ALCOHOL-RELATED SUDDEN-DEATH WITH HEPATIC FATTY METAMORPHOSIS - A COMPREHENSIVE CLINICOPATHOLOGICAL INQUIRY INTO ITS PATHOGENESIS

To clarify the pathogenesis of the widely known but obscure syndrome o f sudden death with hepatic fatty metamorphosis observed in alcohol ab users, we have scrutinized both the clinical and pathological data of 11 subjects who died under such circumstances between 1987 and 1993. D eath followed several days of uninterrupted drinking often with little dietary intake. The notable clinical features on arrival at the emerg ency room were disturbance of consciousness (11/11), hypotension (4/6) , hypothermia (3/5), hypoglycaemia (8/11), metabolic acidosis (6/6), r enal dysfunction (11/11), and hyperammonaemia (5/5). The common hepati c pathology was the extensive appearance of numerous microvesicular fa tty droplets in the hepatocytes together with varying degrees of macro vesicular fatty change; four subjects had an underlying cirrhosis. Dea th undoubtedly results from a variety of metabolic disturbances trigge red by the combination of massive ethanol intake and starvation. The a ppearance of extensive microvesicular fatty change superimposed on mac rovesicular fatty change was considered to be an associated phenomenon .