Abstract
The rate of alcohol elimination from blood was determined in drunken drivers by taking two blood samples about 1 h apart. These cases were selected because the individuals concerned had reached an extremely high blood-alcohol concentration (BAC) when they were apprehended. This suggests a period of continuous heavy drinking leading to the development of metabolic tolerance. Use of double blood samples to calculate the elimination rate of alcohol from blood is valid provided that drunken drivers are in the post-absorptive phase of the BAC curve, the time between sampling is not too short, and that zero-order elimination kinetics operates. Evidence in support of this came from other drunken drivers in which three consecutive blood samples were obtained at hourly intervals. The mean BAC (N = 21) was 4.05 g/l (range, 2.71–5.18 g/l), and the average rate of alcohol elimination from blood was 0.33 g l−1 h−1 with a range of 0.20–0.62 g l−1 h−1. The possibility of ultra-rapid rates of ethanol elimination from blood in drunken drivers having extremely high BAC deserves to be considered in forensic casework, e.g., when retrograde extrapolations and other blood-alcohol calculations are made. The mechanism accounting for more rapid metabolism is probably related to induction of the microsomal enzyme (CYP2E1) pathway for ethanol oxidation, as one consequence of continuous heavy drinking. However, the dose of alcohol and the duration of drinking necessary to boost the activity of CYP2E1 enzymes in humans have not been established.
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References
Al-Lanqawi Y, Moreland TA, McEwen J, Halliday F, Durnin CJ, Stevenson IH (1992) Ethanol kinetics; extent of error in back extrapolation procedures. Br J Clin Pharmacol 34:316–321
Bogusz M, Pach J, Stasko W (1977) Comparative studies on the rate of ethanol elimination in acute poisoning and in controlled conditions. J Forensic Sci 22:446–451
Brick J (2006) Standardization of alcohol calculations in research. Alcohol Clin Exp Res 30:1276–1287
Brinkmann B, Beike J, Kohler H, Heinecke A, Bajanowski T (2002) Incidence of alcohol dependence among drunken drivers. Drug Alcohol Depend 66:7–10
Coon MJ, Koop DR (1987) Alcohol-inducible cytochrome P-450 (P-450ALC). Arch Toxicol 60:16–21
Crabb DW, Borson WF, Li TK (1987) Ethanol metabolism. Pharm Ther 34:59–73
Crabb DW, Dipple KM, Thomasson HR (1993) Alcohol sensitivity, alcohol metabolism, risk of alcoholism, and the role of alcohol and aldehyde dehydrogenase genotypes. J Lab Clin Med 122:234–240
Ferner RE (1996) Forensic pharmacology: medicines, mayhem, and malpractice. Oxford University Press, Oxford, pp 1–249
Gabrielsson J, Weiner D (2004) Pharmacokinetic and pharmacodynamic data analysis: concepts and applications, 4th edn. Swedish Pharmaceutical Press, Stockholm, pp 1–1250
Girre C, Lucus D, Hispard E, Menez C, Dally S, Menez JF (1994) Assessment of cytochrome P4502E1 induction in alcoholic patients by chlorzoxazone pharmacokinetics. Biochem Pharmacol 29:1503–1508
Haffner HT, Besserer K, Stetter F, Mann K (1991) Die Äthanol-Eliminationsgeschwindigkeit bei Alkoholikern unter besonderer Berücksichtigung der Maximalwertvariante der forensischen BAK-Rückrechnung. Blutalkohol 28:46–54
Haffner HT, Batra A, Bilzer N et al (1992) Statistische Annäherung an forensische Rückrechnungswerte für Alkoholiker. Blutalkool 29:53–61
Hagedorn E, Steigleder E (1968) Statistische Untersuchungen über die Beziehungen zwischen Trinkende und Resorption anhand von doppelten Blutentnahmen. Blutalkohol 5:468–481
Holford NHG (1987) Clinical pharmacokinetics of ethanol. Clin Pharmacokinet 13:273–292
Jacobsen E (1952) The metabolism of ethyl alcohol. Pharmacol Rev 4:107–135.
Jackson PR, Tucker GT, Woods HF (1991) Backtracking booze with Bayes —the retrospective interpretation of blood alcohol data. Br J Clin Pharmacol 31:55–63
Jones AW (1991) Limits of detection and quantitation of ethanol in specimens of whole blood analyzed by headspace gas chromatography. J Forensic Sci 36:1277–1279
Jones AW (1993) The disappearance rate of ethanol from blood in human subjects: implications in forensic toxicology. J Forensic Sci 38:104–118
Jones AW, Alling C, Becker W, Änggård E (1983) Tolerance to ethanol in rats bred on essential fatty acid deficient diets. Pharmacol Biochem Behav 19:115–119
Jones AW, Schuberth J (1989) Computer-aided headspace gas chromatography applied to blood-alcohol analysis; Importance of on-line process control. J Forensic Sci 34:1116–1127
Jones AW, Jönsson KÅ, Neri A (1991) Peak blood-alcohol concentration and time of its occurrence after rapid drinking on an empty stomach. J Forensic Sci 36:376–385
Jones AW, Sternebring B (1992) Kinetics of ethanol and methanol in alcoholics during detoxification. Alcohol Alcohol 27:641–647
Jones AW, Jönsson KA (1994) Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal. J Forensic Sci 39:1084–1093
Jones AW, Andersson L, Kopp L (1994) Enforcement of drunk driving laws in Sweden with blood and breath alcohol concentration as evidence for prosecution. Krim Forens Wissenschaft 82:11–26
Jones AW, Andersson L (1996) Influence of age, gender, and blood-alcohol concentration on the disappearance rate of alcohol from blood in drinking drivers. J Forensic Sci 41:922–926
Jones AW, Holmgren P (2003) Comparison of blood-ethanol concentration in deaths attributed to acute alcohol poisoning and chronic alcoholism. J Forensic Sci 48:874–879
Kalant H (1996a) Pharmacokinetics of ethanol: absorption, distribution and elimination. In. Begleiter H and Kissin B (eds) The pharmacology of alcohol and alcohol dependence. Oxford University Press, New York, pp 15–58
Kalant H (1996b) Current state of knowledge about the mechanisms of alcohol tolerance. Addict Biol 1:133–141
Kalant H (2004) Effects of food and body composition on blood alcohol levels. In: Preedy V, Watson R (eds) Comprehensive handbook of alcohol related pathology, vol. 1. Elsevier, London, pp 87–101
Keiding S, Christensen NJ, Damgaard SE et al (1983) Ethanol metabolism in heavy drinkers after massive and moderate alcohol intake. Biochem Pharmacol 32:3097–3102
Klockhoff H, Näslund I, Jones AW (2002) Faster absorption of ethanol and higher peak concentration in women after gastric-bypass surgery. Br J Clin Pharmacol 54:587–591
Knight B (1991) Forensic pathology. Edward Arnold, London
Koop DR, Coon MJ (1996) Ethanol oxidation and toxicity—role of alcohol P450 oxygenase. Alcohol Clin Exp Res 10(Suppl 6):44S–49S
Lentner C (1981) Units of measurements, body fluids, composition of the body, nutrition. Geigy scientific tables, vol. 1. Ciba-Geigy, Basel
Lewis KO (1987) Back calculation of blood alcohol concentration. BMJ 295:800–801
Lewis MJ (1986) Blood alcohol: the concentration-time curve and retrospective estimation of level. J Forensic Sci Soc 26:95–113
Li TK, Yin SJ, Crabb DW, O’Connor S, Ramchandani VA (2001) Genetic and environmental influences on alcohol metabolism in humans. Alcohol Clin Exp Res 25:136–144
Lieber CS (2000) Hepatic, metabolic, and nutritional disorders of alcoholism: from pathogenesis to therapy. Crit Rev Clin Lab Sci 37:551–584
Lieber CS (2004) CYP2E1: from ASH to NASH. Hepatol Res 28;1–11
Lockemann U, Puschel K (1991) On blood alcohol concentrations of drunken drivers exceeding 3‰ in Hamburg 1979–1988. J Traffic Med 19:61–67
Lucus D, Menez C, Girre C, Bodenez P, Hispard E, Menez JF (1995) Decrease in cytochrome P4502E1 as assessed by the rate of chlorzoxazone hydroxylation in alcoholics during withdrawal phase. Alcohol Clin Exp Res 19:362–366
Lund A (1979) The rate of disappearance of blood alcohol in drunken drivers. Blutalkohol 16:395–398
Lundqvist F, Wolthers H (1958) The kinetics of alcohol elimination in man. Acta Pharmacol Toxicol 14:265–289
Mallach HJ, Röseler P (1962) Über die hochgradige Alkoholwirkung beim Menschen. Blutalkohol 1:161–175
Montgomery MR, Reasor MJ (1992) Retrograde extrapolation of blood alcohol data: an applied approach. J Toxicol Environ Health 36:281–292
Neuteboom W, Jones AW (1990) Disappearance rate of alcohol from the blood of drunk drivers calculated from two consecutive samples; what do the results really mean? Forensic Sci Int 45:107–115
Norberg A, Jones AW, Hahn R, Gabrielsson J (2003) Role of variability in explaining ethanol pharmacokinetics. Research and forensic applications. Clin Pharmacokinet 42:1–31
Oneta CM, Lieber CS, Li J et al (2002) Dynamics of cytochrome P4502E1 in man; induction by ethanol and disappearance during withdrawal phase. J Hepatol 36:47–52
Perper JA, Twerski A, Wienand JW (1986) Tolerance at high blood alcohol concentrations; a study of 110 cases and review of the literature. J Forensic Sci 31:212–221
Rowland M, Tozer TN (1980) Clinical pharmacokinetics—concepts and applications. Lea & Febiger, Philadelphia
Schweitzer H (1968) Statistische Untersuchungen zur Alkoholelimination an 1512 Doppelentnahmen. Blutalkohol 5:73–91
Stead AH, Moffat AC (1983) A collection of therapeutic, toxic, and fatal blood drug concentrations in man. Human Toxicol 3:437–464
Sullivan JB, Hauptman M, Bronstein AC (1987) Lack of observable intoxication in humans with high plasma alcohol concentrations. J Forensic Sci 32:1660–1665
Teschke R, Gellert J (1986) Hepatic microsomal ethanol-oxidizing systems (MEOS): metabolic aspects and clinical implications. Alcohol Clin Exp Res 10(Suppl 6):20S–32S
Urso T, Gavaler JS, Van Thiel DH (1981) Blood ethanol levels in sober alcohol users seen in an emergency room. Life Sci 28:1053–1056
Voas RB, Romano F, Tippetts AS, Farr-Holden CD (2006) Drinking status and total crashes; which drinkers contribute most to the problem? J Stud Alcohol 63:722–729
Wartburg JP Von (1989) Pharmacokinetics of alcohol. In: Crow KE, Batt RD (eds) Human metabolism of alcohol, vol. 1. CRC, Boca Raton, pp 9–22
Watkins RL, Adler EV (1993) The effect of food on alcohol absorption and elimination patterns. J Forensic Sci 38:285–291
Widmark EMP (1922) Eine Mikromethode zur Bestimmung von Äthylalkohol im Blut. Biochemische Z 131:473–484
Widmark EMP (1932) Die theoretischen Grundlagen und die praktische Verwendbarkeit der gerichtlich-medizinischen Alkoholbestimmung. Urban & Schwarzenberg, Berlin, pp 1–140
Widmark EMP (1981) Principles and applications of medicolegal alcohol determination. Biomedical Publications, Foster City, CA, pp 1–163
Zink P, Reinhardt G (1984) Der Verlauf der Blutalkoholkurve bei großen Trinkmengen. Blutalkohol 21: 422–442
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Jones, A.W. Ultra-rapid rate of ethanol elimination from blood in drunken drivers with extremely high blood-alcohol concentrations. Int J Legal Med 122, 129–134 (2008). https://doi.org/10.1007/s00414-007-0181-7
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DOI: https://doi.org/10.1007/s00414-007-0181-7