Excessive drinking and drunkenness are underlying factors in many fatal accidents, which makes the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons, although in medical examiner cases interpretation of the results is more complicated, owing to various pre-analytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem (AM) ingestion of ethanol from PM synthesis. One approach involves determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid (CSF), vitreous humor (VH) and/or urine, and comparison of results with blood-alcohol concentration (BAC). Another involves the analysis of various alcohol biomarkers, such as ethyl glucuronide (EtG), ethyl sulfate (EtS), and/or phosphatidylethanol (PEth) or the urinary metabolites of serotonin (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol, and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as enzyme inhibitor, to all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment, and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 g% to 0.02 g%, when PM blood are analyzed. Low BACs are more often produced after death than high BAC. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.

中文翻译：

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影响尸检样本乙醇分析结果的分析前因素。

过量饮酒和醉酒是许多致命事故的潜在因素，这使得死后 (PM) 标本中乙醇的定量测定成为所有非自然死亡调查的重要组成部分。使用相同的分析方法来测定生者和死者血液中的乙醇，尽管在法医案例中，由于各种分析前因素，结果的解释更加复杂。最大的问题是，在厌氧条件下，通过微生物活动和血糖发酵，可以在分解的尸体中自然产生乙醇。需要找到方法来区分死前 (AM) 摄入的乙醇和 PM 的合成。一种方法涉及测定胆汁、脑脊液 (CSF)、玻璃体液 (VH) 和/或尿液等替代样本中的乙醇，并将结果与​​血液酒精浓度 (BAC) 进行比较。另一个涉及各种酒精生物标志物的分析，例如乙基葡萄糖醛酸苷 (EtG)、硫酸乙酯 (EtS) 和/或磷脂酰乙醇 (PEth) 或血清素的尿代谢物 (5-HTOL/5-HIAA)。如果体内微生物活动产生乙醇，则血样还应含有其他低分子挥发物，例如乙醛、正丙醇和/或正丁醇。在所有 PM 样本中添加 1-2% w/v 氟化钠或氟化钾作为酶抑制剂对于降低采样后（例如运输过程中）和分析前储存期间产生乙醇的风险至关重要。此外，在分析 PM 血液时，如果将报告阳性 BAC 的分析临界值从 0.01 g% 提高到 0.02 g%，可能会获得很大的收获。与高 BAC 相比，死后更容易产生低 BAC。因此，当尸体明显腐烂时，务实的做法是从平均分析结果中减去0.05 g%。任何剩余的 BAC 预计都能更可靠地表明死前是否饮酒。