Significant ketoacidosis at autopsy: a single-centre systematic review

AimTo examine the value of vitreous beta-hydroxybutyrate and serum acetone in the investigation of sudden unexpected death.MethodsCoroners’ autopsy reports from a provincial UK city, with a population of approximately 900 000, over a 24-month period with significant ketoacidosis were studied. Demographic features, medical history, anatomical and histological findings, and biochemical parameters, including renal function, vitreous glucose, serum and vitreous alcohol, were analysed.ResultsForty-two cases (28 males and 14 females) were identified; 55% had a history of alcohol and/or substance misuse, and mental health problems, particularly depression and anxiety, and 16% were diabetic. In all, 50% of subjects had alcoholic ketoacidosis (AKA), 19% had diabetic ketoacidosis (DKA) and 12% had a history of both diabetes and alcohol abuse. In 19% of cases, an exact cause of ketoacidosis was established. In AKA, the subjects typically had low vitreous glucose and low or undetected blood alcohol levels. All of the subjects with raised vitreous glucose levels had DKA.ConclusionKetoacidosis is relatively common and should be considered as a cause of sudden death, especially in alcoholic patients and patients with diabetes with no clear cause of death at autopsy.

Alcohol and trauma: the influence of blood alcohol levels on the severity of injuries and outcome of trauma patients - a retrospective analysis of 6268 patients of the TraumaRegister DGU®

Background Blood alcohol level (BAL) has previously been considered as a factor influencing the outcome of injured patients. Despite the well-known positive correlation between alcohol-influenced traffic participation and the risk of accidents, there is still no clear evidence of a positive correlation between blood alcohol levels and severity of injury. The aim of the study was to analyze data of the TraumaRegister DGU® (TR-DGU), to find out whether the blood alcohol level has an influence on the type and severity of injuries as well as on the outcome of multiple-trauma patients. Methods Datasets from 11,842 trauma patients of the TR-DGU from the years 2015 and 2016 were analyzed retrospectively and 6268 patients with a full dataset and an AIS ≥ 3 could be used for evaluation. Two groups were formed for data analysis. A control group with a BAL = 0 ‰ (BAL negative) was compared to an alcohol group with a BAL of ≥0.3‰ to < 4.0‰ (BAL positive). Patients with a BAL > 0‰ and < 0.3‰ were excluded. They were compared with regard to various preclinical, clinical and physiological parameters. Additionally, a subgroup analysis with a focus on patients with a traumatic brain injury (TBI) was performed. A total of 5271 cases were assigned to the control group and 832 cases to the BAL positive group. 70.3% (3704) of the patients in the control group were male. The collective of the control group was on average 5.7 years older than the patients in the BAL positive group (p < .001). The control group showed a mean ISS of 20.3 and the alcohol group of 18.9 (p = .007). In terms of the injury severity of head, the BAL positive group was significantly higher on average than the control group (p < 0.001), whereas the control group showed a higher AIS to thorax and extremities (p < 0.001). The mean Glasgow Coma Scale (GCS) was 10.8 in the BAL positive group and 12.0 in the control group (p < 0.001). Physiological parameters such as base excess (BE) and International Normalized Ratio (INR) showed reduced values ​​for the BAL positive group. However, neither the 24-h mortality nor the overall mortality showed a significant difference in either group (p = 0.19, p = 0.14). In a subgroup analysis, we found that patients with a relevant head injury (AIS: Abbreviated Injury Scale head ≥3) and positive BAL displayed a higher survival rate compared to patients in the control group with isolated TBI (p < 0.001). Conclusions This retrospective study analyzed the influence of the blood alcohol level in severely injured patients in a large national dataset. BAL positive patients showed worse results with regard to head injuries, the GCS and to some other physiological parameters. Finally, neither the 24-h mortality nor the overall mortality showed a significant difference in either group. Only in a subgroup analysis the mortality rate in BAL negative patients with TBI was significantly higher than the mortality rate of BAL positive patients with TBI. This mechanism is not yet fully understood and is discussed controversially in the literature.

Ethanol-Related Behaviors in Mouse Lines Selectively Bred for Drinking to Intoxication

Alcohol use disorder (AUD) is a devastating psychiatric disorder that has significant wide-reaching effects on individuals and society. Selectively bred mouse lines are an effective means of exploring the genetic and neuronal mechanisms underlying AUD and such studies are translationally important for identifying treatment options. Here, we report on behavioral characterization of two replicate lines of mice that drink to intoxication, the High Drinking in the Dark (HDID)-1 and -2 mice, which have been selectively bred (20+ generations) for the primary phenotype of reaching high blood alcohol levels (BALs) during the drinking in the dark (DID) task, a binge-like drinking assay. Along with their genetically heterogenous progenitor line, Hs/Npt, we tested these mice on: DID and drinking in the light (DIL); temporal drinking patterns; ethanol sensitivity, through loss of righting reflex (LORR); and operant self-administration, including fixed ratio (FR1), fixed ratio 3:1 (FR3), extinction/reinstatement, and progressive ratio (PR). All mice consumed more ethanol during the dark than the light and both HDID lines consumed more ethanol than Hs/Npt during DIL and DID. In the dark, we found that the HDID lines achieved high blood alcohol levels early into a drinking session, suggesting that they exhibit front loading like drinking behavior in the absence of the chronicity usually required for such behavior. Surprisingly, HDID-1 (female and male) and HDID-2 (male) mice were more sensitive to the intoxicating effects of ethanol during the dark (as determined by LORR), while Hs/Npt (female and male) and HDID-2 (female) mice appeared less sensitive. We observed lower HDID-1 ethanol intake compared to either HDID-2 or Hs/Npt during operant ethanol self-administration. There were no genotype differences for either progressive ratio responding, or cue-induced ethanol reinstatement, though the latter is complicated by a lack of extinguished responding behavior. Taken together, these findings suggest that genes affecting one AUD-related behavior do not necessarily affect other AUD-related behaviors. Moreover, these findings highlight that alcohol-related behaviors can also differ between lines selectively bred for the same phenotype, and even between sexes within those same line.

Breathometer: Shut Down by the Federal Trade Commission

Breathometer was the first Shark Tank pitch where all five sharks invested in one deal. This case examines how Charles Yim created a product that tests blood alcohol levels that is connected to an iPhone or Android smartphone. The product was reported to be innovative in its design and functionality. In the early stages of the company, Yim was able to raise over 2 million dollars from Silicon Valley VC’s, Shark Tank, and Indiegogo. Ultimately, the product’s advertising claims were found to be dubious by the Federal Trade Commission, and they were ordered to provide refunds to all customers. The case examines the processes of value proposition development and investor due diligence. In addition, the case explores the issues related to board composition and the value that board members with extensive industry experience bring to the success of the company. Ultimately, the company underwent a major pivot, transforming its product into one that measures bad breath and oral health. The case and instructor materials provide the vehicle for class discussion and analysis of the early-stage venture success and failure and how industry experience is essential to long-term survivability.

Keeping a cool head at all times. What determines choice consistency?

Many rational choice theories posit that rational decision makers assign subjective values to all available choice options and choose the option with highest subjective value. Choice options are usually composed of multiple attributes, e.g. healthiness and taste in dietary choice or risk and expected returns in financial choice. These attributes have to be integrated into a single subjective value. Subjective value maximizing choice requires choice consistency, i.e. consistent weighing of the choice attributes across choices. However, empirical work suggests that perfect choice consistency is often violated, for example when decision makers weigh choice attributes differently across multiple decisions. Some researchers propose to extend certain bounds of rationality or to abandon the concept of rationality as adherence to consistency principles altogether. A more conservative stance assumes that perfect consistency can be violated by decision makers in practice, but that consistency principles still can explain large parts of behavior. In a review of the recent literature, we identify factors for compromised consistency relative to baseline conditions. Broadly, we distinguish between undynamic trait factors and fluid state factors. We find evidence for an influence of age, education, intelligence, and neurological status. In contrast, choice consistency appears to be relatively robust to the influence of sex, personality traits, cognitive load, sleepiness and blood alcohol levels. We conclude, that, according to the current state of the literature, only fundamental differences in decision makers, that is, trait differences, have a significant impact on choice consistency.

Corelations and Interferences of Blood Alcohol Levels Measured By Cordebard and Gascromatography-Headspace Methods

Ethanol (ethyl alcohol) is an organic compound belonging to the alcohol class, being the main alcohol found in alcoholic beverages. It is a volatile, fl ammable and colorless liquid, with a characteristic odor, being considered one of the oldest drugs consumed by humans. Taking into account the prevalence of alcohol intoxication among drivers, and also among criminal offenders, it was deemed necessary to accurately determine the blood alcohol level detected in the biological samples taken from the suspects, considering the justice system requirements regarding the application of retributive measures in direct proportion to the detected blood alcohol level. The method currently used in Romania is the modified Cordebard Nitrochromic method, which comes with certain limitations, such as the variable homogeneity of the samples that induces sampling errors, thus resulting in blood alcohol levels below the real values. For these reasons, it is deemed necessary to align the methods of ethyl alcohol dosing at a national level and to the analytical requirements of the European Union exigencies, imposing the need to adopt a new method that eliminates as many sources of error as possible, a viable candidate at the moment being the Gascromatographic-Headspace method.