BLOOD ALCOHOL
WHOLE, SERUM, PLASMA, VENOUS

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PubMed/Medline
See also: Blood/Breath tests

Carey, K. B., Hustad, J. T.; "Are retrospectively reconstructed blood alcohol concentrations accurate? Preliminary results from a field study", JOURNAL OF STUDIES ON ALCOHOL (2002), 63(6):762-6. (44 persons were studied, 64% male and 34% female.)The purpose of this study was to evaluate the relationship between blood alcohol concentration (BAC) derived from an invivo breath test and retrospective estimates of BAC (eBAC) for the same drinking event. The relationship was expected to be lower at higher levels of BAC as a result of inaccuracies in the recall of self-report data. Conclusions: Although self-report data can be used to approximate the BAC obtained during a naturally occurring drinking event the relationship is moderated by measured level of intoxication. Retrospective calculations are less accurate when estimating higher BACs.

Charlebois, R. C.; Corbett, M. R.; Wigmore, J. G.; "Comparison of ethanol concentrations in blood, serum, and blood cells for forensic application," JOURNAL OF ANALYTICAL TOXICOLOGY (1996), 20: 171-177. (SAC:BAC ratios ranged between 1.04 and 1.26. The mean was 1.14 and the normal distribution had a standard deviation of 0.041.) Jones, A. W.' "Determination of liquid/air partition coefficients for dilute solutions of ethanol in water, whole blood, and plasma," JOURNAL OF ANALYTICAL TOXICOLOGY (1983), 7: 193-97.

Detting, A,; Witte, S.; Skopp, G.; Graw, M.; Haffner, M. T.; "A regression model applied to gender-specific ethanol elimination rates from blood and breath measurement in non-alcoholics", INTERNATIONAL JOURNAL OF LEGAL MEDICINE (2009), 123 (5): 381-5. As elimination rates for alcohol are suggested to gender specific, a novel regression model has been applied to estimate those rates for both men and women using experimentally measured data from 81 female and 96 male volunteers described in previous papers. Breath alcohol measurements were done with the Alcotest 7110 evidential device and were coupled with concomitant sampling of venous blood. Statistical analyses involved use of a mixed linear model for blood alcohol concentration (BAC) and breath alcohol concentration (BrAC), respectively. The model takes regression lines for each test subject into account with an individual starting value (2 h after the end of drinking) and with an individual alcohol elimination rate per hour (coincidental effects). Further, the data was modeled so that an average alcohol elimination rate per hour could be estimated separately for both genders (constant effects). This enables us to methodically correctly estimate the back calculation. The elimination rates beta (60), which can be use for minimum and maximum back calculations for the BAC, were 0.115 g/kg/h and 0.260 g/kg/h, respectively, for women and 0.096 g/kg/h and 0.241 g/kg/h, respectively for men these figures widely deviate from gender-unspecific values commonly used in Germany (0.1 and 0.23 g/kg/h, respectively). The corresponding values for the BrAC were 0.061 mg/l/h and 0.124 mg/l/h for women and 0.049 mg/l/h and o.112 mg/l/h for men. The probability of an over-or underestimation of the above mentioned extreme values is 0.3% in each case.

Dubowski, K.; Gadsden, R. H. , Sr.; Poklis, A.; "The stability of ethanol in human whole blood concentrations : an inter-laboratory evaluation," JOURNAL OF ANALYTICAL TOXICOLOGY (1997), 21 (6): 486-91. [Whole blood and sodium alzide as a preservative showed no loss of alcohol over a one year period.]

Gubala, W., Zuba, D., Pickoszewski, W.; "Variability of BAC/BrAC and SAC/BrAC ratios during absorption and elimination of alcohol", Proceedings of the 16th International Conference on Alcohol, Drugs, and Traffic Safety, Montreal, Canada, August 4-9, 2002. Volume 3, pp 8031244. This is paper was not PEER REVIEWED.

Head, William C,; "Defense of driving under the influence cases"; In: Garriott, James C., ed.; Medicolegal aspects of alcohol, 3rd ed. Lawyers & Judges Publishing Company, Inc., c1996, 526p.

Haffner, HT.; Graw, M.; Dettling, A.;' Schmitt, G.; Schuff, A.; "Concentration dependency of the BAC/BrAC (blood alcohol concentration/breath alcohol concentration) conversion factor during the linear elimination phase", INTERNATIONAL JOURNAL OF LEGAL MEDICINE (2003), 117 (5): 276-81. Note: N-12 subjects who were measured between 18 and 34 times. This research would need to be replicated by more subjects

Jones, A. W.' "Determination of liquid/air partition coefficients for dilute solutions of ethanol in water, whole blood, and plasma," JOURNAL OF ANALYTICAL TOXICOLOGY (1983), 7: 193-97.

Jones, A. W.; "DUI defenses"; In: Steven B. Karch, Ed.; Drug Abuse Handbook, CRC Press, 1998, 1138p. [ Include: drinking after the offense; laced drinks; rising blood alcohol concentrations; pathological states and ethanol pharmacokinetics; drug-alcohol interactions; gastric alcohol dehydrogenase; endogenous ethanol and the autobrewery syndrome; urine samples; blood samples--use of alcohol swabs and disinfectants, trauma and intravenous fluids (sample should be taken above the IV site), blood-water content and hematocrit (serum or plasma and whole blood); breath-alcohol analysis--mouth alcohol and the use of mouthwash preparations; regurgitation and gastro esophageal reflux disease; dentures and denture adhesives; alleged interfering substances in breath; variability in blood/breath alcohol ratio; pulmonary function; breathing pattern and hypo- and hyperthermia.]

Jones, A. W.; "Limits of detection and quantities of ethanol in specimens of whole blood from drinking drivers analyzed by headspace gas chromatography," JOURNAL OF FORENSIC SCIENCES (1991), 36 (5): 1277-79.

Jones, A. W,; Lindberg, L.; Olsson, S. G.; "Magnitude and time-course of arterio-venous differences in blood-alcohol concentration in healthy men", CLINICAL PHARMACOKINETICS *2004), 43(15):1157-66. (9 male subjects). The authors investigated the intravenous and intra-arterial concentrations of alcohol (ethanol) during the absorption, distribution and elimination state of alcohol metabolism in health men. The conclusion was that "arterial and venous blood-alcohol profiles were shifted in time owing to the time it takes for alcohol to equilibrate between arterial blood and tissue water. Alcohol is metabolized in the liver, but not in muscle tissue, which acts as a reservoir for alcohol. The concentrations of alcohol in arterial and venous blood were the same at only one timepoint, which signifies complete equilibration of alcohol in total body water. During the entire post=absorptive phase, the concentration of alcohol in venous blood draining skeletal muscles was slightly greater than the arterial blood concentration, therefore, the AV differences were negative.

Jones, A. W.; Jorfeldt, L.; Hjertbert, H.; Jonsson, K. A.; "Physiological variations in blood ethanol measurements during the post-absorptive state," JOURNAL OF THE FORENSIC SCIENCES SOCIETY (1990), 30 ( 5) : 273-83. (9 volunteers, moderate drinkers, .08 g/kg body weight ethanol in orange juice over 30 minutes. Specimens of arterial plasma and venous whole blood were take at 3-10 minute intervals during the post-peak phase of ethanol metabolism. Time-to-time variations were seen, it was concluded that the study did not support the existence of sporadic fluctuations in the blood alcohol concentrations (BAC) profile but does support the need for careful control of sampling methods.

Jones, A. W.; "Salting-out effect of sodium fluoride and its influence on the analysis of ethanol by headspace gas chromatography (letter to the editor)," JOURNAL OF ANALYTICAL TOXICOLOGY (1994), 18: 292-3.

Kaye, S.: " The Collection and handling of the blood alcohol specimen," AMERICAN JOURNAL OF CLINICAL PATHOLOGY (1980), 74: 743-746. [Dated, see Dubowski article on same subject.]

Levine, B; Smialek, J. E.; "Status of alcohol absorption in drinking drivers killed in traffic accidents", JOURNAL OF FORENSIC SCIENCES (2000), 45 (1); 3-6. One issue which constantly confronts the forensic toxicologist in drinking driver cases is the relationship between the breath and blood alcohol concentration (AC) of the driver at the time of an event such as a traffic stop or an accident and the AC measured at a time subsequent to the event. In theory, the AC can be rising, on a plateau or declining at the time of the event. Several studies have indicated that the overwhelming majority of drinking drivers are on a plateau or are post-absorptive at the time of the event. In this study, driver fatality case investigated by the Office of the Chief Medial Examiner, State of Maryland during a three-year period were reviewed. Included in this study were cases positive for alcohol in the blood at a cut off of 0.010 g/dl and death occurring within 15 min, of the accident. In fact, many of these deaths were instantaneous based on the injuries documented by the medical examiner at autopsy. The blood and urine were analyzed for alcohol by head-space gas chromatography and urine AC to blood AC rations were calculated. A total of 129 cases were included in this study. Eleven of the 129 cases (8.5%) had urine to blood AC ration less that 1.0. It is likely that these individuals were in the absorptive phase at the dime of that the accident occurred. 32 cases had a urine to blood AC ratio between 1.0 and 1.2 inclusive. In these cases, the subject could be viewed as in the plateau phase of the blood AC versus time curve. The remaining 86 cases had a urine to blood AC ration greater than 1.2. This suggests that these individuals were int he post-absorptive state at the time of the accident. This information acquired from this study provides additional evidence to support the notion that the vast majority of individuals are not in the absorptive phase at the time of a traffic stop or accident.

McCartt, Anne T., Williams, Allan F., "Characteristics of fatally injured drivers with high blood alcohol concentrations (BACs)" Insurance Institute for Highway Safety, 2004. Blood alcohol concentrations (BACs) of fatally injured passenger vehicle drivers in the United States were used to examine the current and historical distributions of BACs and the characteristics of fatally injured drivers by BAC categories, including those with very high BACs. All categories of illegal BACs (0.08 percent or higher) declined substantially from 1982 to 2002, and declines were similar across BAC categories. Among illegally impaired drivers, the prevalence of several driver and crash characteristics increased systematically, but gradually, with increasing BACs. This study does not support the claim that "hard core drinking drivers" have become a larger part of the problem and have been unaffected by general deterrent approaches.

Rainey, P. M.; "Relation between serum and whole-blood ethanol concentrations," CLINICAL CHEMISTRY (1993), 39 (11): 2288-2292.

Ridker, P. M.; Vaughan, D. E.; Stampfer, M. J.; Glynn, R. J.; Hennekens, C. H.; "Association of moderate alcohol consumption and plasma concentration of endogenous tissue-type plasminogen activator," Journal of the American Medical Association, (1994), 273 (12): 929-933.

Shajani, N. K., Godolphin, W.; Image, B. A.; "Blood alcohol analysis: comparison of whole blood analysis by gas chromatography with serum analysis by enzymatic method," CANADIAN FORENSIC SCIENCES JOURNAL (1989), 22 (1): 317-329. [Venous blood samples were drawn from 14 drinking subjects and analyzed by gas chromatographic procedure and compared with serum samples analyzed by DuPont ACA III Discrete Clinical Analyzer. The Conversion factor for serum to whole blood for alcohol was found to be 1.14 (range 1.12-1.18, s.d. 0.015.)]

Simie, M.; Tasic, M.; Stojiljkovic, G.; Budakov, B.; Vukovic, R.; "Cognac alibi" as a drunk-driving defense and medico-legal challenge, MEDICINE AND THE LAW (2004), 23: 367-378. Some drivers with positive forensic ethanol analyses, offer an explanation that they consumed alcohol a short time before a traffic accident or after driving. In medico legal practice this is commonly known as hip-flask defense, but to us as "cognac alibi" defense. In these cases, the lawyers require the medico legal experts to offer as much information as possible so that the curt may come to the most reliable conclusions about the driver's blood alcohol concentration at the moment of the traffic accident (BACAcc). At the Institute of Forensic Medicine our own analytical approach was established to study this medico legal problem. It consists of three interrelated phases in which it combines the obtained BAC values, with testimonies of the drunk driving suspect and also witnesses. A specific algorithm was designed for calculating absorption and elimination of consumed alcohol. All the above-mentioned elements and blood-ethanol values calculated according to Widmark's method were inserted into appropriate cells of MS Excel software in order to calculate BAC in the function of time. The result is a relevant analysis of the drunk driving suspect's BAC in 5-minute intervals, as well as a graphic representation in chart form.

Thomasson, H., "Alcohol elimination: faster in women?" ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH (2000), 24 (4): 419-240. 11.(References) (The author describes his study examining gender differences in ethanol elimination rates in 45 male and 45 female subjects with identical ADH2 and ALDH2 genotypes and with control of as many relevant environmental factors as possible. The ethanol elimination rate was significantly higher in women than in men, but how this related to women's greater vulnerability to ethanol toxicity is a mystery.)This is one of a series of short papers that were presented at a workshop on issues relevant to the absorption, distribution, and elimination of alcohol in non-alcoholics. The meeting was convened by the National Institute on Alcohol Abuse and Alcoholism. This article is not peer reviewed.

Winek, C. L.; Carfagna, M.; "Comparisons of plasma, serum, and whole blood ethanol concentrations," JOURNAL OF ANALYTICAL TOXICOLOGY (1987), 11: 267-68.

Winek, T.; Winek, C. L.; Wahba, W. W.; "The Effect of storage at various temperature on blood alcohol concentration," FORENSIC SCIENCE INTERNATIONAL (1996), 78 (3): 179-84. [It is concluded that a whole blood sample obtained from a living individual and stored in a locker, glove compartment or other environment where the temperatures is elevated, may lose 10-19% of its alcohol content over 35 days of storage. On the other hand, when serum or plasma is exposed to the same environment, no significant change in SAC was observed.]

Zernig, Charles and Battista Hans J., "How to Calculate maximum blood alcohol levels after a drinking event " In: HANDBOOK OF ALCOHOLISM, edited by Gerald Zernig, Boca Raton: CRC Press, 2000, pp. 419-420. "Under real-life drinking conditions, the maximum blood alcohol levels were, on average, found to be 10 to 30% lower than those obtained with Widmark's formula.

Zernig, Charles and Battista Hans J., "Basic pharmacokinetics of alcohol" In: HANDBOOK OF ALCOHOLISM, edited by Gerald Zernig, Boca Raton: CRC Press, 2000, pp. 421-423. "After consumption, 10 to 20% of alcohol is absorbed in the stomach and 80 to 90% in the small intestine, especially in the duodenum. The rate of absorption varies greatly, peak BAL time ranging from 100 to 100 min after the downing of 0.7 kgk-1 neat whiskey on an empty stomach by male volunteers. For forensic purposes, absorption is considered to be complete 90 minutes after the end of a drinking bout."


About the blood\ breath tests:
11:41 pm PBT .99 (under .10) "just under .10" R. Anderson
12:28 am plasma draw BAC .120 tested October 7, 1996
12:28 am whole blood draw BAC .087 tested October 30, 1996
If you convert the BrAC at 11:41 pm to BAC by increasing it by the 10-20% Dubowski espouses, that level would be .109 to .118 BrAC at 11:41 p.m.

PBT
Date Time Reading 10-20% for undervaluation 0.014% per hr. 0.020% per hr.
10/04/96 11:41 pm .099 0.109 - 0.118 0.118 - .129 0.121 - 0.130
.120 BAC test
10/07/96 .120 0.102 conversion whole blood 0.13 0 0.142

The testimony doesn't answer the question of how Rokes' PBT result was higher more than an hour after he stopped drinking on an empty stomach and why Rokes' BAC tested at .087 1.5 hours after the crash, or nearly 2 hours after he quit drinking. If his BAC really was between .087 to .050 as Mr. Jensen testified, at the time of the crash to have the same or an increased BAC, Rokes would have had to imbibe more alcohol after the crash. At 11:41 pm the PBT is .99, at 12:20 a.m. BAC is .087, this is a .012 elimination rate over 40 minutes, therefore over an hour Rokes may have been eliminating at the rate of .018 and his BAC was most likely in the range of [.018 x 1.5 hours for an elimination total of .027 plus .087 equals .114 or higher. Both tests together determine that Rokes' BAC was decreasing after the crash.

Even without adding 10-20% for the undervaluation, just adding 0.010 for one hour of elimination of, one had the answer of 0.113 - 0.119.

Rehberg testified that he believed Rokes was "probably at .115 BAC at the time of the collision" (Page 477 criminal trial), or 0.015 EER times two for the two hours from the time he quit drinking, adding .030 to .087 BAC you get .117 BAC.

Jensen converted the .120 BAC hospital plasma by decreasing it by 15% to .102. (Page 38 civil trial deposition.)

Page 56 line
17 A. --it's .117 at the time of peak, if
18 that occurred at 11:30.

Bederka's Report: Results of the BAC Calculations:

The Plasma Alcohol Value of 120 mg/dl (0.125%) when corrected for the conversion to a Whole Blood Equivalent value affords a range of 103-109 mg/dl (0.103-0.109%) at the drawing time of 00:28 on October 5, 1996. Thus, the BAC Profile of Mr. Rokes back to the time of the accident is probably as follows:

BAC Range (%)

Date Time 0.014% per hr. 0.020% per hr.

10/05/96 00.28 0.103 - 0.109 0.103 - 0.109

10/04/96 23:2 8 0.117 - 0.123 0.132 - 0.138

10/04/96 22.58 0.124 - 0.130 0.147 - 0.153

updated 12/12/16