).

    [26] RJ Dinis-Oliveira, DN Vieira, T Magalhães. Guidelines for collection of biological samples for clinical and forensic toxicological analysis. Forensic Sci Res, 1, 42-51(2016).

    [27] L Lindberg, S Brauer, P Wollmer et al. Breath alcohol concentration determined with a new analyzer using free exhalation predicts almost precisely the arterial blood alcohol concentration. Forensic Sci Int, 168, 200-207(2007).

    [28] RB Forney, FW Hughes, RN Harger et al. Alcohol distribution in the vascular system. Concentration of orally administered alcohol in blood from various points in the vascular system, and in rebreathed air, during absorption. Q J Stud Alcohol, 25, 205-217(1964).

    [29] TA Alobaidi, DW Hill, JP Payne. Significance of variations in blood: breath partition coefficient of alcohol. Br Med J, 2, 1479-1481(1976).

    [30] AW Jones, JM Cowan. Reflections on variability in the bloodbreath ratio of ethanol and its importance when evidential breathalcohol instruments are used in law enforcement. Forensic Sci Res, 5, 300-308(2020).

    [31] DD Fiorentino, H Moskowitz. Breath alcohol elimination rate as a function of age, gender, and drinking practice. Forensic Sci Int, 233, 278-282(2013).

    [32] BK Logan, S Distefano. Ethanol content of various foods and soft drinks and their potential for interference with a breath-alcohol test. J Anal Toxicol, 22, 181-183(1998).

    [33] AW Jones, L Andersson, K Berglund. Interfering substances identified in the breath of drinking drivers with Intoxilyzer 5000S. J Anal Toxicol, 20, 522-527(1996).

    [34] CC Fessler, FA Tulleners, DG Howitt et al. Determination of mouth alcohol using the Dräger evidential portable alcohol system. Sci Justice, 48, 16-23(2008).

    [35] AW Jones. How breathing technique can influence the results of breath-alcohol analysis. Med Sci Law, 22, 275-280(1982).

    [36] PT Normann, H Olsen, J Sakshaug et al. Measurement of ethanol by Alkomat breath analyzer. Chemical specificity and the influence of lung function, breath technique and environmental temperature. Blutalkohol, 25, 153-162(1988).

    [37] MP Hlastala, JC Anderson. Alcohol breath test: gas exchange issues. J Appl Physiol, 121, 367-375(1985).

    [38] JA Mulder, W Neuteboom. The effects of hypo- and hyperventilation on breath alcohol measurements. Blutalkohol, 24, 341-347(1987).

    [39] RG Hahn, A Norberg, AW Jones. Rate of distribution of ethanol into the total body water. Am J Ther, 2, 50-56(1995).

    [40] RC Charlebois, MR Corbett, JG Wigmore. Comparison of ethanol concentrations in blood, serum, and blood cells for forensic application. J Anal Toxicol, 20, 171-178(1996).

    [41] MT Jr Barnhill, D Herbert, DJ Jr Wells. Comparison of hospital laboratory serum alcohol levels obtained by an enzymatic method with whole blood levels forensically determined by gas chromatography. J Anal Toxicol, 31, 23-30(2007).

    [42] CL Winek, M Carfagna. Comparison of plasma, serum, and whole blood ethanol concentrations. J Anal Toxicol, 11, 267-268(1987).

    [43] DM Penetar, JF McNeil, ET Ryan et al. Comparison among plasma, serum, and whole blood ethanol concentrations: impact of storage conditions and collection tubes. J Anal Toxicol, 32, 505-510(2008).

    [44] TL Kurt. Serum alcohol is not the same as blood alcohol concentration. Ann Emerg Med, 25, 430-431(1995).

    [45] AW Jones, C Tilson. Distribution ratios of ethanol and water between whole blood, plasma, serum, and erythrocytes: recommendations for interpreting clinical laboratory results in a legal context. J Forensic Sci, 68, 9-21(2023).

    [46] C Ialongo. Blood alcohol concentration in the clinical laboratory: a narrative review of the preanalytical phase in diagnostic and forensic testing. Biochem Med (Zagreb), 34(2024).

    [47] EA Grice, JA Segre. The skin microbiome. Nat Rev Microbiol, 9, 244-253(2011).

    [48] PA Kosecki, PJ Brooke, ME Raines. Lack of fermentation in antemortem blood samples stored unstoppered in various locations. J Forensic Sci, 68, 308-314(2023).

    [49] HM Chen, WW Lin, KH Ferguson et al. Studies of the oxidation of ethanol to acetaldehyde by oxyhemoglobin using fluorigenic high-performance liquid chromatography. Alcohol Clin Exp Res, 18, 1202-1206(1994).

    [50] KW Smalldon, GA Brown. The stability of ethanol in stored blood. II. The mechanism of ethanol oxidation. Anal Chim Acta, 66, 285-290(1973).

    [51] L Kristoffersen, LE Stormyhr, A Smith-Kielland. Headspace gas chromatographic determination of ethanol: the use of factorial design to study effects of blood storage and headspace conditions on ethanol stability and acetaldehyde formation in whole blood and plasma. Forensic Sci Int, 161, 151-157(2006).

    [52] LN Rodda, J Beyer, D Gerostamoulos et al. Alcohol congener analysis and the source of alcohol: a review. Forensic Sci Med Pathol, 9, 194-207(2013).

    [53] R Iffland, AW Jones. Evaluating alleged drinking after driving—the hip-flask defence. Part 1. Double blood samples and urine-to-blood alcohol relationship. Med Sci Law, 42, 207-224(2002).

    [54] MA Miller, A Rosin, ME Levsky et al. Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study. Am J Emerg Med, 24, 815-817(2006).

    [55] A Kramer, H Below, N Bieber et al. Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans. BMC Infect Dis, 7, 117(2007).

    [56] G Lippi, AM Simundic, G Musile et al. The alcohol used for cleansing the venipuncture site does not jeopardize blood and plasma alcohol measurement with head-space gas chromatography and an enzymatic assay. Biochem Med (Zagreb), 27, 398-403(2017).

    [57] CL Winek, T Eastly. Factors affecting contamination of blood samples for ethanol determinations. Leg Med Annu, 1976, 147-162(1977).

    [58] RA McIvor, SH Cosbey. Effect of using alcoholic and non-alcoholic skin cleansing swabs when sampling blood for alcohol estimation using gas chromatography. Br J Clin Pract, 44, 235-236(1990).

    [59] HA Heise. How extraneous alcohol affects the blood test for alcohol: pitfalls to be avoided when withdrawing blood for medicolegal purposes. Am J Clin Pathol, 32, 169-170(1959).

    [60] A Higuchi, R Kurihara, T Yoshimoto et al. Problems in blood alcohol testing of severely injured drivers brought to emergency departments in Japan. Leg Med (Tokyo), 7, 299-305(2005).

    [61] AM Simundic, K Bölenius, J Cadamuro et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med, 56, 2015-2038(2018).

    [62] T Kawai, Y Okada, T Odachi et al. Monitoring of occupational exposure to 1-butanol by diffusive sampling and urinalysis. Int Arch Occup Environ Health, 69, 266-272(1997).

    [63] F Wehner, A Moosmayer, HD Wehner. Box size, liquid volume, ethanol concentration and congener spectrum of chocolates containing alcohol. Blutalkohol, 37, 440-448(2000).

    [64] RJ Dinis-Oliveira. The auto-brewery syndrome: a perfect metabolic “storm” with clinical and forensic implications. J Clin Med, 10, 4637(2021).

    [65] LN Rodda, S Pearring, CE Harper et al. Inferences and legal considerations following a blood collection tube recall. J Anal Toxicol, 45, 211-214(2021).

    [66] AW Jones, E Ericsson. Decreases in blood ethanol concentrations during storage at 4 ◦C for 12 months were the same for specimens kept in glass or plastic tubes. Pract Lab Med, 4, 76-81(2016).

    [67] DB Zittel, GG Hardin. Comparison of blood ethanol concentrations in samples simultaneously collected into expired and unexpired venipuncture tubes. J Anal Toxicol, 30, 317-318(2006).

    [68] ML Olds, JL Naquin. Statistical comparisons of blood alcohol samples from 6-mL and 10-mL grey-top tubes. J Forensic Sci, 66, 687-693(2021).

    [69] BA Miller, SM Day, TE Vasquez et al. Absence of salting out effects in forensic blood alcohol determination at various concentrations of sodium fluoride using semi-automated headspace gas chromatography. Sci Justice, 44, 73-76(2004).

    [70] AW Jones, M Fransson. Blood analysis by headspace gas chromatography: does a deficient sample volume distort ethanol concentration?. Med Sci Law, 43, 241-247(2003).

    [71] JE Corry. A review. Possible sources of ethanol ante- and postmortem: its relationship to the biochemistry and microbiology of decomposition. J Appl Bacteriol, 44, 1-56(1978).

    [72] E Vuori, OV Renkonen, R Lindbohm. Validity of post mortem blood alcohol values. Lancet, 1, 761-762(1983).

    [73] AS Ceciliason, MG Andersson, E Lundin et al. Microbial neoformation of volatiles: implications for the estimation of postmortem interval in decomposed human remains in an indoor setting. Int J Leg Med, 135, 223-233(2021).

    [74] VA Boumba, KS Ziavrou, T Vougiouklakis. Biochemical pathways generating post-mortem volatile compounds co-detected during forensic ethanol analyses. Forensic Sci Int, 174, 133-151(2008).

    [75] ML Olds, AW Jones. Preanalytical factors influencing the results of ethanol analysis in postmortem specimens. J Anal Toxicol, 48, 9-26(2023).

    [76] VA Boumba, N Kourkoumelis, P Gousia et al. Modeling microbial ethanol production by E. coli under aerobic/anaerobic conditions: applicability to real postmortem cases and to postmortem blood derived microbial cultures. Forensic Sci Int, 232, 191-198(2013).

    [77] PS Lough, R Fehn. Efficacy of 1% sodium fluoride as a preservative in urine samples containing glucose and Candida albicans. J Forensic Sci, 38, 266-271(1993).

    [78] VA Boumba, V Economou, N Kourkoumelis et al. Microbial ethanol production: experimental study and multivariate evaluation. Forensic Sci Int, 215, 189-198(2012).

    [79] G Velivasi, N Kourkoumelis, H Sakkas et al. Modeling microbial ethanol production by S. aureus, K. pneumoniae, and E. faecalis under aerobic/anaerobic conditions—applicability to laboratory cultures and real postmortem cases. Int J Leg Med, 135, 2555-2565(2021).

    [80] AW Jones, R Andersson, J Sakshaug et al. Possible formation of ethanol in postmortem blood specimens after antemortem treatment with mannitol. J Anal Toxicol, 15, 157-158(1991).

    [81] AW Jones, L Hylén, E Svensson et al. Storage of specimens at 4◦C or addition of sodium fluoride (1%) prevents formation of ethanol in urine inoculated with Candida albicans. J Anal Toxicol, 23, 333-336(1999).

    [82] S Ahmad, M Aamir, SI Kirmani et al. Effect of temperature and preservative on neo-ethanol formation in postmortem whole blood samples. J Coll Physicians Surg Pak, 31, 1159-1162(2021).

    [83] DV Canfield, T Kupiec, E Huffine. Postmortem alcohol production in fatal aircraft accidents. J Forensic Sci, 38, 914-917(1993).

    [84] S Paczkowski, S Schütz. Post-mortem volatiles of vertebrate tissue. Appl Microbiol Biotechnol, 91, 917-935(2011).

    [85] S Felby, E Nielsen. The postmortem blood alcohol concentration and the water content. Blutalkohol, 31, 24-32(1994).

    [86] B Kuhnholz, N Bilzer. Further experiences in postmortem determinations of ethanol and water content of tissues and body fluids. Blutalkohol, 18, 120-130(1981).

    [87] CL O'Neal, A Poklis. Postmortem production of ethanol and factors that influence interpretation: a critical review. Am J Forensic Med Pathol, 17, 8-20(1996).

    [88] RJ Lewis, RD Johnson, MK Angier et al. Ethanol formation in unadulterated postmortem tissues. Forensic Sci Int, 146, 17-24(2004).

    [89] DR Harper. A comparative study of the microbiological contamination of postmortem blood and vitreous humour samples taken for ethanol determination. Forensic Sci Int, 43, 37-44(1989).

    [90] B Levine, ML Smith, JE Smialek et al. Interpretation of low postmortem concentrations of ethanol. J Forensic Sci, 38, 663-667(1993).

    [91] EJ Armstrong, KL Erskine. Investigation of drowning deaths: a practical review. Acad Forensic Pathol, 8, 8-43(2018).

    [92] JV Marraccini, T Carroll, S Grant et al. Differences between multisite postmortem ethanol concentrations as related to agonal events. J Forensic Sci, 35, 1360-1366(1990).

    [93] DJ Pounder, DR Smith. Postmortem diffusion of alcohol from the stomach. Am J Forensic Med Pathol, 16, 89-96(1995).

    [94] RW Prouty, WH Anderson. A comparison of postmortem heart blood and femoral blood ethyl alcohol concentrations. J Anal Toxicol, 11, 191-197(1987).

    [95] Y Iwasaki, M Yashiki, A Namera et al. On the influence of postmortem alcohol diffusion from the stomach contents to the heart blood. Forensic Sci Int, 94, 111-118(1998).

    [96] PA Sylvester, NA Wong, BF Warren et al. Unacceptably high site variability in postmortem blood alcohol analysis. J Clin Pathol, 51, 250-252(1998).

    [97] E Martin, W Moll, P Schmid et al. The pharmacokinetics of alcohol in human breath, venous and arterial blood after oral ingestion. Eur J Clin Pharmacol, 26, 619-626(1984).

    [98] P Holmgren, H Druid, A Holmgren et al. Stability of drugs in stored postmortem femoral blood and vitreous humor. J Forensic Sci, 49, 820-825(2004).

    [99] GL Dick, HM Stone. Alcohol loss arising from microbial contamination of drivers' blood specimens. Forensic Sci Int, 34, 17-27(1987).

    [100] TC Chao, DS Lo. Relationship between postmortem blood and vitreous humor ethanol levels. Am J Forensic Med Pathol, 14, 303-308(1993).

    [101] DC Yip, BS Shum. A study on the correlation of blood and vitreous humour alcohol levels in the late absorption and elimination phases. Med Sci Law, 30, 29-33(1990).

    [102] BS De Martinis, CM de Paula, A Braga et al. Alcohol distribution in different postmortem body fluids. Hum Exp Toxicol, 25, 93-97(2006).

    [103] L Jungmann, MG Perdekamp, M Bohnert et al. Complex suicide by ethanol intoxication and inhalation of fire fumes in an old lady: interdisciplinary elucidation including post-mortem analysis of congener alcohols. Forensic Sci Int, 209, e11-e15(2011).

    [104] HB Greizerstein. Congener contents of alcoholic beverages. J Stud Alcohol, 42, 1030-1037(1981).

    [105] C Wunder, C Weber, A Paulke et al. Endogenous formation of 1-propanol and methanol after consumption of alcoholic beverages. Forensic Sci Int, 325(2021).

    [106] VA Boumba. Modeling postmortem ethanol production/insights into the origin of higher alcohols. Molecules, 27, 700(2022).

    [107] W Gubala. n-Butanol in blood as the indicator of how long a dead body lay in water. Forensic Sci Int, 46, 127-128(1990).

    [108] T Gilg, L von Meyer, E Liebhardt. Formation and accumulation of endogenous methanol in relation to alcohol burden. Blutalkohol, 24, 321-332(1987).

    [109] NE Walsham, RA Sherwood. Ethyl glucuronide and ethyl sulfate. Adv Clin Chem, 67, 47-71(2014).

    [110] GB Ingall. Alcohol biomarkers. Clin Lab Med, 32, 391-406(2012).

    [111] A Thierauf, CC Halter, S Rana et al. Urine tested positive for ethyl glucuronide after trace amounts of ethanol. Addiction, 104, 2007-2012(2009).

    [112] S Dresen, W Weinmann, FM Wurst. Forensic confirmatory analysis of ethyl sulfate—a new marker for alcohol consumption—by liquid-chromatography/electrospray ionization/tandem mass spectrometry. J Am Soc Mass Spectrom, 15, 1644-1648(2004).

    [113] CC Halter, S Dresen, V Auwaerter et al. Kinetics in serum and urinary excretion of ethyl sulfate and ethyl glucuronide after medium dose ethanol intake. Int J Leg Med, 122, 123-128(2008).

    [114] ML Hannuksela, MK Liisanantti, AE Nissinen et al. Biochemical markers of alcoholism. Clin Chem Lab Med, 45, 953-961(2007).

    [115] H Krabseth, J Mørland, G Høiseth. Assistance of ethyl glucuronide and ethyl sulfate in the interpretation of postmortem ethanol findings. Int J Leg Med, 128, 765-770(2014).

    [116] G Høiseth, R Karinen, A Christophersen et al. Practical use of ethyl glucuronide and ethyl sulfate in postmortem cases as markers of antemortem alcohol ingestion. Int J Leg Med, 124, 143-148(2010).

    [117] A Thierauf, J Kempf, MG Perdekamp et al. Ethyl sulphate and ethyl glucuronide in vitreous humor as postmortem evidence marker for ethanol consumption prior to death. Forensic Sci Int, 210, 63-68(2011).

    [118] TG Rosano, J Lin. Ethyl glucuronide excretion in humans following oral administration of and dermal exposure to ethanol. J Anal Toxicol, 32, 594-600(2008).

    [119] A Helander, H Dahl. Urinary tract infection: a risk factor for false-negative urinary ethyl glucuronide but not ethyl sulfate in the detection of recent alcohol consumption. Clin Chem, 51, 1728-1730(2005).

    [120] A Helander, I Olsson, H Dahl. Postcollection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption. Clin Chem, 53, 1855-1857(2007).

    [121] LM Huppertz, L Gunsilius, C Lardi et al. Influence of Gilbert's syndrome on the formation of ethyl glucuronide. Int J Leg Med, 129, 1005-1010(2015).

    [122] S Aradottir, G Asanovska, S Gjerss et al. Phosphatidylethanol (PEth) concentrations in blood are correlated to reported alcohol intake in alcohol-dependent patients. Alcohol Alcohol, 41, 431-437(2006).

    [123] M Winkler, G Skopp, A Alt et al. Comparison of direct and indirect alcohol markers with PEth in blood and urine in alcohol dependent inpatients during detoxication. Int J Leg Med, 127, 761-768(2013).

    [124] S Aradottir, S Seidl, FM Wurst et al. Phosphatidylethanol in human organs and blood: a study on autopsy material and influences by storage conditions. Alcohol Clin Exp Res, 28, 1718-1723(2004).

    [125] S Aradottir, BL Olsson. Methodological modifications on quantification of phosphatidylethanol in blood from humans abusing alcohol, using high-performance liquid chromatography and evaporative light scattering detection. BMC Biochem, 6, 18(2005).

    [126] PM Thompson, N Hill-Kapturczak, M Lopez-Cruzan et al. Phosphatidylethanol in postmortem brain and serum ethanol at time of death. Alcohol Clin Exp Res, 40, 2557-2562(2016).

    [127] RD Johnson, RJ Lewis, DV Canfield et al. Utilizing the urinary 5-HTOL/5-HIAA ratio to determine ethanol origin in civil aviation accident victims. J Forensic Sci, 50, 670-675(2005).

    [128] A Helander, O Beck, AW Jones. Distinguishing ingested ethanol from microbial formation by analysis of urinary 5-hydroxytryptophol and 5-hydroxyindoleacetic acid. J Forensic Sci, 40, 95-98(1995).

    [129] D Pounder. Dead sober or dead drunk?. BMJ, 316, 87(1998).

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    Ricardo Jorge Dinis-Oliveira. “Not everything that can be counted counts” in ethanol toxicological results: an antemortem and postmortem technical interpretation focusing on driving under the influence[J]. Forensic Sciences Research, 2024, 9(3): owae023

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    Paper Information

    Category: Research Articles

    Received: Jan. 25, 2024

    Accepted: Mar. 29, 2024

    Published Online: Sep. 22, 2025

    The Author Email: Ricardo Jorge Dinis-Oliveira (ricardo.dinis@iucs.cespu.pt)

    DOI:10.1093/fsr/owae023

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