Information

In humans what is the last metabolic process to cease after death?


After death which of our body's metabolic processes will continue functioning for the longest?


My answer isn't researched; it is speculative.

I interpret metabolic processes as anabolic or catabolic processes. I assert that only anaerobic processes can continue for a long time after vegetative death (the epithelia could house a counter-example of a post-mortem process, but I can't think of one), and I speculate that only catabolic processes are likely to have sufficient pools of reactants to continue after death. So we're looking for a catabolic process with a large reactant pool. Therefore I think that the action of digestive proteases will continue for the longest time, because these enzymes are very stable and could have a lot of substrate around (including, at a very slow rate, cleaving each other.) The neutralization of stomach pH would inactivate this process… I don't know how long that takes.

If something like blood clotting is considered a metabolic process, then probably that continues the longest. The binding of CO₂ by hemaglobin is probably faster than blood clotting. Again, I don't really consider those processes to be metabolic.


This is what happens to your body as you die of dehydration

Stage 3: Organ Damage Michael Brandon Myers

Wandering around the desert is a good way to get dangerously dehydrated, but severe dehydration can also occur in more moderate conditions if you’re exercising a lot, or just not drinking enough water. Moyan Brenn via Flickr

Water makes up about 55 to 65 percent of your body. It’s a crucial ingredient in the chemistry that helps your brain think, your blood flow, and your muscles move. But what happens after you sweat through a spin class, spend a day at the beach, or simply ignore your thirst? Dehydration is different for everybody—it depends on how much you’re exercising, the temperature around you, and how much you typically sweat—but it can get dangerous quick.


Being with someone when they die

Being with someone you love at the point of their death is a profound experience. Nonetheless, you may find the anticipation emotionally and mentally exhausting. At times you may fervently wish for it to be over. And then you may feel guilty for thinking like this. But it is a normal and understandable response to a very stressful situation.

Being there at the end

  • Remember: hearing is thought to be the last sense to go in the dying process, so never assume the person is unable to hear you. Talk as if they can hear you, even if they appear to be unconscious or restless.
  • If possible, lower lighting until it is soft, or light candles, making sure they burn in a safe place. Try to keep bright sunlight away from the dying person&rsquos face and eyes.
  • You can create a peaceful, soothing atmosphere by playing a favourite piece of music or songs softly in the background.
  • You might wish to quietly read a favourite poem, a spiritual passage or a religious text that means something special to the person.
  • Strong physical contact can be painful or invasive. It is often best just to sit beside the bed and gently hold their hand. If appropriate, a gentle massage to the feet or hands can provide comfort and help communication on a deeper level. Even when a person is unconscious or semi-conscious, they might be able to respond with faint pressure from their thumb, or twitch a toe.
  • If appropriate or desired, arrange for end-of-life prayers by a relevant faith minister.
  • Remember: it is impossible to predict when death will actually happen. People can hover between life and death for hours and often days, and it is easy to miss the final moment.

Physical signs that death is near

There are certain physical signs which indicate the person is close to death.

  • Congestion in the lungs/Death rattle: the person&rsquos breath becomes laboured and &lsquogurgling&rsquo, which can sound alarming. There may also be a rattling noise (often referred to as the "death rattle") at the back of the throat. However, this is normal. The person is no longer able to cough or swallow, which causes secretions such as saliva to pool in the back of the throat.
  • Yawning: even when unconscious or semi-conscious, the person may often yawn. This is a natural response to draw more oxygen into the body.
  • Coldness in the limbs: sometimes the person&rsquos hands, arms, feet and legs become cold, with the skin tone changing as blood circulation slows down. However, this many not happen until right at the end.
  • Tea-coloured urine: the lack of fluid intake coupled with the kidneys beginning to shut down means the person&rsquos urine will become concentrated. It may also have a pungent smell, or cease altogether.
  • Incontinence: as the muscles of the body cease to function, there may be a loss of bladder and bowel control. This can be very upsetting and embarrassing for the person. With patients who are unconscious, nursing staff will insert a catheter.
  • Agitation and restlessness: dying people who are confused or semi-conscious can become quite distressed. They may also cry out. Sometimes in their confusion, they may try and remove medical interventions such as canulas or other tubes into their body. Nursing staff will often give medication such as morphine to calm them down.
  • Dark bruising: as the body system slows down, blood may coagulate, or pool, particularly at the base of the spine, with patches which look like dark purple bruising.
  • Smell: the shutting down of the dying person&rsquos system and the changes of the metabolism from the breath and skin and body fluids create a distinctive acetone odour that is similar to the smell of nail polish remover. If a person is dying from bowel or stomach cancer, the smell can sometimes be pungent and unpleasant. Be aware that this will happen, and that it may at first be uncomfortable for you.
  • No longer responding: the person can no longer speak even when awake, and will take rasping breaths through an open mouth. This can sound like loud snoring which can be disconcerting to listen to. It also makes their mouth dry. You can help to ease this by gently wiping their mouth and lips with a damp cloth.
  • Breathing pattern change: the person can alternate between loud rasping breaths to quiet breathing. Towards the end, dying people will often breathe only periodically, with an intake of breath followed by no breath for several seconds, and then a further intake. This is known as Cheyne-Stokes breathing. This can be upsetting to witness as the person seems to have ceased breathing only to start again.

When death happens, it happens very quickly. There is no doubt about what is taking place. Sometimes the person will give several outward pants as their heart and lungs stop. Others may give a long out-breath followed quite a few seconds later by what seems another intake of breath. This may be repeated for several minutes, which can be alarming if you are not ready for it. However, this is only the lungs expelling air.

Other indicators are very clear:

  • There will be no pulse
  • Skin tone alters and the facial expression changes, or loosens. You may not feel you recognise the person anymore. Some people look remarkably at peace.
  • There is no awareness or alertness.

The moment of death

The moment of death can happen in many ways. It can be an intensely spiritual experience. Alternatively, it may feel rather prosaic. The essence of the person has gone, leaving behind a body that can seem like an empty envelope.

You may feel grief. You may feel numb. You may feel relief. It may feel like an anti-climax &ndash especially in a hospital or institution where nursing staff may be coming in and out to deal with necessary practicalities. There is no &lsquoright&rsquo or &lsquowrong&rsquo way to feel.

If it&rsquos what you want, staff may also leave you alone for a while with the body. This can be both reassuring and sometimes unexpectedly peaceful.

Death-related phenomena

Sometimes those present at the deathbed report less immediately physical experiences. Carers and relatives may talk of seeing vapours leaving or hovering over the body.

Others have described loving light filling the room or a sudden change in room temperature. Or there may be a heaviness in the air which takes time to clear, or there may be other strange phenomena such as clocks stopping at the moment of death, pets behaving out of character, or birds and butterflies appearing at the window.

Relatives and friends who were not there may experience &lsquoseeing&rsquo or sensing the dead person and knowing the exact time of death before they are officially informed. These &lsquovisitations&rsquo are usually comforting and reassuring, and very memorable.

Immediately afterwards

It&rsquos not unusual after someone has died, especially when you were present at the time, to feel disconnected from people, places or things. It can feel as if you are in a dream, or looking at life through frosted glass. This can be especially difficult when you are thrown into the intensity of making funeral arrangements.

It can be hard to explain how you are feeling, especially to those who have never witnessed a death. But feeling strange or disconnected from reality for a period of time is understandable when we have watched someone die.

You may also feel that you are being forced to face your own mortality, or you may feel you don&rsquot know what to do with yourself. You can find yourself aimlessly wandering around, feeling lost and alone and deeply questioning everything in your life..

However you experience what happens, life will never be the same again. It can&rsquot be after something so profound.

Over the following weeks and months, for some there may be emotional and spiritual rawness that throws up feelings of anger as well as grief. For others, it can be truly liberating. We only really know what we need to deal with as we go through our grieving process. Make sure you find the right support for yourself.


What happens to the body after death?

When someone dies, it may be the end of their journey through this world, but this is not the case with their body. Instead, it will begin the long process of shedding its components. So, what happens when bodies decompose, and why should we learn about it?

Share on Pinterest Decomposition is what naturally occurs to bodies after death. What is there to know about it?

For the majority of us, contact with the bodies of people who have passed away begins and ends with the sad occasion of a funeral.

And even then, what we usually get is either an urn with the person’s cremated remains, or a body laid out neatly in a casket, having been carefully prepared for the occasion by a funeral home.

What happens to bodies naturally, after they have had their grand encounter with death? What if they don’t get cremated or choose to become embalmed , so as to delay the process of decomposition and keep them “fit” for viewing for longer?

Under natural conditions — for example, if the body is left out in a natural environment, or placed in a shallow grave — a lifeless body begins to slowly disintegrate, until only the bones are left for future archeologists to dig up.

In this Spotlight, we describe the process of decomposition and explain why it can be useful to understand what happens to the body after death.

Although many of us may think of decomposition as synonymous with putrefaction, it is not. In fact, the decomposition of a human body is a longer process with many stages, of which putrefaction is only one part.

Decomposition is a phenomenon through which the complex organic components of a previously living organism gradually separate into ever simpler elements.

In the words of forensic scientist M. Lee Goff, it is “a continuous process, beginning at the point of death and ending when the body has been reduced to a skeleton.”

There are several signs that a body has begun its process of decomposition, Goff explains. Perhaps the three best-known ones, which are often cited in crime dramas, are livor mortis, rigor mortis, and algor mortis.

Livor, rigor, and algor mortis

Livor mortis, or lividity, refers to the point at which a deceased person’s body becomes very pale, or ashen, soon after death. This is due to the loss of blood circulation as the heart stops beating.

Goff explains, “[T]he blood begins to settle, by gravity, to the lowest portions of the body,” causing the skin to become discolored. This process may begin after about an hour following death and can continue to develop until the 9–12 hour mark postmortem.

In rigor mortis, the body becomes stiff and completely unpliable, as all the muscles tense due to changes that occur in them at a cellular level. Rigor mortis settles in at 2–6 hours after death and can last for 24–84 hours. After this, the muscles become limp and pliable once more.

Another early process is that of algor mortis, which occurs when the body goes cold as it “ceases to regulate its internal temperature.” How cold a body will go largely depends on its ambient temperature, which it naturally matches within a period of about 18–20 hours after death.

Other signs of decomposition include the body assuming a greenish tinge, skin coming off the body, marbling, tache noire, and, of course, putrefaction.

Other signs of decomposition

The greenish tint that the body may assume after death is due to the fact that gases accumulate within its cavities, a significant component of which is a substance known as hydrogen sulfide.

Share on Pinterest Putrefaction is ‘nature’s recycling process.’

This, Goff writes, reacts “with the hemoglobin in blood to form sulfhemoglobin,” or the greenish pigment that gives dead bodies their uncanny color.

As for skin slippage — in which the skin neatly separates from the body — it might sound less disturbing once we remember that the whole outer, protective layer of our skin is, in fact, made out of dead cells.

“The outer layer of skin, stratum corneum, is dead. It is supposed to be dead and fills a vital role in water conservation and protection of the underlying (live) skin,” Goff explains.

“ This layer is constantly being shed and replaced by underlying epidermis. Upon death, in moist or wet habitats, epidermis begins to separate from the underlying dermis […] [and it] can then easily be removed from the body.”

M. Lee Goff

When the skin comes clean off of a dead person’s hands, it is typically known as “glove formation.”

A phenomenon known as “marbling” occurs when certain types of bacteria found in the abdomen “migrate” to the blood vessels, causing them to assume a purple-greenish tint. This effect gives the skin on some body parts — usually the trunk, legs, and arms — the appearance of marble (hence its name).

Moreover, in instances wherein the eyes remain open after death, “the exposed part of the cornea will dry, leaving a red-orange to black discoloration,” Goff explains. This is referred to as “tache noire,” which means “black stain” in French.

Finally, there is putrefaction, which Goff calls “nature’s recycling process.” It is facilitated by the concerted actions of bacterial, fungal, insect, and scavenger agents over time, until the body is stripped of all soft tissue and only the skeleton remains.

Goff also notes that different scientists split the process of decomposition into different numbers of stages, but he advises considering five distinct stages.

The first one, the fresh stage, refers to the body right after death, when few signs of decomposition are visible. Some processes that may begin at this point include greenish discoloration, livor mortis, and tache noire.

Some insects — typically flies — may also arrive at this stage, to lay the eggs from which larvae will later hatch, which will contribute to stripping the skeleton of the surrounding soft tissue.

“As revolting as they may seem, flies and their larvae — maggots — are created perfectly for the job they need to do and many experts call them ‘the unseen undertakers of the world,'” writes pathology technician Carla Valentine in her book.

The egg-laying flies that are attracted to dead bodies, she explains, “are mainly bluebottles from the Calliphora genus,” which will “lay eggs on orifices or wounds only, because the very young larvae need to eat decaying flesh but can’t break the skin to feed.”

Another type of fly, she adds, “doesn’t lay eggs but tiny maggots, which can start consuming flesh immediately. These are descriptively named Sarcophagidae or ‘flesh flies.'”

At the second stage of decomposition, the bloated stage, is when putrefaction begins. Gases that accumulate in the abdomen, therefore causing it to swell, give the body a bloated appearance.

Down to the bones

During the third stage, that of decay, the skin breaks due to putrefaction and the action of maggots, allowing the accumulated gases to escape. Partly for this reason, this is when the body emanates strong, distinctive odors.

Mortician Caitlin Doughty offers a striking description of these smells in her book Smoke Gets In Your Eyes:

“ [T]he first note of a putrefying human body is of licorice with a strong citrus undertone. Not a fresh, summer citrus, mind you — more like a can of orange-scented industrial bathroom spray shot directly up your nose. Add to that a day-old glass of white wine that has begun to attract flies. Top it off with a bucket of fish left in the sun. That […] is what human decomposition smells like.”

Postdecay is the next-to-last stage of decomposition, in which, as Goff writes, “the body is reduced to skin, cartilage, and bone.” At this point, various types of beetle usually come in to remove the softer tissue, leaving only the bones behind.

The final stage of decomposition is the skeletal stage, in which only the skeleton — and sometimes hair — is left.

How long it takes for a body to decompose largely depends on the geographical area in which the body is found and the interaction of environmental conditions. If a body is found in a dry climate, with either very low or very high temperatures, it could mummify.


After a person's pulse and breathing stop, how much later does all cellular metabolism stop?

As best as anyone can gauge, cell metabolism likely continues for roughly four to 10 minutes after death, depending on the ambient temperature around the body.

During this time period, oxygenated blood, which normally exchanges carbon dioxide with oxygen, is not circulating. Thus, cell respiration&mdashwhich uses oxygen to make cellular energy while creating carbon dioxide as a by-product&mdashcreates carbon dioxide that is not transported out of the cell. This lowers the pH of the cell, resulting in an acidic intracellular environment. This acidic environment causes intracellular membranes to rupture&mdashincluding those around the cell's lysosome, which contains enzymes for digesting everything from proteins to fats and nucleic acids. Once the membranes have burst, these enzymes are released and begin to digest the cell from the inside out. This process is known as autolysis (or self-digestion).

The rate of autolytic spread throughout the body is dependent on the quantity of enzymes present&mdashthe dispersion in liver tissue, which is rich in these proteins, would take place much more rapidly than it would in lung tissue, which has a smaller reserve. This progression also depends on the amount of water present in a tissue. (The brain, being very high in water content, would degrade faster than, say, muscle tissue.) Autolytic spread, however, is most intimately tied to environmental temperature. In cold surroundings, the autolytic process slows down, while warm conditions speed up the progression. This is why people who have drowned in very cold water and are not recovered for an hour or so can, in some circumstances, be completely revived. The cold temperatures have slowed down the autolytic process to the point that no permanent damage has occurred in the tissues.

Autolysis will eventually affect all the cells of the body, although those on the surface of organs will show self-digestion's visual effects first&mdashin the form of very small, fluid-filled blisters. Once these rupture, the nutrient-rich fluids present within the blisters then fuel the onset of the second major phase of decomposition, called putrefaction, which is the process where microbiological organisms (in the body, on the body and in the environment) feed on the nutrient-rich fluids produced during autolysis.


Main Digest

A person's body can go without oxygen for approximately five to ten minutes and around three to eight days without water. Yet remarkably, people have been known to live for more than seventy days without food. The question that arises is, 'How can this be?'

The answer to this question lies in a series of evolved physiological and metabolic defenses that work to keep a person alive for as long as possible in the event they do not have access to food. Just because a person is starving does not mean they have become helpless. What follows is an explanation of how a person's body fights to keep them alive and active.

Defining the Word "Starvation"

Starvation is defined as a severe deficiency in caloric energy intake needed to maintain human life. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death. The basic cause of starvation is an imbalance between energy intake and energy expenditure. The term inanition refers to the symptoms and effects of starvation. Starvation can be caused by factors, other than illness, outside of the control of the individual.

By its very definition, starvation is a process. Our bodies are not like vehicles which promptly shut down when they are out of gasoline. When we experience prolonged low-energy intake and as long as water is available, our bodies enter into a series of metabolic modes. It is the body's way of recognizing that food is scarce and that it needs to re-allocate resources in preparation for what might be an extended period of time. Basically, a person's body is buying them some time to give them a chance to find some food.

Despite the cause, starvation takes about the same course and consists of three phases. The events of the first two phases happen even during fairly short periods of dieting or fasting. The third phase happens only in prolonged starvation and may end in the person's death.

The First Phase of Starvation

During the first stage of starvation, blood glucose levels are maintained through the production of glucose from proteins, glycogen and fats.

At first, glycogen is broken down into glucose. Only enough glycogen however, is stored in the person's liver to last a few hours. After that period of time, blood glucose levels are maintained by the breakdown of fats and proteins.

Fats are decomposed into glycerol and fatty acids. Fatty acids can be used as a source of energy, particularly by skeletal muscle, thereby decreasing the use of glucose by tissues other than the brain.

Glycerol may be used to make a small amount of glucose, yet most of the glucose is formed from the amino acids of proteins. Some amino acids might be used directly for energy.

The Second Phase of Starvation

In the second phase, which might last for several weeks, fats are the main energy source.

A person's liver metabolizes fatty acids into ketone bodies that can be used as a source of energy.

After approximately a week of fasting, a person's brain starts to use ketone bodies, as well as glucose, for sources of energy. Proteins not essential for survival are used first.

The Third Phase of Starvation

Additional signs of starvation may include flaky skin, changes in hair color and massive edema in the lower limbs and abdomen, causing the person's abdomen to seem bloated. During the process of starvation, the ability of the human body to consume volumes of food also decreases.

Foods low in protein yet high in bulk often times cannot reverse the process of starvation. Intervention involves feeding the affected person low-bulk food that provides lots of proteins and kilo-calories and is fortified with minerals and vitamins.

The process of starvation also results in dehydration and dehydration is an important part of intervention. Even with intervention, a person might be so affected by weakness or disease they do not have the ability to make a recovery.

Starvation and Death

Few people die directly from starvation because they usually die of an infectious disease first.

Starvation wreaks havoc on a person's immune system, largely on account of an extreme deficiency of minerals and vitamins. Some people will become weak and perish of immune-related diseases during starvation. Eventually, the person's body will run out of options. Fats, glucose, muscle mass and tissue are finite resources that will eventually be spent and the person will die. The end-stage of starvation usually brings with it one of two different diseases - kwashiorkor and marasmus.

Marasmus happens due to extreme energy deficiency, often from inadequate amounts of calories and protein. The person's body weight reaches dangerously low levels and infections are common. Kwashiorkor is a related disease that affects children who are protein-energy deficient and might result in edema and an enlarged and fatty liver, resulting in the distending of the children's bellies, providing the illusion that children who are starving are well-fed.

When the person's death finally arrives, its most immediate cause is by cardiac arrhythmia or a heart attack brought on by either extreme tissue degradation brought about by autophagy, or severe electrolyte imbalances. People can die of starvation in as little as three-weeks, or as long as seventy days.

About the Author

Thomas C. Weiss attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's para and quadriplegia to Spina Bifida.

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Fatality in neurodegenerative disorders

Neurodegeneration is thought to shorten the life expectancy of affected patients. If this concept is unfortunately true in many instances, it should be emphasized that not all “mortal” neurodegenerative disorders are fatal per se. Only those in which the affected neurological structures impair ability to control or execute such vital functions as respiration, heart rate, or blood pressure are unquestionably deadly. These include ALS, in which the loss of lower motor neurons innervating respiratory muscles leads the patient to succumb to respiratory failure. Alternatively, in diseases like Friedreich ataxia, the association of neurodegeneration with heart disease (33) can also cause the death of the patient, although, in this case, death is due not to any neuronal loss but instead to serious cardiac problems such as congestive heart failure. In most other neurodegenerative disorders, death is attributed neither to the disease of the nervous system nor to associated extra–nervous system degeneration but rather to the resulting motor and cognitive impairments that increase the risk of fatal accidental falling, aspiration pneumonia, pressure skin ulcers, malnutrition, and dehydration. Also, to our knowledge, there is no evidence that neurodegeneration increases the odds of developing comorbidity, such as with cancer, stroke, or heart attack, which remain the leading causes of death in industrialized countries. In conclusion, while a few specific neurodegenerative disorders directly cause death, most instead facilitate the occurrence of secondary health problems that carry a high mortality rate. Although this distinction may seem a matter of semantics, we believe that it is significant, not only for the management of patients, but also for our understanding of the actual consequences of the neurodegenerative process.


"What is the proper way to acclimatize?"

The human body is able to exist within an amazing range of environments, however, the necessary habituation processes usually take time. When climbing, it is advisable to adopt the "climb high, sleep low" strategy. Especially in expedition-style climbs, mountaineers will often climb as high as they safely can during the day, but return to a much lower elevation to sleep. Increasing the sleeping elevation by only 350m (1,150ft) per day, greatly reduces the chances of getting one the the potentially deadly altitude-related conditions (AMS, HACE & HAPE). Every 1000m (3,280ft), climbers should factor in a rest day, in order to fully get used to the new atmospheric pressure. If any member of your party doesn't feel well sleeping at a particular altitude, wait until normal functions have returned before attempting to go higher. By conservatively observing these practices, you should stay relatively safe regarding altitude-related illness.

Alpine-style climbs, on the other hand, usually entail light and fast climbing, which doesn't leave much time to "climb high, sleep low." In this situation, a specific acclimatization climb may be in order, where a group climbs a slightly lower peak observing proper acclimatization principles, and then quickly travels to their chosen mountain where they can safely complete an alpine-style ascent. Acclimatization is rapidly lost after leaving high altitudes, so fast travel and rapid re-ascent are imperative to maintaining altitude adaptation.

It should also be noted that in the "Death Zone," above 7500m (24,600ft), acclimatization is virtually impossible. There are a very few people with the genetic predisposition to be able to exist at these extreme elevations. Climbers like Ed Viesturs and the late Babu Chiri Sherpa possess a better-than-average ability to absorb oxygen into their bloodstream. While modern medicine cannot do anything to boost this ability for those of us who "didn't choose their parents well," doctors can test this genetic ability to predict who may perform well at altitude. Most people should limit their exposure to altitudes such as these to the minimum amount possible, as the human body is slowly going through the process of dying. The idea is to get up and back down fast enough such that you don't have a chance to die all the way. Viesturs describes being in the "Death Zone" as "climbing on borrowed time." If you are not extremely careful, your time may run out.


The shocking

Death can be shocking enough. But imagine if you had said your final goodbye, the last breath has come and gone, then the person who you thought was dead suddenly draws a gasp and twitches.

Agonal breathing or agonal gasps are the last reflexes of the dying brain.

They are generally viewed as a sign of death, and can happen after the heart has stopped beating.

Another strange and disturbing reflex that has been observed after death is called the Lazarus reflex.

People who have been declared brain dead and have had artificial ventilation turned off have been seen to raise their arms and lower them slowly, sometimes crossed across the chest, sometimes by their side.

Brain death may also be accompanied by other reflexes that are no more a sign of life than the jerk of your knee when it is tapped with a hammer.

These include repetitive facial twitches, slow toe twitches and even the entire leg twitching.

Thankfully these more disturbing aspects of death tend to be rare.

Being with someone when they die may be a confronting and even terrifying prospect to many.

But of those people who have sat with a loved one — or even a stranger — when that person died, very few regret it.

For most people who are present at this event, it is a gift a chance for stillness and communion and honesty and reflection that we are rarely granted at any other time in life.

Bianca Nogrady is a freelance science journalist and author of the book The End: The Human Experience Of Death.


Considerations

If the deceased person was involved in an accident or caused an event that injured or killed others, experts must take care to either confirm or rule out intoxication as a factor. Because alcohol production in the body after death is chemically the same as that from drinking, blood-alcohol content alone cannot determine whether the person consumed alcohol before death. The alcohol level of the person's urine may not give an accurate before-death picture either. The vitreous humour sample usually proves more useful in estimating intoxication, but in the end, the medical examiner must take into account the body's weight, age, sex, fat content, time of death and other factors.