Abstract
AimClaimed intake of alcohol after a traffic incident, called the hip-flask defence, can be objectively assessed by different methods. One of them is the use of two consecutive ethanol concentrations in urine and the ratio between ethanol concentrations in urine and blood. Another one is the concentrations of ethyl glucuronide (EtG) and ethyl sulphate (EtS) in blood and their ratio to ethanol. The experimental basis for both these models is from single dose studies only. The aim of this study was therefore to describe the kinetics of ethanol, EtG and EtS after ingestion of two repeated doses of ethanol and to investigate the usefulness of the different models for the assessment of the hip-flask defence. MethodsThirty-five subjects ingested a first dose of 0.51 g of ethanol per kilo body weight, and two hours later a second dose (the hip-flask drink) of 0.25, 0.51 or 0.85 g of ethanol per kilo body weight. Ten urine and 17 blood samples were collected and analysed for ethanol, EtG and EtS using fully validated methods. It was investigated if all subjects fulfilled the criteria for recent drinking, according to the two different models, when using the samples collected 180–240 minutes after start of first dose drinking. According to the first model, increase in urinary ethanol concentrations and a ratio UAC/BAC below 1.3 indicated recent drinking. According to the second model, increase in blood EtG concentrations and a ratio ethanol (g/kg)/EtG (mg/L) above 1 indicated recent drinking. ResultsAll subjects in the high dose group fulfilled all criteria for recent drinking. One subject in the medium dose group and nine subjects in the low dose group failed to show increasing UAC and/or a UAC/BAC ratio below 1.3. One subject in the low dose group failed to show increasing concentrations of blood EtG, but all subjects showed a ratio ethanol/EtG above 1. ConclusionsThe present study showed, by the use of experimental data, that both two models used to investigate the hip-flask defence can be used, but only when the hip-flask dose is sufficiently high.
Highlights
Use of non-alcohol drugs increases, ethanol is still widely detected in impaired drivers, and this is the drug associated with the highest increase in risk of traffic accident, both fatal and non-fatal [1,2,3,4,5,6]
As the shipping period was much shorter than three months, both ethyl glucuronide (EtG) and ethyl sulphate (EtS) were considered stable for the purpose of the study
The present study showed pharmacokinetics of ethanol, EtG and EtS after ingestion of two doses of ethanol and used the experimental data to investigate the hip-flask defence by the use of two pharmacologically different but objective methods
Summary
Use of non-alcohol drugs increases, ethanol is still widely detected in impaired drivers, and this is the drug associated with the highest increase in risk of traffic accident, both fatal and non-fatal [1,2,3,4,5,6]. After for instance a car accident, the suspect sometimes claims that he or she had not drunk any alcohol or just a smaller amount before driving, but ingested alcohol after the end of driving, before apprehension by the police. This is named the hip-flask defence [7,8,9,10]. Regarding blood EtG and EtS, low absolute concentrations [12], a high ratio between ethanol (g/kg) and EtG/EtS (mg/L) and increasing EtG or EtS values in two consecutive samples indicate that intake occurred shortly before sample collection
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