The aim of our study was to gain more knowledge about the significance of acute alcoholization at the moment of death. The blood-alcohol concentrations of all sudden unexpected and nonnatural fatalities that were investigated at the Institute of Legal Medicine in Hamburg (5044 fatalities with an age below 60 years: 1177 females, 3867 males) were tested in a prospective 5-year-series (1989-1993). Measurable blood-alcohol concentrations (at least > or = 0.1 / 1000) were found in 30.2% of all deceased. Higher concentrations of > 2 / 1000 existed in 436 cases (8.6%). Alcohol prevalence and the amount of alcoholization are discussed with respect to age, sex and the manner of death (sudden natural death, accident, suicide, homicide). Alcohol as a relevant factor in sudden/unexpected death and nonnatural death seems to be underestimated. Only a small proportion of these cases are elucidated by way of routine police investigations or by the insurance companies.