Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post mortem Computed Tomography (PMCT) A Validation Study
Year: 2018

Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine. Urinary bladder volume (UBV) was calculated based on the equation used in ultrasonographic volumetry, V=axbxcx 0.5. These 3 parameters correlated well with the UBV and having a strong positive relationship. There was a signifi cant positive correlation at low strength between alcohol concentrations with calculated UBV. There was statistical signifi cant correlation between urinary bladder distension on postmortem CT and cases of intoxication especially more corresponding for positive alcohol detection. The average sensitivity was 35.65% whereby it was slightly lower than those reported in Rohner C, et al. In this study we have deduced that diuretics effect of alcohol was the main reason causing bigger urinary bladder or UBV and was more prominent than the infl uence of drug of abuse on the urinary bladder sphincter. The distension of urinary bladder should raise suspicion of intoxication, but would not provide information on the quantity of the intoxicating agent due to its signifi cant but poor correlation. It was important to note that intoxication may also be present in cases with low urinary bladder volume. In conclusion, it is vital to consider circumstantial evidence, as well as the presence of additional fi ndings on imaging before suggesting the diagnosis of intoxication based on urinary bladder distension on imaging. Currently, the use of CT bladder imaging should serve as a strong indication that the individual may be intoxicated but should be confi rmed by a complete autopsy and a detailed toxicological analysis.  Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post mortem Computed Tomography (PMCT) A Validation Study Lai Poh Soon1* Mohamad Helmee Mohamad Noor2, Nor Fadhilah Madon3, Mohd Hilmi Saidin1, Mansharan Kaur Chainchel Singh4 and Kunasilan Subramaniam5 1Forensic Scientifi c Offi cer, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Ministry Of Health Malaysia 2Forensic Radiologist, Diagnostic Imaging Department, Hospital Kuala Lumpur, Ministry Of Health Malaysia 3Forensic Medical Offi cer, Pathology Department, Hospital Univeristi Kebangsaan Malaysia (HUKM) 4Forensic Radiologist, Institute for Pathology, Laboratory and Forensic Medicine, Universiti Teknologi MARA (UiTM) 5Forensic Clinical Specialist, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Ministry Of Health Malaysia *Address for Correspondence: Lai Poh Soon, Forensic Scientifi c Offi cer, National Institute of Forensic Medicine, Hospital Kuala Lumpur, Ministry Of Health Malaysia, Malaysia, Tel: 0326906694;   15 January 2018   2018 Soon LP, et al.