Fatal acute alcohol intoxication in an ALDH2 heterozygote: a case report

On an evening in November, a 25-year-old man was found dead in his bedroom. There were many empty snap-out sheets for flunitrazepam tablets in the tra sh at his bedside. He had been beaten by a gang of young people earlier in the morning of the same day. At the medico-legal autopsy, although there we re many bruises and/or abrasions on the whole body, only slight subdural he morrhage was observed, and none of them was thought to be the cause of deat h. Flunitrazepam and its metabolites were not detected in his body fluid by gas chromatography-mass spectrometry (GC-MS). Marked lung edema and a seve re congestion of organs were observed. His blood alcohol concentration from the femoral vein was 2.00 mg/ml. Fatal cases of acute alcohol intoxication usually have shown higher alcohol concentration (2.25-6.23 mg/ml). Althoug h the genotype of aldehyde dehydrogenase 2 (ALDH2) has not previously been mentioned as a contributing factor in determining the cause of death, in th is case the genotype of ALDH2 was ALDH2*1/2 and thus is important. Those wh o possess the ALDH2*2 gene show high concentrations of acetaldehyde (AcH) a t even comparatively lower alcohol levels. Consequently, the cause of death was considered to be acute alcohol intoxication including AcH poisoning. ( C) 2000 Elsevier Science Ireland Ltd. All rights reserved.