Question #107 (8/30/2024)

National Association of Medical Examiners
Educational Activities Committee

Question Title

Submitted by Laura M. Labay, PhD, F-ABFT, DABCC-TC (Principal Toxicologist, NMS Labs)

Question Title

* 1. A 32-year-old female is found deceased at home by her spouse when he returns from work. She did not have a regular primary care physician, and per family, consumed alcohol on a daily basis. Several open containers of wine were found in the recycling bin.

Femoral blood in a grey top tube and vitreous fluid in a red top tube were collected at autopsy and submitted for toxicology testing.

Based on the results above, which of the following would be the best next step in testing and why?

Ethanol test in urine - The ethanol vitreous and blood results should be consistent but are not. Testing the urine for ethanol will show which ethanol result is correct.

Ethanol test in gastric fluid - An ethanol result consistent with at least one drink will prove ethanol was not absorbed prior to death, explain the negative blood result, and show the vitreous result is from ethanol ingested about 2 hours before death.

Glucose test in urine - An elevated glucose result will show the decedent was in a state of diabetic ketoacidosis and the ethanol result in vitreous fluid is due to postmortem formation.

β-hydroxybutyric acid (BHB) test in blood, vitreous, or urine - An elevated BHB result will show the decedent was in a state of diabetic ketoacidosis and the ethanol result in vitreous fluid is due to postmortem formation.

Question #107 (8/30/2024)

National Association of Medical Examiners Educational Activities Committee

Question Title

Submitted by Laura M. Labay, PhD, F-ABFT, DABCC-TC (Principal Toxicologist, NMS Labs)

Question Title

National Association of Medical Examiners
Educational Activities Committee