The forensic literature offers differing opinions about the blood-ethanol concentration necessary to cause death; the variations in opinion are unacceptably high. As such, the goal of this study was to provide medians and reference ranges for the postmortem blood-ethanol concentrations in deaths due to alcohol-related poisoning. The authors drew all blood specimens from the femoral vein and used the analytical method of headspace chromatography. The sample included 705 men and 120 women who had died of chronic alcoholism and 529 men and 164 women who had died of acute alcohol poisoning. Findings indicated no relationship between blood-ethanol concentrations and age. In the acute poisoning cases, the distribution of blood-ethanol concentration agreed with a normal curve, while the corresponding concentrations of ethanol in the chronic alcoholism deaths were not normally distributed. An elevated level of acetone in the blood was found in 98 individuals who died of chronic alcoholism; 50 of these 98 also had elevated isopropanol. Only 28 cases of the acute alcohol poisonings had elevated acetone and 22 had elevated isopropanol. The authors offer explanations of the differences observed in blood-ethanol and blood-acetone in the two types of alcohol-related deaths. Explanations include chronic tolerance, alcohol-related organ and tissue damage, positional asphyxia or suffocation by inhalation of vomit, and exposure to cold coupled with alcohol-induced hypothermia. References