Sudden unexpected death in alcohol misuse: a case report

Alcohol is associated with a significant number of sudden deaths per year in the UK and deaths from alcohol-related causes are increasing at an alarming rate. These deaths are more common among white men who are over 50 years with fatty changes rather than the cirrhotic liver. The only findings at postmortem are fatty liver and a negative or low blood alcohol level. The mechanism of death is uncertain in most of the instances but there are some theories related to the suggested mechanism. Sometimes, pre-existing minor causes are incorrectly diagnosed as the cause of death. Therefore, forensic pathologist experiences major difficulties in ascertaining the cause of death. Awareness of the association between alcohol-related fatty change and sudden death is essential to give a correct cause of death at the autopsy examination. A 63-year-old man was found dead in his bathroom by his partner. There was no past medical history of diabetes mellitus, hypertension and alcohol withdrawal. He consumed 5-6 bottles of wine per day over the past 9 months. Postmortem examination revealed slight jaundice, pallor, mild atheromatous changes in coronary arteries, mild left ventricular hypertrophy and marked fatty changes in the liver. Microscopic examination of the liver revealed severe steatosis, predominantly macrovesicular. In addition to that, there was no evidence of chronic disease or pathology. Toxicology analysis revealed 113mg/dl of blood alcohol reset of investigations were unremarkable. Limited biochemical analyses were done. They did not show any evidence of significant electrolytes imbalances or hypo or hyperglycemia.  Excluding all the possibilities and considering macroscopic and microscopic features, and toxicological investigations, the cause of death was ascertained as sudden unexpected death in alcohol misuse (SUDAM).