Assessing the importance of post-mortem interval and other variables on the analysis of ethanol in the vitreous humour with a focus on ethyl glucuronide and ethyl sulfate: A critical review.

Vitreous humour is used to assess intoxication at the time of death due to its anatomical isolation, which reduces contamination risk. Toxicological analysis typically includes drugs and alcohol. For interpreting post-mortem ethanol concentrations, distinguishing between ante-mortem ingestion and post-mortem production from putrefaction is essential. For this purpose, biomarkers like ethyl glucuronide (EtG) and ethyl sulfate (EtS) are crucial for confirming alcohol consumption. Factors such as post-mortem interval (PMI), the cause of death, individual characteristics like sex, age, body mass index (BMI), ambient temperature at corpse discovery, and body storage temperature may affect vitreous humour analysis. The present review explores how these factors have been integrated into the current scientific discussion on the quantification of ethanol, EtG and EtS in vitreous humour, and how they ultimately impact the determination of the cause of death. Our findings indicate that the PMI is often unspecified in reviewed cases (64 %), and when mentioned, it is under 24 h (17 %). Individual characteristics like sex, age, and BMI are frequently omitted (43 %, 46 %, and 86 %, respectively), and details on ambient and storage temperatures are rarely provided. Although post-mortem alterations in ocular anatomy are well-documented, there are limited studies that report ethanol stability in vitreous humour across various PMIs. For EtG and EtS, no studies have evaluated quantitative changes in vitreous humour in relation to PMI. Despite these data gaps, available studies suggest that age and BMI may influence the analysis of ethanol in cases of alcohol-related deaths, underscoring the need for further research on factors affecting substance levels in vitreous humour.