Accidental alcohol poisoning mortality in the United States, 1996-1998 - NIAAA'S Epidemiological Bulletin No.40

Alcohol Research & Health, Wntr, 2003 by Young-Hee Yoon, Frederick S. Stinson, Hsiao-Ye Yi, Mary C. Dufour

(*) In the years since the 1978 publication of the International Classification of Diseases, Ninth Revision (ICD-9) (WHO 1978), researchers and epidemiologists have come more and more to use the word "unintentional" rather than "accidental" to describe injuries and adverse effects resulting from acts that are not deliberate. In this article the word "accidental" is sometimes used to describe unintentional alcohol poisoning when quoting or paraphrasing ICD-9 terminology.

(1) Ethanol is metabolized in the liver at a rate of approximately one drink per hour, with wide variation depending on conditions. Rapid consumption of large quantities of alcohol can overload the liver's metabolic capacity, causing the blood alcohol concentration (BAC) to rise rapidly. At BACs of 0.25 to 0.40 grams/deciliter, alcohol poisoning can lead to slurred speech, ataxia, stupor, coma, and eventually to death (Seller and Kalant 1976; Poikolainen and Vuori 1985). Alcohol poisoning is a result of extremely high levels of intoxication. With 20 drinks in 1 hour, an average male weighing 160 pounds could reach a BAC level beyond 0.40 grams/deciliter. At this point, the brain centers that control the heart and lungs are partially anesthetized and coma or death may occur (Kinney 2000). Some studies have estimated the mean lethal BAC as 0.50 grams/deciliter, but large variations in tolerance of high BAC levels have been observed. Experienced drinkers can tolerate much higher BAC levels than inexperienced drinkers. Factors such as sex, size, age, preexisting medical conditions (e.g., heart disease), whether the person vomited, and whether other drugs were used in combination with alcohol also play a role (Adinoff et al. 1988; Poikolainen 1984). When other drugs are present, even lower BAC levels may be fatal as a result of alcohol and other drug interactions (Lahti and Vuori 2002).

(2) Underlying cause is defined as "the disease or injury which initiated the train of morbid events leading directly or indirectly to death, or the circumstances of the accident or violence which produced the fatal injury" (NCHS 1995, p. 12). For each death, there is only one underlying cause.

(3) Contributing causes are defined as "other significant conditions contributing to death, but not resulting in the underlying cause" (NCHS 1995, p. 12). Up to 20 such conditions may be listed for each death.

(4) All of the disease classification codes in this article are taken from this source.

(5) With the implementation of ICD-10, alcohol poisoning codes are further classified by three categories: accidental, intentional, and undetermined intent.

(6) In 1998, there were five deaths from "excessive blood level of alcohol" based on underlying cause alone. However, there were an additional 933 deaths with excessive blood level of alcohol coded as one of the contributing causes. Deaths from motor vehicle accidents (E810-E825 codes) accounted for 47 percent of these deaths; deaths from other accidents and adverse effects (E800-E809, E826-E949 codes)--accidental poisoning, drowning, and falls--accounted for 22 percent of these deaths; suicide (E950-E959 codes) accounted for 16 percent; homicide (E960-E978 codes) accounted for 4 percent; and diseases and mental disorders (001-799 codes) and other undetermined injuries (E980-E999 codes) accounted for 11 percent.