Blood Alcohol Research Articles

Does cleaning of venipuncture site with alcohol affect blood ethanol concentration?

BackgroundIt is important to accurately determine the blood ethanol concentration (BEC) to ensure appropriate diagnosis and treatment of patients in the emergency department (ED) and protect their legal rights. This study aimed to determine whether sterilization of venipuncture site with ethanol, which is frequently used in practice in the ED would affect BEC. MethodsVenous blood samples were collected by two consecutive techniques from 94 individuals who were admitted to the ED, had an indication for BEC measurement, and volunteered to participate in the study. The reference technique involved applying 3 cc of 10 % povidone-iodine solution to a gauze pad, cleaning the right arm antecubital region, and performing phlebotomy. The index technique used 3 cc of alcohol-based antiseptic (89 % ethanol) on another gauze for cleaning the left arm antecubital region. Both techniques allowed the antiseptic to air-dry for 30 s before phlebotomy. Two blood sample tubes per patient were sent to the laboratory, and BEC were measured using the alcohol dehydrogenase enzymatic method. Results94 patients were included in the study. The mean age was 37.8 years (±15.7), with 77 % (n = 72) of them were male. The median BEC levels measured by both the reference and index techniques were 2 mg/dL (IQR: 0.97–16.25) and 2 mg/dL (IQR: 0.90–15.22), respectively, with no significant statistical difference (p = 0.536). 72 (77 %) of the patients had a BEC level below the legal driving limit of 20 mg/dL. Bland-Altman analysis, performed on these patients, revealed a small negative bias, −0.116 mg/dL with a standard deviation of 1.13 mg/dL. The upper and lower limit of the agreement was 2.092 and −2.323 respectively. ConclusionIn patients with a BEC level of less than 20 mg/dL, using ethanol-containing antiseptics before blood sampling does not lead to erroneously elevated BEC levels.

The Physiological and Perceptual Responses During Acute Heat Stress Following Alcohol Consumption

Introduction: Alcohol consumption has been suggested to increase the risk of heat-related injury during heat waves, however, current evidence remains inconclusive on the underlying mechanisms. The purpose of the proposed study was to investigate whether alcohol consumption would alter physiological and perceptual responses during heat stress relative to a volume matched placebo. Methods: 5 participants (2 females 25.2±7.8 y; 77.9±23.1 kg; 1.7±0.2 m) have completed two experimental trials presented in random order on separate days. Participants voided their bladder upon arrival to the lab, were instrumented and entered a climate room maintained at 40°C & 25%RH, completed a 20 minute baseline to equilibrate with the environment, and then consumed either i) an alcoholic beverage (ALC, orange juice and 80-proof gin) suffcient to target a blood alcohol concentration of 0.08 mg/ml, or ii) a volume matched placebo (PLA, orange juice and tonic) over 30 minutes, and rested for an additional 120 minutes in the heat. Blood alcohol concentration, core and mean skin temperature, heart rate, blood pressure, thermal comfort, and thermal sensation were assessed before beverage consumption, and every 30 minutes thereafter. Urine production was calculated as the sum of all micturition during and immediately following the heat exposure. Whole-body sweat loss was calculated as the net difference in mass following the 120-min heat exposure accounting for urine output. Results: No differences were observed at baseline for core temperature (PLA: 37.0±0.3°C, ALC: 36.9±0.2°C, P=0.12), heart rate (PLA: 82±10 BPM, ALC: 81±12 BPM, P=0.89), mean arterial pressure (PLA: 95±5 mmHg, ALC: 97±9 mmHg, P=0.61), and thermal comfort (P=0.21) and sensation (P>0.55). Blood alcohol concentration was 0.10±0.02 mg/ml at 30 minutes following alcohol consumption, and remained elevated at 120-min (0.09±0.01 mg/ml). Throughout heat exposure, core (P>0.49) and mean skin (P>0.61) temperature were not different between PLA and ALC. Thermal comfort was not different between PLA and ALC throughout heat exposure (P≥0.16), however a reduced thermal sensation was observed with ALC compared to PLA at 120-min (P=0.02). Heart rate was higher with ALC compared to PLA at 60-min (ALC: 94±12 BPM, PLA: 88±10 BPM, p<0.02), and remained higher with ALC compared to PLA throughout the remaining heat exposure (p<0.001). Mean arterial pressure was lower at 30-min with ALC (86±10 mmHg) compared to PLA (98±5 mmHg, p<0.001), and remained lower with ALC throughout heat exposure (p<0.001). Urine production was not different between PLA (559±254 ml) and ALC (681±101 ml, P=0.32). Whole-body sweat losses were not different between PLA (398±161 g) and ALC (477±242 g, P =0.52). Conclusion: Preliminary results suggest that the consumption of alcohol does not alter whole-body sweating, core and skin temperature, thermal comfort, and urine production during acute heat stress. However, relative to placebo, alcohol consumption increased heart rate and reduced mean arterial pressure during acute heat stress, and reduced thermal sensation. This research was supported by Dr. Ravanelli’s Lakehead University Research Funding and the Natural Sciences and Engineering Research Council of Canada Discovery Grant (PIN#2022-05096). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of Adolescent Ethanol Exposure on Taste Sensitivity and Preference in Male and Female Mice

Adolescent alcohol use is prevalent in the U.S. and there is increasing evidence that neural and behavioral consequences of adolescent alcohol use may differentially alter the developing neural circuitry in males and females. Taste has been implicated in the preference for and intake of alcohol and alcohol exposure regulates taste perception. Data from our laboratory indicate that adolescent ethanol exposure (AIE) significantly alters lingual expression of fat and sweet taste receptors and decreases the density of fungiform papillae in male and female mice. The goal of the current study was to examine the effects of adolescent ethanol exposure (AIE) on the taste preference thresholds for fat and sweet tastants in male and female C57/Bl6 mice. Mice (postnatal day (P)27) were exposed to intermittent ethanol vapor or volatilized water. The AIE protocol was run for two, 4-day cycles of 16h in-chamber sessions and 8h out-of-chamber sessions separated by 3 days from P27-P35. Ethanol vapor chambers were maintained to achieve blood alcohol concentrations ~ 200mg/dL. One week following the last ethanol exposure, mice (n=9-10/group) were given access to two bottles, one containing a control solution and one containing increasing concentrations of either sucrose or linoleic acid. A single concentration of sucrose was presented to each mouse for 48 hours [0.1, 0.25, 0.5, 1.0, 2.0, 4.0%]. Following access to all concentrations of sucrose, a single concentration of linoleic acid (in 0.3% Xanthan gum) was presented to each mouse for 48 hours [0.0025, 0.025, 0.25, 0.5, 1.0, 2.0%]. Following access to linoleic acid, each mouse received a solution of 1.0% sucrose plus 0.25% linoleic acid for 24 hours. Total intake of the tastant was determined and the preference for each concentration was calculated. A percent intake of 50% is indicative of no preference between solutions. Mice preferred the sucrose solution to the control solution at all concentrations tested. Males had a higher preference for 0.25% sucrose than females and significant effects of AIE and sex were detected at 2.0% sucrose, with males demonstrating a higher preference for sucrose and mice exposed to AIE exhibiting a higher preference for the sucrose solution. No preference or aversion for lower concentrations of linoleic acid were detected (0.0025-0.25%) in females, however, AIE significantly decreased linoleic acid preference (0.5%, 1.0%, 2.0%) compared to air-exposed females. Linoleic acid preference at concentrations of 0.5% and 1.0% was significantly lower than the preference for the control solution and was considered aversive in females. Males were able to detect linoleic acid at lower concentrations than females, and males exposed to AIE exhibited a higher preference for 0.025% linoleic acid, compared to air-exposed males. Linoleic acid at concentrations of 0.025, 0.25 and 2.0% were significantly lower than the preference for the control solution and were considered aversive in males. In males exposed to AIE, the 1.0% sucrose/0.25% linoleic acid solution was preferred over the control solution. These data support our previous findings that ethanol exposure, using this model, significantly alters taste receptor mRNA expression on the circumvallate papillae and fungiform papillae density in adolescent male and female mice. Further understanding of ethanol’s effect on taste sensitivity is needed to better understand the long-term effects of adolescent ethanol exposure on food and beverage preferences and consumption patterns. NIH AA028011 T.W. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors.

Subjective intoxication (SI) when drinking may serve as an internal barometer of whether to continue drinking or engage in potentially unsafe behavior. Mobile assessments offer the potential to use SI as a prospective risk indicator during drinking episodes; little evidence exists for the validity of real-time SI measures. We test the correspondence of SI with estimated blood alcohol concentration and transdermal alcohol concentration (TAC) in young adults' natural settings. We provide a novel test of whether SI features (peak and mean SI) uniquely predict consequences adjusting for alcohol concentration. Two hundred twenty-two heavy-drinking young adults (Mage = 22.3, 64% female, 79% non-Hispanic White, 84% undergraduates) participated in a 6-day study that used ecological momentary assessment of drinking and TAC sensors. SI was assessed every 30 min during drinking episodes. Multilevel modeling was used to test hypotheses. Momentary SI and estimated blood alcohol concentration had moderate associations at the moment and day levels (standardized βs = 0.5-0.6); SI was moderately associated with TAC at the day level (βs = 0.5). Associations between SI and alcohol concentration varied widely between persons and across days. Day-level SI features predicted consequences when adjusting for alcohol concentration (incidence rate ratios, IRRs = 1.29-1.70). Our two-item SI measure shows evidence of validity in real-world settings with heavy-drinking young adults. SI was significantly correlated with alcohol concentration and was a unique predictor of consequences. The strength of these associations varied greatly across persons and days. Real-time SI measurement may be useful in preventive interventions, but continued research is needed into when and for whom momentary SI is most predictive of risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Making decisions one drink at a time and the "just one drink" effect: A fuzzy-trace theory model of harmful drinking.

Understanding the decision factors that drive harmful alcohol use among young adults is of practical and theoretical importance. We apply fuzzy-trace theory (FTT) to investigate a potential danger that may arise from the arguably correct notion that a single drink carries no meaningful risk. Decisions that are mentally represented as one drink at a time could contribute to excessive drinking. College students (N = 351) made a series of decisions to take or decline eight hypothetical drinks presented one at a time. Outcome measures included each decision, recent alcohol consumption (weekly drinks, peak blood alcohol content, and binges), and alcohol-related harms (scores on the Brief Young Adult Alcohol Consequences Questionnaire and Alcohol Use Disorders Identification Test). Linear regression models predicted each outcome from sex, perceived risk of a single drink, perceived risk of heavy drinking, perceived consequences of drinking, and general health-related risk sensitivity. Consistent with FTT, decisions to have a first drink and up to four additional drinks in short succession were each associated with lower perceived risk of one drink-a "just-one drink" effect-independent of perceived risks of heavy drinking, perceived consequences of drinking, and general risk sensitivity. Similarly, all measures of recent alcohol consumption and consequent harms were associated with perceived risk of one drink. Participants reporting "zero risk" of a single drink had worse outcomes on all measures than those reporting at least "low risk." Results are consistent with the theoretically informed premise that consumption decisions are typically made one drink at a time rather than by deciding the total number of drinks to be consumed in a sitting. When decisions about alcohol use proceed one drink at a time, a perception of zero risk in a single drink may contribute to heavy drinking.

Six months of voluntary alcohol consumption in male cynomolgus macaques reduces intracortical bone porosity without altering mineralization or mechanical properties

Chronic heavy alcohol consumption is a risk factor for low trauma bone fracture. Using a non-human primate model of voluntary alcohol consumption, we investigated the effects of 6 months of ethanol intake on cortical bone in cynomolgus macaques (Macaca fascicularis). Young adult (6.4 ± 0.1 years old, mean ± SE) male cynomolgus macaques (n = 17) were subjected to a 4-month graded ethanol induction period, followed by voluntary self-administration of water or ethanol (4 % w/v) for 22 h/d, 7 d/wk. for 6 months. Control animals (n = 6) consumed an isocaloric maltose-dextrin solution. Tibial response was evaluated using densitometry, microcomputed tomography, histomorphometry, biomechanical testing, and Raman spectroscopy. Global bone response was evaluated using biochemical markers of bone turnover. Monkeys in the ethanol group consumed an average of 2.3 ± 0.2 g/kg/d ethanol resulting in a blood ethanol concentration of 90 ± 12 mg/dl in longitudinal samples taken 7 h after the daily session began. Ethanol consumption had no effect on tibia length, mass, density, mechanical properties, or mineralization (p > 0.642). However, compared to controls, ethanol intake resulted in a dose-dependent reduction in intracortical bone porosity (Spearman rank correlation = −0.770; p < 0.0001) and compared to baseline, a strong tendency (p = 0.058) for lower plasma CTX, a biochemical marker of global bone resorption. These findings are important because suppressed cortical bone remodeling can result in a decrease in bone quality. In conclusion, intracortical bone porosity was reduced to subnormal values 6 months following initiation of voluntary ethanol consumption but other measures of tibia architecture, mineralization, or mechanics were not altered.

7 Alcohol Use Acuity and Burn Mortality: A Ten-Year Retrospective Analysis

Abstract Introduction The high incidence of alcohol consumption nationally is linked to increased susceptibility for burn injuries in both cases of acute intoxication as well as chronic misuse. While detection of elevated blood ETOH levels on admission intuitively does not always reflect a patient’s history of use, it does introduce bias and can influence clinical decision-making. Understanding these inherent biases at play, our institution through a retrospective analysis, sought to investigate the differing effects a positive blood alcohol level and true chronic alcohol use disorder had on overall mortality within our burn center. Methods We conducted a retrospective analysis utilizing data from the Institutional Burn Center Registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. Using logistic regression modeling we evaluated the association between burn mortality and ETOH. Results Over the ten-year study period, a total of 9,955 adult patients were admitted to our burn center. 6,943 tested negative and 541 patients tested positive for blood ETOH on admission. The remaining 2,471 had no test. 567 were determined to have a diagnosis of alcohol use disorder. A positive for ETOH did not have significant impact on mortality (p=0.76) while history of chronic ETOH use had a nearly three-fold increase in odds of mortality (OR 2.58, CI 1.52-4.24, p=0.000) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury. Conclusions Chronic alcoholism has a greater association with mortality than acute alcohol intoxication at our institution. Further, clinicians should exercise caution when presuming alcohol use disorder solely based on a positive test. This highlights the necessity of accurate medical history taking when estimating and counseling patients on mortality risk. Applicability of Research to Practice This emphasizes the pressing need for research into the effects of multiple comorbidities and social determinants on mortality among burn patients. The insights gained have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.

A fatal case of desvenlafaxine and paroxetine poisoning

Desvenlafaxine (O-desmethylvenlafaxine) and paroxetine are antidepressants that inhibit serotonin reuptake. Despite their relatively safe profiles, several serious side effects, including serotonin syndrome, bleeding, mania, and high blood pressure, are observed. We report the confirmation of the death of a 41-year-old female, with an overdose of desvenlafaxine and paroxetine suspected as the main cause of death. To quantify the level of desvenlafaxine and paroxetine in whole blood and urine, solid phase extraction combined with liquid chromatography–tandem mass spectrometry was developed and validated. Calibration curves were linear with coefficients of determination (r2) >0.999 for desvenlafaxine and paroxetine. The limits of detection and the limits of quantification for both desvenlafaxine and paroxetine were 0.001 µg/mL and 0.02 µg/mL, respectively. Desvenlafaxine and paroxetine were detected in the postmortem samples, along with various psychiatric drugs, and the blood alcohol content level was below 0.010%. The concentrations of desvenlafaxine and paroxetine in the heart blood were 11.0 µg/mL and 2.1 µg/mL, respectively, indicating lethal concentrations. In the urine, the concentrations of desvenlafaxine and paroxetine were 87.7 µg/mL and 3.5 µg/mL, respectively. This is the first report to determine the blood concentration of desvenlafaxine in a fatal intoxication caused by an overdose of desvenlafaxine single formulation.

Ethyl alcohol. Influence on the dynamics of blood supply of skin and other soft tissues during their sudden cooling

It is shown that in norm (i.e. in sober people in the absence of ethyl alcohol in blood) sudden local cooling of skin and soft tissues of different parts of the body from +37 to +18 °С and below (but not below 0 °С) causes in the cooled tissues 2-phase change in the value of blood vessels tone, their blood filling, intensity of blood supply and feeling of painfulness. Thus from the first seconds of cooling the tone of blood vessels of muscular type begins to increase, their blood filling begins to decrease, skin color lightens and soon in the cooled area of the body there is a feeling of acute soreness. After a few tens of seconds of cooling, the spasm of blood vessels reaches maximum values, their filling with blood decreases to a minimum, the skin turns white, and the soreness reaches maximum values. These changes persist at their peak for a few minutes, after which they begin to disappear, despite the persisting hypothermia. But then, after 10-15 minutes of cooling, hyperemia inevitably develops in the hypothermia zone, as a result of which the soreness disappears and the skin reddens. It is established that in the norm, sudden cooling of tissues causes irritation of temperature receptors located in them. The resulting excitation of temperature receptors causes reflex spasm of blood vessels, which has an adaptive value, as it is evolutionarily developed for temperature homeostasis of warm-blooded organism. It has been found out that acute painfulness accompanying cold spasm of blood vessels arises due to mechanical squeezing of pain receptors located under the muscular layer in the wall of blood vessels. On the other hand, the presence of ethyl alcohol in the blood (the presence of alcohol intoxication) fundamentally changes the dynamics of blood supply of tissues at their sudden cooling: during cooling, blood vessels expand and overflow with blood without the initial phase of spasm and the appearance of a sense of pain. At the same time, hyperemia persists not only throughout the cooling period, but also after it. In other words, alcohol intoxication is manifested by the immediate development of hyperemia and redness of the skin in the cooled area of the body without the initial spasm of blood vessels, the appearance of a feeling of soreness and pallor of the skin in the area of cooling.

Analysis and numerical simulation of fractional-order blood alcohol model with singular and non-singular kernels

Abstract In this manuscript, we examine the blood alcohol model to investigate the dynamics of alcohol concentration in the human body. The classical model of blood alcohol concentration is converted into the fractional model by using Caputo, Caputo-Fabrizio (CF), and Atangana-Baleanu-Caputo derivatives. The existence and uniqueness theory for the model’s solution is constructed using the Banach fixed point theory. Also, the stability of the solution is established by Ulam-Hyers conditions. For the numerical simulation of the considered model, the Adams-Bashforth method with a two-step Lagrange polynomial is used and the numerical solution of the model with three different derivatives is presented in the tabular and graphical form. The comparison between the exact solution and observed solution is made by root mean square technique which is found to be in good agreement. Finally, the results from the three fractional derivatives are also compared with the exact data, which revealed that the CF fractional derivative performs better than the other two fractional derivatives.

Ethanol Content of Medications and Its Effect on Blood Alcohol Concentration in Pediatric Patients.

Ethanol is a common excipient used in liquid medications to enhance solubility and inhibit -bacterial growth. While the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) have released guidance for how much ethanol is acceptable in medicines, many medications contain more than the recommended amount. The objective of this study was to determine what effect these medications would have on blood alcohol concentration (BAC) for pediatric patients, defined as those medications that would increase the BAC by ≥2.5 mg/dL. A list of medications dispensed to pediatric patients from a single hospital over a period of 4 months was obtained. The package inserts of these medications were reviewed to determine ethanol content. Typical doses were used to determine the amount of ethanol pediatric patients weighing 10, 20, and 40 kg would receive. The theoretical BAC was then calculated for each medication containing ethanol. Seven hundred ninety-six medications were dispensed for pediatric patients during the study period, of which 33 contained ethanol. Seven medications would be projected to increase the BAC above 2.5 mg/dL with a normal pediatric dose. While most medications do not contain ethanol, we found 7 that contained enough ethanol to potentially raise the BAC above 2.5 mg/dL. Health care practitioners should consider the ethanol content of medications prior to recommending them in children and when assessing overdoses.

Alcohol's impact on fine motor skills: Insights from minimally invasive surgical simulation

BackgroundAlcohol misuse among medical professionals poses a significant concern, and there is a lack of clarity in (inter)national guidelines regarding alcohol use during work. Moreover, there exists an insufficient body of research on the specific impact of alcohol on fine motor skills within the medical sector, specifically surgery. This study aims to investigate the impact of alcohol on fine motor skills in a minimally invasive surgical setting. MethodsA cross-sectional study was conducted at Lowland Science on August 19th, 20th, and 21st, 2022, during the Lowlands music festival in Biddinghuizen, the Netherlands. Participants were divided into five groups based on measured alcohol consumption. Exclusion criteria included drug use, prior surgical experience, being underage, and previous participation. The main outcomes were the number of correctly transferred rings during the PEG transfer task and the number of errors. Blood alcohol concentration (BAC) was measured using a breathalyser. ResultsA total of 1056 participants were included in the study. The results indicated an inverse relationship between BAC levels and surgical performance, with higher alcohol levels associated with a decrease in performance (p = 0.023). However, there was no significant difference in the number of errors among the five groups (p = 0.597). The group with the highest alcohol consumption (BAC >0.08 %) exhibited significantly worse performance compared to the group with a BAC of 0.0 % (p = 0.002). ConclusionThis study uncovers a negative impact of increased alcohol intake on fine motor skills in a minimally invasive surgery simulation exercise. While there was no effect on the occurrence of errors. Professional medical organizations should reconsider and explicate their position on alcohol use in (surgical) healthcare.

Non-Invasive Alcohol Concentration Measurement Using a Spectroscopic Module: Outlook for the Development of a Drunk Driving Prevention System.

Alcohol acts as a central nervous system depressant and falls under the category of psychoactive drugs. It has the potential to impair vital bodily functions, including cognitive alertness, muscle coordination, and induce fatigue. Taking the wheel after consuming alcohol can lead to delayed responses in emergency situations and increases the likelihood of collisions with obstacles or suddenly appearing objects. Statistically, drivers under the influence of alcohol are seven times more likely to cause accidents compared to sober individuals. Various techniques and methods for alcohol measurement have been developed. The widely used breathalyzer, which requires direct contact with the mouth, raises concerns about hygiene. Methods like chromatography require skilled examiners, while semiconductor sensors exhibit instability in sensitivity over measurement time and has a short lifespan, posing structural challenges. Non-dispersive infrared analyzers face structural limitations, and in-vehicle air detection methods are susceptible to external influences, necessitating periodic calibration. Despite existing research and technologies, there remain several limitations, including sensitivity to external factors such as temperature, humidity, hygiene consideration, and the requirement for periodic calibration. Hence, there is a demand for a novel technology that can address these shortcomings. This study delved into the near-infrared wavelength range to investigate optimal wavelengths for non-invasively measuring blood alcohol concentration. Furthermore, we conducted an analysis of the optical characteristics of biological substances, integrated these data into a mathematical model, and demonstrated that alcohol concentration can be accurately sensed using the first-order modeling equation at the optimal wavelength. The goal is to minimize user infection and hygiene issues through a non-destructive and non-invasive method, while applying a compact spectrometer sensor suitable for button-type ignition devices in vehicles. Anticipated applications of this study encompass diverse industrial sectors, including the development of non-invasive ignition button-based alcohol prevention systems, surgeon's alcohol consumption status in the operating room, screening heavy equipment operators for alcohol use, and detecting alcohol use in close proximity to hazardous machinery within factories.

Spironolactone in Alcohol Use Disorder (SAUD): Introduction to an ongoing double-blind, placebo-controlled, ascending dose, Phase 1b study

Introduction Efforts are critically needed to increase the armamentarium of options that clinicians can use to treat patients with alcohol use disorder (AUD). Numerous preclinical studies support the hypothesis that mineralocorticoid receptor (MR) pharmacological antagonism may represent a novel and promising treatment for AUD. Namely, the non-selective MR antagonist spironolactone dose-dependently decreased 1) the intake of alcohol in mice in a model of alcohol binge drinking procedure and 2) alcohol self-administration in dependent and non-dependent rats (Farokhnia, Rentsch, Choung et al., Mol Psychiatry 2022; 27(11):4642-4652). Furthermore, two U.S.-based independent human pharmacoepidemiologic studies utilizing electronic health records data showed that patients treated with spironolactone for any indication reduced their weekly alcohol use in a primary care-type medical setting (Palzes et al., Neuropsychopharmacology 2021; 46(12):2140-2147) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score in a Veterans Affairs medical setting (Farokhnia, Rentsch, Choung et al., 2022; 27(11):4642-4652). In both studies, spironolactone-treated patients were compared to matched ones without spironolactone prescription using propensity score matching.Objectives We are conducting a Phase 1b human study to assess the pharmacokinetics and pharmacodynamics of spironolactone-alcohol co-administration and testing the safety and tolerability of spironolactone, alone and combined with alcohol in individuals with AUD.MethodsSpironolactone in Alcohol Use Disorder (SAUD) is a double-blind, placebo-controlled, randomized, within-subject, ascending dose study with spironolactone (0, 100, 200, 400 mg/day) PO for 5 days to reach steady-state, followed by oral fixed-dose alcohol administration aimed at reaching a blood alcohol level of approximately 0.08 %. Our sample consists of 12 adults diagnosed with AUD.ResultsThe primary endpoint is to measure spironolactone and alcohol PK during concomitant administration. Our secondary endpoints are 1) assessment of subjective and cognitive effects of acute alcohol administration during concomitant spironolactone treatment; 2) number and severity of adverse events (AEs) experienced, compared between placebo (0 mg/day) and all three spironolactone doses; 3) PK characteristic of spironolactone active metabolites, canrenone, 7-α-thiomethylspirolactone (TMS) and 6β-hydroxy-7α-thiomethylspirolactone (HTMS), before and after administration of alcohol. Recruitment is underway.ConclusionsThe above-mentioned preclinical and clinical evidence suggest that spironolactone may be repurposed for the treatment of AUD. Our Phase 1b study is a key step before moving to larger efficacy trials.Disclosure of InterestNone Declared

An updated systematic review of neuroprotective agents in the treatment of spinal cord injury.

This systematic review aims to summarize the findings from all clinical randomized trials assessing the efficacy of potential neuroprotective agents in influencing the outcomes of acute spinal cord injuries (SCI). Following the PRISMA guidelines, we conducted comprehensive searches in four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) up to September 5th, 2023. Our analysis included a total of 30 studies. We examined the effects of 15 substances/drugs: methylprednisolone, tirilazad mesylate, erythropoietin, nimodipine, naloxone, Sygen, Rho protein antagonist, granulocyte colony-stimulating factor, autologous macrophages, autologous bone marrow cells, vitamin D, progesterone, riluzole, minocycline, and blood alcohol concentration. Notable improvements in neurological outcomes were observed with progesterone plus vitamin D and granulocyte colony-stimulating factor. In contrast, results for methylprednisolone, erythropoietin, Sygen, Rho Protein, and Riluzole were inconclusive, primarily due to insufficient sample size or outdated evidence. No significant differences were found in the remaining evaluated drugs. Progesterone plus vitamin D, granulocyte colony-stimulating factor, methylprednisolone, Sygen, Rho Protein, and Riluzole may enhance neurological outcomes in acute SCI cases. It is worth noting that different endpoints or additional subgroup analyses may potentially alter the conclusions of individual trials. Therefore, certain SCI grades may benefit more from these treatments than others, while the overall results may remain inconclusive.

Homicide numbers, rates, and victims' characteristics in the Tri-City metropolitan area, Poland, between 2010 and 2019.

Despite a clear global downward trend, homicides still account for a relatively high proportion of all violent deaths, making them a serious problem both in Poland and worldwide. The discrepancy in available data prompted the authors of the study to analyse the numbers and rates of homicides and the characteristics of the homicide victims in the Tri-City area of northern Poland. The study was based on data from autopsy reports, supplemented by information from prosecutor's files on all homicides in the Tri-City area between 2010 and 2019. A total of 107 homicides were statistically analysed for age, sex, blood alcohol concentration at the time of death, time and place of death. The annual homicide rate was 1.24 per 100,000 inhabitants, with a clear downward trend over the period analysed. The average age of victims was about 48 years, and the majority of victims were male (70.1%). 92.5% of homicides were committed in the Tri-City, with a clear predominance of Gdansk (49.5%) over other, mostly rural, areas of the analysed agglomeration. The majority of victims (57.8%) whose blood alcohol concentration was measured were intoxicated, with a clear predominance of males in this group (70.9%). Victim characteristics and the homicide rates obtained from the analysed material were similar to other countries in Central and Eastern Europe, which may be related to historical, cultural, and demographic similarities. The study highlights the significant impact of alcohol abuse on the risk of homicide.

Determination of Ethanol and Aromatics in Blood by Headspace Portable Gas Chromatography-Mass Spectrometry (HS-PGC-MS)

Ethanol abuse is increasingly becoming a global issue, adversely affecting both society and families. In blood alcohol concentration (BAC) detection, traditional techniques have long experimental cycles and harsh experimental conditions and often fail to produce timely results. Consequently, achieving swift and precise on-site detection of ethanol poisoning in humans poses a formidable challenge in analytical science. We designed a novel assay for swift on-site analysis of ethanol and BTEX (benzene, toluene, ethylbenzene, and xylene) poisoning in humans using a custom portable headspace injector (portable HS) and portable gas chromatography-mass spectrometry (portable GC-MS). This setup, known for its lightweight design and speed, allows on-site sampling and delivers rapid results. We established a calibration curve (R2 > 0.99) for ethanol in blood using portable gas chromatography-mass spectrometry (portable GC-MS). This on-site blood alcohol concentration (BAC) assay proves simpler than traditional methods, enabling rapid analysis of each sample within a short timeframe and requiring only a small blood volume (0.1 ml). In addition to our investigation on ethanol, we developed a portable method for detecting BTEX in blood. This method provides a favorable coefficient of determination (R2 > 0.99) for various substances, thereby broadening the utility of portable mass spectrometry in areas such as traffic inspection and forensic identification.

Delays in blood collection and drug toxicology results among crash-involved drivers arrested for impaired driving

Objective The concentration of drugs in a driver’s system can change between an impaired driving arrest or crash and the collection of a biological specimen for drug testing. Accordingly, delays in specimen collection can result in the loss of critical information that has the potential to affect impaired driving prosecution. The objectives of the study were: (1) to identify factors that influence the time between impaired-driving violations and specimen collections (time-to-collection) among crash-involved drivers, and (2) to consider how such delays affect measured concentrations of drugs, particularly with respect to common drug per se limits. Method Study data included blood toxicology results and crash-related information from 8,923 drivers who were involved in crashes and arrested for impaired driving in Wisconsin between 2019 and 2021. Analyses examined how crash timing and severity influenced time-to-collection and the effects of delays in specimen collection on blood alcohol concentrations (BACs) and blood delta-9-tetrahydrocannabinol (THC) concentrations. Results The mean time-to-collection for the entire sample was 1.80 h. Crash severity had a significant effect on time-to-collection with crashes involving a fatality having the longest duration ( M = 2.35 h) followed by injury crashes ( M = 2.06 h) and noninjury crashes ( M = 1.69 h). Time of day also affected time-to-collection; late night and early morning hours were associated with shorter durations. Both BAC (r = −0.11) and blood THC concentrations (r = −0.16) were significantly negatively correlated with time-to-collection. Conclusions Crash severity and the time of day at which a crash occurs can result in delays in the collection of blood specimens after impaired driving arrests. Because drugs often continue to be metabolized and eliminated between arrest and biological specimen collection, measured concentrations may not represent the concentrations of drugs that were present at the time of driving. This has the potential to affect drug-impaired driving prosecution, particularly in jurisdictions whose laws specify per se impairment thresholds.

Concentration units used to report blood- and breath-alcohol concentration for legal purposes differ between countries which is important to consider when blood/breath ratios of alcohol are compared and contrasted.

This technical note reviews the plethora of concentration units used to report blood-alcohol concentration (BAC) and breath-alcohol concentrations (BrAC) for legal purposes in different countries. The choice of units sometimes causes confusion when scientific papers originating from a certain country might be introduced into evidence via expert testimony, such as when alcohol-related crimes are prosecuted. The concentration units are also important to consider when blood/breath ratios (BBRs) of alcohol are calculated and compared between countries. Statutory BAC limits for driving in most nations are reported in mass/volume (m/v) units, such as g/100 mL (g%) in the United States, mg/100 mL (mg%) in the United Kingdom and Republic of Ireland, or g/L (mg/mL) in many EU nations. By contrast, Germany and the Nordic countries report BAC as mass/mass (m/m) units, hence g/kg or mg/g, which are ~5.5% lower than m/v units, because whole blood has an average density of 1.055 g/mL. There are historical reasons for reporting BAC in mass/mass units because the aliquots of blood analyzed were measured by weight rather than volume. The difference between m/m and m/v is also important in postmortem toxicology, such as when distribution ratios of ethanol between blood and other biological specimens, such as urine, vitreous humor, and cerebrospinal fluid, are reported.

Suppression of P2X4 and P2X7 by Lactobacillus rhamnosus vitaP1: effects on hangover symptoms

This study aimed to identify substances including Lactobacillus rhamnosus vitaP1 (KACC 92054P) that alleviate hangover-induced emotional anxiety and liver damage. The association between emotional anxiety caused by hangover and the genes P2X4, P2X7, SLC6A4 was investigated. In vitro and in vivo analyses were conducted to assess the influence of free-panica on alcohol-induced upregulated gene expression. Additionally, the concentration of AST, ALT, alcohol, and acetaldehyde in blood was measured. Free-panica, consisting of five natural products (Phyllanthus amarus, Phoenix dactylifera, Vitis vinifera, Zingiber officinale, and Lactobacillus rhamnosus), were evaluated for their regulatory effects on genes involved in alcohol-induced emotional anxiety and liver damage. The combination of these natural products in free-panica successfully restored emotional anxiety, and the concentration of AST, ALT, alcohol, and acetaldehyde in blood to those of the normal control group. These findings support the potential development of free-panica as a health functional food or medicinal intervention for relieving hangover symptoms and protecting liver from alcohol consumption.