What exactly is "suicide by alcohol poisoning"?

I saw Verne Troyer today in something and remembered he had died. I looked it up and indeed, he died two years ago. It was ruled a suicide by alcohol poisoning.

I see nothing about pills with alcohol, just alcohol poisoning. Does a ruling like suicide-by-alcohol-poisoning mean he intentionally drank an super high quantity of alcohol with the plan being to die? Or can it simply be that he drank way too much alcohol without planning to die, but then died?

I know Verne Troyer struggled with drinking big-time. Does suicide definitely mean he intended to kill himself and if it does, how can they know that?

Just because we didn’t hear about a note, doesn’t mean there wasn’t one. Also, he may have mentioned something cryptic to someone that later played out. We can’t know that stuff really.

Maybe he didn’t drink himself to death with stuff from a liquor store-- maybe he drank isopropanol, or methanol. It’s probably Googlable.

It seems to me that to be deemed a suicide you have to know the person was intending to kill themself.

Bad decisions should not apply. Lots of people overdose on drugs and are not deemed suicides. Drinking too much would be in the same category.

I have no idea what evidence the police/coroner had to rule this a suicide assuming it was only alcohol poisoning that caused his death.

If you want to see a dramatization of suicide by alcohol poisoning watch the movie, “Leaving Las Vegas”. Great movie (by far Nicholas Cage’s best movie…he got an Academy Award for it I think and Elizabeth Shue is likewise amazing in it). Very hard to watch though. The kind of movie that, at the end, you feel like someone punched you in the gut.

From the Denver Post:

"Troyer, who weighed only 55 pounds, arrived at the hospital with a blood-alcohol level above 300 mg/ml, enough to be fatal in some adults.

He had called paramedics to his home, saying repeatedly during his 911 call that he wanted to die. He would repeat those words again in the hospital’s emergency room, according to the report.

Troyer’s representatives said at the time that the 49-year-old actor had struggled with depression and thoughts of suicide. He had been admitted to a hospital in similar condition the year before."

From a few weeks prior to his death:

According to The Blast , a psychiatric evaluation was done and the actor, 49, was placed on an involuntary psychiatric hold.

Law enforcement sources told TMZ that Troyer was “extremely upset, drunk and suicidal.” The outlet also reported that he is being held for 72 hours for evaluation.

In my part of the world, nobody rules ‘by suicide’ any more. The coroner determines if it’s a police case, or needs investigation for some other reason, but suicide isn’t a crime anymore so the coroner doesn’t need to make that determination.

Which perhaps is just as well, because it was a notoriously rubbery determination, and not just in my jurisdiction. There was all kinds of social and economic pressure riding on the determination, and depressed people are marked by bad judgement and inattention, leading to accidental deaths which are sometimes very difficult to differentiate from suicide.

Coroners come from all kinds of different backgrounds, and have all kinds of different ideas about what is important. Some will emphasize facts which others will conceal. The same death may be reported as “Taken by shark while surfing” or “Died after taking anti-depressants”

Take any particular coroners report as informative, not definitive. After a coroners report, a criminal trial with judge, prosecutor, defender and full jury may be required, and even that doesn’t always come to sensible conclusions about cause of death.

I do not know how it works where you are but it still matters here for things like life insurance payouts.

Understandably, insurers don’t want to have people taking out a policy and then offing themselves to collect the money for their family (I know you have to wait six months or so for the policy to be active but even so, they do not pay out on suicide and they will want to know because they don’t want to pay out if at all possible).

Someone who’s been habitually drinking excessively will say all kinds of things, obviously. The alcohol itself can make a person want to act melodramatically, and say things like, “I want to die,” but that doesn’t mean they actually are ready to go that far.

Usually something else like pills is necessary to kill someone, because with alcohol alone people just pass out before they can drink enough to die. And it’s very easy with pills for someone who’s already drinking to take a lethal dose of pills without any intention of taking their life.

It seems to me that, when alcohol and drugs are involved, there’s a fine line between truly suicidal intent and just a mental imbalance that leads to death inadvertently.

I’d like to sense check this number. 300mg per ml seems like a huge number to me. If alcohol and blood both have the same density of water (I know they don’t) then this would be saying that 30% of the liquid in his veins was alcohol. :face_with_raised_eyebrow: With more accurate numbers for the density of alcohol and blood, this would still be a rather extreme amount.

Wasn’t that the premise of Leaving Las Vegas? I never really understood how Nicolas Cage’s character was going to reliably “drink himself to death”. At least not before he simply ran out of money to buy alcohol or made himself so sick he ended up in the hospital. To me it seems like trying to smoke yourself to death or give yourself a heart attack by eating too much fast food.

g/100 ml is the SI calculation for blood alcohol concentration.. So, converting 300 mg/ml would yield 30 g/100 ml.

That doesn’t change the fact that this still results in something in the ballpark of 30% of the stuff in his veins (by weight) is alcohol, right? 1ml of water is 1g. So 30g out of 100ml(100g if water) is 30% by weight.
I would imagine that no matter what chemical (other than water) makes up 30% of your blood, you will be dead fairly soon.

I’m replying to myself, because I botched my first take at this, and I know I’ll blow through the edit time to fix it.

From the wiki on BAC:

A BAC of 0.10 (0.10% or one tenth of one percent) means that there are 0.10 g of alcohol for every 100 ml of blood.

So, 30 g is 30%, which is obviously lethal. A 1% BAC is usually one for the medical literature.

I’m wondering if they meant 0.30%, which would be 300 mg/100 ml? I still wouldn’t expect that to be lethal in an alcoholic, but perhaps he had other drugs in him? Or existing comorbidities where that would be a lethal BAC?

I’d like to point out how wrong this is. Depending on the alcohol concentration in what one is drinking, it is easy to ingest a lethal amount of alcohol in a short period of time, before the effects are such that further drinking stops.

The LD50 of ethanol (dose at which 50% of persons will die) is ~12g/kgbw. Troyer, who was reportedly 55 lbs/25 kg, would have hit that at 300g of ethanol, or 32 oz of 80-proof liquor

Granted, given a history of alcoholism, it may have required more given his tolerance, but it’s absolutely a doable amount. Especially if one is drinking with real intent to self-harm, or if one is already profoundly drunk and then stacks ‘a couple’ quick shots on top of that.

Note that this LD50 isn’t related to deaths due to trauma of passing out and falling, or aspirating on vomit and choking, or passing out head-down and dying of cerebral congestion, but is due to the depressant effects of ethanol directly. Add in those other things (not the case in Troyer’s death, but common enough in, say, frat hazing or binge drinking in general) and much lower doses can be lethal for their downstream effects.

It was widely reported that his BAL was ‘over three times the legal limit’ of 0.08%, or 8mg/dL. So the actual value was probably 30 mg/dL, or 300 mg/L, and the 300 mg/ml was an error.

Does the body not typically throw up if one drinks an enormous quantity? If I took two 750ML bottles of 40%(80 proof) alcohol and slammed both in less than 5 minutes, would I not puke it up?

I am kind of estimating that two bottles slammed like that has the potential to kill a 5’9 170 lb man.

If, per the wiki quote I had above, a 0.10% BAC is equivalent to a concentration of .10 g per 100 ml of blood, then would the concentration of alcohol for a .30% BAC be .30g per 100 ml, or 300 mg per dl, not 30 mg per dl?

I can see how the reporter got confused…

Is there a conversion for g EtOH / kg body weight to g EtOH / dl of blood? What range of BAC does that LD50 correspond to?

Ahh crap, your’e totally right. 0.08% is 80 mg/dl; ~three times that is 300 mg/dl. That’s embarrassing.

To complete my penance, I rechecked the LD50 for ethanol in humans - aaand it turns out that the 12 g/kg was a rat study but reported elsewhere as a human value. Other studies show 3g/kg for mice, 6g/kg for rabbits and 9g/kg for rats. Human studies suggest 5-8 g/kg, but variable by age and body type.

The NIH link found that the estimated mean peak BAL at time of death in cases attributed to accidental ethanol poisoning was 463 mg/dL , or 0.46%, in uncomplicated cases. That’s about 5.75 times the legal limit. That falls to 311 mg/dL when in combination with other psychotropic drugs. That’s maybe a poor proxy, given that all of these subjects were dead, but it gives a ballpark figure. Compare with the chart from here:

https://awareawakealive.org/educate/blood-alcohol-content

which suggests that a BAL of 0.450% is life-threatening.

Let’s compare that to a proposed LD50 of 5g/kg for a 70 kg man:
5g/kg x 70kg = 350 g
70kg adult male → ~5250mL blood volume
350g/5250mL = 666 mg/dL, or a BAL of 0.6%, or about eight times the legal limit. That seems like the high side to me. Further, for a woman of the same weight the same dose of ethanol would give a BAL of 0.77%, which would almost certainly be lethal. So perhaps the 5g/kg value is higher than it should be. On the other hand, chronic drinkers can tolerate much higher BAL:

Anyway, mea culpa.

I haven’t seen alternate methods of taking alcohol, and yes, I mean the “other way to take it” described in “One Flew Over The Cuckoo’s Nest.” It’s not uncommon for people who can no longer consume alcohol orally without getting sick to use enemas, and that can kill you too, because it’s also absorbed through the colon.

Probably.

Suspected alcohol intoxication - the blood ethanol level is typically elevated to 100 to 300 mg/dL (32.6 to 65.2 millimol/L) in acute intoxication. Most fatalities occur with levels > 400 mg/dL (86.8 millimol/L).