Facial changes in individuals deceased from ethanol poisoning

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BACKGROUND: Changes in the facial area (facial edema, its purplish or bluish color, drooling, tearing, and a sign described by A.P. Kurdyumov) are among the most commonly observed signs of ethanol poisoning. However, their diagnostic capabilities are not investigated, and the mechanisms of development are not described.

AIM: To study the occurrence of changes in the facial area in individuals who died from ethanol poisoning. From a modern perspective, the mechanism of their development, characteristics, and specificity were assessed.

MATERIALS AND METHODS: A single-center retrospective observational cross-sectional study was conducted based on the archive of the State Budgetary Healthcare Institution of Moscow Region “Bureau of Forensic Medical Examination,” including cases of death from January 1, 2020, to December 31, 2020. Cases were grouped into five categories: ethanol poisoning, poisoning with other alcohols, asphyxia, other violent causes of death, and natural death.

RESULTS: The study included 1,181 cases, with a median age of 52 (range, 19–95) years. Women were older, with no significant difference in blood ethanol concentration. Facial puffiness was observed in 53.1% of ethanol poisoning cases and bluish discoloration in 59.5%. The sign described by A.P. Kurdyumov was less frequently observed. Facial puffiness (p=0.002) and the sign described by A.P. Kurdyumov (p=0.014) were more common in poisoning with other alcohols than in deaths from asphyxia. However, no such differences were observed for facial bluish discoloration (p=0.176). Facial bluish discoloration had the highest sensitivity in both alcohol and other alcohol poisoning cases (59.53% and 40.74%, respectively) but had the lowest specificity in the same groups among the examined signs. The sign described by A.P. Kurdyumov had the highest specificity among those examined for both ethanol poisoning and poisoning with other alcohols.

CONCLUSION: In ethanol poisoning, facial bluish discoloration was the most sensitive sign, and the sign described by A.P. Kurdyumov was the most specific among the analyzed signs. The examined signs were observed in both ethanol and other alcohol poisoning but less frequently. The forensic medical signs considered are largely similar to the clinical signs observed in flush syndrome.

About the authors

Semyon S. Plis

Institute of Forensic Medicine and Pathology

Author for correspondence.
Email: SSPlis.work@gmail.com
ORCID iD: 0000-0002-0232-0425
SPIN-code: 4347-1925

MD

Russian Federation, Moscow

Olesya V. Veselkina

Institute of Forensic Medicine and Pathology; Moscow Regional Research and Clinical Institute

Email: ves-olesya@yandex.ru
ORCID iD: 0000-0002-9486-5421
SPIN-code: 9188-2988

MD

Russian Federation, Moscow; Moscow

Aleksandr V. Maksimov

Moscow Regional Research and Clinical Institute; Federal State University of Education

Email: mcsim2002@mail.ru
ORCID iD: 0000-0003-1936-4448
SPIN-code: 3134-8457

MD, Dr. Sci. (Med.), Assistant Professor

Russian Federation, Moscow; Moscow

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2. Fig. 1. Proposed scheme of the flush syndrome development mechanism.

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3. Fig. 2. Illustrations of the sign described by A.P. Kurdyumov (Reproductions from [7]).

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