Breath Alcohol Measurements Research Articles

Metrological traceability of the breath alcohol measurements

Breath alcohol measurements are widely used worldwide to detect the presence of alcohol in the human body. For those measurements, different metrological traceability chains are used, both in the international normative documents and at the national level. Different measurement standards used to calibrate breath analysers reproduce different quantities: on the one hand, an «actual» ethanol mass concentration, and, on the other hand, the operationally defined «ethanol mass concentration by Dubowski (or Harger)». This makes the comparability of the breath alcohol measurements questionable. According to various studies, the discrepancy between the operationally defined quantity and the concentration not related to the empirical interphase distribution coefficients, lays within (1-2) %, although there is also an evidence of a larger deviation. It is possible to construct a common metrological traceability chain by using reference gas mixtures in cylinders and dynamic gas mixture generators based on the principles not related to empirical equations, as well as determining more accurately the interphase distribution coefficient and evaluating its uncertainty. SE «Ukrmetrteststandart» possesses internationally recognised calibration and measurement capabilities for measuring ethanol concentration and producing reference materials: calibration gas mixtures of ethanol with nitrogen or air in cylinders and reference aqueous solutions of ethanol that provide metrological traceability for the breath alcohol measurements.

Investigations on the influence of different mouth and nose protection masks on the evidential breath alcohol measurement

Anlässlich eines richterlichen Gutachtenauftrages zur Frage, ob das Tragen von Mund-Nase-Schutzmasken zu einer Verfälschung des Atemalkoholmesswertes zuungunsten des Angeklagten führen kann, erfolgte unter Pandemiebedingungen eine experimentelle Testreihe an 6 gesunden Proband*innen (4 Männer, 2 Frauen), die risikoarmen Freizeitalkoholkonsum betrieben. Pro Untersuchungstag wurde jeweils ein Maskentyp (Op.-Maske, Textilmaske, FFP2-Maske) untersucht. Nach Aufnahme einer individuell berechneten Menge Alkohol und einer 30-minütigen Resorptionsphase erfolgten in halbstündigen Abständen 6 aufeinanderfolgende Atemalkoholmessungen, wobei zwischen den Messungen jeweils im Wechsel eine der Masken oder keine Maske getragen wurde. Anschließend wurden Wertepaare für Zeiträume mit und ohne Maske gebildet und die stündlichen Atemalkoholabbauraten berechnet. Im Ergebnis unterschieden sich die Atemalkoholabbauraten mit und ohne Masken nicht voneinander. Fehlermeldungen durch das Atemalkoholmessgerät, die auf das vorherige Tragen einer Maske zurückzuführen sind, traten nicht auf.

Detection of Breath Alcohol After Oral Anti-Inflammatory Spray Use

Background: We aimed to investigate the effect of ethanol-containing oral antiseptic sprays on breath alcohol levels and its relationship with time and body mass index. Materials and Methods: This study includes the results of 99 patients. Body mass index of each individual was recorded. Individuals were asked to blow into the alcoholmeter immediately after taking 8 puffs of oral antiseptic sprays and in this way, the breath alcohol concentration. 0th minute value was obtained. The measurements were repeated three times, at the 3rd, 5th, and 10th minutes. Breath alcohol concentration values were recorded. Results: The median age of the patients was 34 (IQR 25-75: 28-42) and 55 (55.6%) of the patients were male. While the mean alcohol level measured at the 0th minute was 0.075 ± 0.013 promil, the mean alcohol level measured at the 10th minute was 0.001 ± 0.004 promil. A statistically significant difference was found between the alcohol levels measured at the 0th, 3rd, 5th, and 10th minutes (χ²:288,762, p<0.001). A statistically significant difference was found between all groups in the pairwise comparison of alcohol levels measured at the 0th, 3rd, 5th, and 10th minutes (p<0.001). Conclusion: This study shows that ethanol-containing sprays may exceed the legal criteria in breath alcohol measurements.

Abstract 12236: Population-Level Analyses of Alcohol Consumption as a Predictor of Acute Atrial Fibrillation Episodes

Introduction: We conducted an instrumental variable analysis to test whether acute alcohol consumption leads to increased emergency department (ED) visits for AF at the level of the general population. Methods: We analyzed blood alcohol concentration measurements obtained from individuals using commercially available Bluetooth-enabled breathalyzer devices (BACtrack, San Francisco, CA) collected between January 1, 2014 and December 31, 2016 to identify dates associated with heightened alcohol consumption that corresponded to recurrent, nationally-recognized events. Outcomes included ED visits with AF (main analysis) or supraventricular tachycardia (SVT; as a negative control) in California between January 1, 2005 to December 30, 2015 using Office of Statewide Health Planning and Development data. A secondary analysis examining rates of new-onset AF was conducted. We utilized population denominators for age, sex, and race/ ethnicity in California from the US Census. Multivariable adjusted Poisson regression models were utilized to compare rates of AF during and 6 days following instrumental events compared to all other days of the year. Results: Using 1,269,054 breath alcohol measurements obtained from 36,158 individuals, we identified 8 recurring events associated with heightened alcohol consumption. After multivariable adjustment, excess alcohol consumption inferred from our instrumental variables was associated with 719 additional AF visits per 100,000 person-years (95% CI 189-1249, p = 0.008; Table ). The association between these events and new-onset AF exhibited a stronger effect (1,757 additional visits, 95% CI 945-2,569, p < 0.001). A negative control analysis failed to exhibit significantly heightened rates of SVT during those same dates. Conclusion: These data suggest that acute alcohol consumption is associated with a higher risk for discrete AF episodes, as well as for new-onset (incident) AF, in the general population.

Embedded Transdermal Alcohol Detection via a Finger Using SnO2 Gas Sensors.

In this paper, we report the fabrication and characterization of a portable transdermal alcohol sensing device via a human finger, using tin dioxide (SnO2) chemoresistive gas sensors. Compared to conventional detectors, this non-invasive technique allowed us the continuous monitoring of alcohol with low cost and simple fabrication process. The sensing layers used in this work were fabricated by using the reactive radio frequency (RF) magnetron sputtering technique. Their structure and morphology were investigated by means of X-ray spectroscopy (XRD) and scanning electron microscopy (SEM), respectively. The results indicated that the annealing time has an important impact on the sensor sensitivity. Before performing the transdermal measurements, the sensors were exposed to a wide range of ethanol concentrations and the results displayed good responses with high sensitivity, stability, and a rapid detection time. Moreover, against high relative humidity (50% and 70%), the sensors remained resistant by showing a slight change in their gas sensing performances. A volunteer (an adult researcher from our volunteer group) drank 50 mL of tequila in order to realize the transdermal alcohol monitoring. Fifteen minutes later, the volunteer’s skin started to evacuate alcohol and the sensor resistance began to decline. Simultaneously, breath alcohol measurements were attained using a DRAGER 6820 certified breathalyzer. The results demonstrated a clear correlation between the alcohol concentration in the blood, breath, and via perspiration, which validated the embedded transdermal alcohol device reported in this work.

Comparison of Breath- and Blood-Alcohol Concentrations in a Controlled Drinking Study.

In this work, 114 volunteers were dosed with 80-proof liquor to produce peak blood-alcohol concentration (BAC) or breath-alcohol concentration (BrAC) of 0.040-0.080 g/100 mL blood or g/210 L breath. This was followed by a 30 minute deprivation period before simultaneous blood and breath samples were collected and the alcohol concentration quantified. BAC was determined by gas chromatography with flame ionization detection and BrAC by a dual-sensor Intox EC/IR II instrument. Paired Student t-tests showed that differences between paired blood- and breath-alcohol results differed significantly. Results from these two measurement methods are highly correlated and, on average, measured BAC was 11.3% greater than BrAC. There were 10 instances of BrAC being greater than the corresponding BAC, and the average difference between these two values was 0.0059 g/100 mL. Agreement plots of coupled BAC and BrAC revealed a mean bias of 0.00754 g/100 mL and 95% limits of agreement (LOA) at -0.00705 and 0.0221 g/100 mL. Once BrAC values were truncated to the hundredths place as required by Wisconsin state statute, only three participants had greater BrAC than corresponding BAC, with an average difference between these values of 0.008 g/100 mL. Agreement plots with truncated BrAC values gave a mean bias of 0.0120 g/100 mL and 95% LOA at -0.00344 and 0.0275 g/100 mL. Data showed that typically, blood samples had greater alcohol concentrations than corresponding breath values. Differences were exacerbated by Wisconsin's statutory requirement that reported breath alcohol measurements be truncated to the hundredths place, whereas blood has no corresponding mandate.

Hip-flask defense: An experimental study in the Hungarian population

Toxicology tests and medical expert opinions are part of routine work in drunk driving cases in both domestic and international practice. The greatest challenge to forming an opinion is that the perpetrator claims to have consumed alcohol after the act of driving. To determine the time of consumption, it is essential to establish whether the alcohol in the body was in the absorption phase or in the elimination phase when the sample was collected. In domestic practice, breath alcohol content can be measured several times, two blood samples can be collected, and both blood and urine samples can be taken almost simultaneously. A recent Swedish study showed that taking a single blood sample and two urine samples allows for a more accurate examination of consumption after the fact. This study aimed to examine the applicability of such model to the domestic environment. We conducted a controlled drinking experiment involving 15 Hungarian casual drinker volunteers aged 18–25 years who consumed different amounts of alcohol at specified times while providing regular breath alcohol measurements as well as blood and urine samples. These measurement results provided accurate information about the changes in alcohol metabolism compared to the time of drinking and allowed us to draw the necessary conclusions, offering further evidence that alcohol metabolism can vary significantly between different ethnic groups. The results showed that the absorption and excretion of ethyl alcohol in the volunteers were much faster than those in the current Hungarian standards used in practice. In conclusion, the comparison of blood and urine samples collected between 60 min and 120 min cannot be considered suitable for establishing the fact of drinking after driving in Hungarian practice, and a local model is needed.

Effect of Ethanol in Oral Antiseptic Sprays on Breath Alcohol Measurement

Effect of Ethanol in Oral Antiseptic Sprays on Breath Alcohol Measurement

Estimating Uncertainty in Wisconsin's Evidential Breath Alcohol Measurements.

Breath alcohol measurement accuracy and precision quantification is a critical component of impaired driving prosecution and is required for laboratory accreditation. The Chemical Testing Section of Wisconsin's Department of Transportation conducted a bottom-up study to quantify uncertainty of breath alcohol measurements conducted on Intoximeter's EC/IR II instrument. After an exercise in combined uncertainty source identification, individual input values were either reported from National Institute of Standards and Technology traceable reference materials or quantified using instrument data from 2014 to 2018. From input values, an expanded uncertainty value of 4.58 × 10-3 g/210L was found that encompasses all identified sources with a 95% confidence interval.

Evaluation of a new non-invasive measurement technique based on bioimpedance spectroscopy to estimate blood alcohol content: a pilot study.

The gold standard for estimating blood alcohol content (BAC) after alcohol consumption is a blood sample analysis. An innovative technology to estimate BAC is based on impedance cardiography and bioimpedance spectroscopy (BIS). This study investigated whether it is possible to estimate increasing blood alcohol levels during a drinking trial with bioimpedance measurement techniques. Twenty-one healthy volunteers were assigned to a test (ethanol) group (ETH) or a reference group (H2O). After baseline measurements, the ETH group ingested 120 ml of vodka, followed by a resorption phase of 50 min. Then, bioimpedance and breath alcohol measurements were performed. Thereafter, 60 ml of vodka was ingested and another resorption phase of 50 min was followed by bioimpedance and breath alcohol measurements. This procedure was repeated until alcohol levels exceeded 0.4 mg/l. The H2O group performed in the same way with water. For all measurements, extracellular resistance (Re) and the base impedance (Z0) were computed. Regarding BIS, several parameters differed significantly between the ETH and the H2O group. Re increased in ETH (p=0.005), but not in the H2O group when comparing the first and last measurements. Z0 also increased significantly in the ETH group (p=0.001). To conclude, with BIS measurements, it is possible to measure increasing blood alcohol levels.

How many digits should be reported in forensic breath alcohol measurements?

Uncertainty is an inherent property of all measurements. The magnitude of this uncertainty will determine the number of meaningful digits that should be reported in a measurement result. Several statistical arguments are considered providing evidence that three digit truncated results are more appropriate than two since the first significant digit of the combined uncertainty (standard deviation) in breath alcohol measurement is found in the third decimal place. Probably, the most compelling reason for reporting three digits is the significant reduction in combined uncertainty compared with the use of two digits. For a breath alcohol concentration of 0.089 g/210 L, the combined uncertainty for two digit results is ∼0.0042 g/210 L, compared with 0.0031 g/210 L for three digit results. The historical practice of reporting two digit truncated results in forensic breath alcohol analysis has been largely based on the use of analog scale instruments with 0.01 g/210 L scale resolution. With today's modern digital instrumentation, this practice should be reconsidered. While the focus of this paper is on breath alcohol analysis, the general principles will apply to any quantitative analytical measurement.

Can Handling E85 Motor Fuel Cause Positive Breath Alcohol Test Results?

Hand-held breath alcohol analyzers are widely used by police in traffic stops of drivers suspected of driving while intoxicated (DWI). E85 is a motor fuel consisting of 85% ethanol and 15% gasoline or other hydrocarbons, and is available at nearly 2,600 stations in the USA. We sought to determine whether handling E85 fuel could produce measurable breath alcohol results using a hand-held analyzer and to see if this would be a plausible explanation for a positive breath alcohol test. Five healthy adult subjects dispensed or transferred 8 US gallons of E85 fuel in each of four scenarios. We measured breath alcohol concentration in g/210 L of exhaled breath using the BACTrack S50 at 0, 2, 4, 6, 8, 10, 15 and 20 min after each fuel-handling scenario. Most of the subjects had no detectable breath alcohol after handling E85 motor fuel. Transient elevations (0.02-0.04 g/210 L) in breath alcohol measurement occurred up to 6 min after handling E85 in a minority of subjects. We conclude that it is unlikely that handling E85 motor fuel would result in erroneous prosecution for DWI.

Acute Alcohol Intoxication in Adolescents: Frequency of Respiratory Depression

BackgroundAdolescents and young adults are frequent users of alcohol. Younger patients may be more sensitive to the effects of alcohol than their adult counterparts, and toxicity has been known to occur at lower doses. Respiratory depression is a serious adverse effect of alcohol intoxication; however, current monitoring practices may not adequately detect respiratory depression. ObjectiveOur objective was to determine the frequency of hypoventilation as measured by capnography among adolescents with acute alcohol intoxication. Our secondary objective was to determine if an association exists between alcohol levels and incidence of hypoventilation. MethodsThis was a prospective observational pilot study of patients 14–20 years of age with acute alcohol intoxication. Blood or breath alcohol measurements were obtained on arrival. Hourly measurements of vital signs including capnography were recorded. ResultsSixty-five subjects were analyzed. Mean alcohol level was 185 mg/dL. Twenty-eight percent of subjects had episodes of hypoventilation. Episodes occurred in similar proportions on arrival and during the first 5 h of measurements. There was no difference in alcohol levels between subjects who did and did not hypoventilate (185 mg/dL vs. 186 mg/dL; 95% confidence interval −29 to 25). Oxygen desaturations occurred in 14 subjects and were associated with hypoventilation (p = 0.015). ConclusionsHypoventilation is common among adolescents who are acutely intoxicated with alcohol. It is independent of alcohol level and occurs at a steady rate during the first several hours of intoxication. Capnography should be considered as an additional monitoring device to detect these episodes and enhance patient safety.

Continuous Objective Monitoring of Alcohol Use: Twenty‐First Century Measurement Using Transdermal Sensors

Transdermal alcohol sensors continuously collect reliable and valid data on alcohol consumption in vivo over the course of hours to weeks. Transdermal alcohol readings are highly correlated with breath alcohol measurements, but transdermal alcohol levels lag behind breath alcohol levels by one or more hours owing to the longer time required for alcohol to be expelled through perspiration. By providing objective information about alcohol consumption, transdermal alcohol sensors can validate self-report and provide important information not previously available. In this article, we describe the development and evaluation of currently available transdermal alcohol sensors, present the strengths and limitations of the technology, and give examples of recent research using the sensors.

Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality

Alcohol is one of the most important personal risk factors for serious and fatal injuries, contributing to approximately one third of all deaths from accidents. It is also described that alcohol intoxication leads to a higher mortality in the clinical course. In this study, we hypothesized that alcohol intoxication leads to different accident kinematics, a higher ISS (Injury Severity Score), and higher preclinical mortality compared to sober patients. A technical and medical investigation of alcohol intoxated road users was performed on the scene of the crash and at the primary admitting hospital. Alcohol testing was performed with either breath alcohol tests or measurement of blood alcohol concentration (BAC) in a standard laboratory test. Between 1999 and 2010, 37,635 road traffic accidents were evaluated by the Accident Research Unit. Overall 20,741 patients were injured, 2.3% of the patients were killed. Among the injured patients, 2.2% with negative BAC were killed, compared to 4.6% fatal injuries in patients with a positive BAC (p < 0.0001). Of the patients with a positive BAC, 8.0% were severely injured, compared to 3.6% in the BAC negative group (p < 0.0001). Regarding the relative speed at impact (Δv for motorized drivers, vehicle collision speed for pedestrians and bikers), there was a significant higher difference for BAC positive patients (30 ± 20) compared to the BAC negative patients (25 ± 19, p < 0.0001). Alcohol intoxication in trauma patients leads to higher preclinical mortality, higher impact speed difference, and higher injury severity. The subgroup analysis for different alcohol concentrations shows no difference in ISS, MAIS, and relative speed, but a correlation of increasing age of patients with higher alcohol concentrations.

Police custody following drink-driving: A prospective study

BackgroundDrink-driving is a crime and traffic offences are a common cause of detention in police custody. Legal assessment of alcohol intoxication is based on breath or blood testing. We hypothesize that refusal of breath alcohol testing or inability to perform it can correspond to singular medical characteristics of the detainee, possibly assaulted or injured during the arrest. Our objective was to determine medical characteristics of detainees held in custody for drink-driving. MethodsProspective monocentric study (April–October, 2010) of drink-drive arrestees. Controls were persons aged over 18 detained for other reasons than drink-driving. Data collected concerned persons’ characteristics and reported assaults or observed injuries. Results223 drivers were tested positive for breath alcohol level and 55 suspected drink-drivers refused or were not able to complete breath test. 2212 consecutively examined persons served as controls. Drink-drive arrestees requested medical examination more rarely (18% and 7%, vs. 43%, P<0.0001) and drivers tested positive for breath alcohol were more frequently alcohol abusers (25% vs. 14%, P<0.0001) than controls. Drivers who did not complete breath test more often reported assaults than those tested positive for breath alcohol (22% vs. 8%, P=0.007). They had more frequent traumatic injuries than those tested positive and than controls (29% vs. 11% and 17%, P=0.003 and 0.02). Only 1% of drink drivers were unfit for detention after medical examination. ConclusionPhysicians need to give attentive care to detained drink-drivers. Special attention should be paid to drink-drivers who refused or were not able to complete breath alcohol measurement.

Alcohol- and drug-involved driving in the United States: methodology for the 2007 National Roadside Survey.

This article describes the methodology used in the 2007 U.S. National Roadside Survey to estimate the prevalence of alcohol- and drug-impaired driving and alcohol- and drug-involved driving. This study involved randomly stopping drivers at 300 locations across the 48 continental U.S. states at sites selected through a stratified random sampling procedure. Data were collected during a 2-hr Friday daytime session at 60 locations and during 2-hr nighttime weekend periods at 240 locations. Both self-report and biological measures were taken. Biological measures included breath alcohol measurements from 9,413 respondents, oral fluid samples from 7,719 respondents, and blood samples from 3,276 respondents.

Factors contributing to the variability observed in duplicate forensic breath alcohol measurement

Several factors contribute to the variability observed among repeated measurements of breath alcohol concentration. Identifying these factors and the magnitude of their contribution is the focus of this study. Large breath alcohol data sets consisting of duplicate test results from drivers arrested for driving while intoxicated were obtained from four jurisdictions: Sweden, Alabama, New Jersey and Washington State. The absolute difference between duplicate results were fitted to a multivariate linear regression model which included the following predictor variables: mean breath alcohol concentration, absolute exhalation time difference between repeated measurements, absolute exhalation volume difference, gender and age. In all data sets considered here, the breath alcohol concentration was the most statistically and practically significant predictor of absolute difference between the duplicate results. The next two most important predictors to enter models for all jurisdictions were exhalation volume difference and exhalation time difference. The maximum multivariate R2 for any jurisdiction, however, was only 0.24, suggesting that other factors not considered here may be of importance. Two predictors over which the subject would have some influence included exhalation time and volume. When these were set at values expected to have maximum impact, the effect on duplicate test differences was very small, 0.008 g/210 L or less in all jurisdictions, indicating that subject manipulation of exhalation time and volume would have at most a very small systematic effect on estimated breath alcohol concentration. This study presents multivariate models useful for identifying the impact of five variables that may influence breath test variability.

Truncation of Breath Alcohol Measurements and Its Effect on Peak Concentrations

An intra-subject comparative study was performed using breath analysis to assess the forensic implications of data truncation on peak blood alcohol concentrations (Cmax). Accordingly, several other forensically relevant pharmacokinetic parameters associated with Cmax were investigated, including the time-to-peak (Tmax), plateau (PLAT) duration, and the rise in blood alcohol concentration (BAC) following the end of drinking (EOD). The study consisted of three drinking sessions, nine subjects per session, with drinking intervals of 30, 90, and 180 minutes, and ethanol doses of 1.0, 1.1, and 1.6 g/kg, respectively. Three-digit breath measurements were collected in duplicate at 10, 30, 45, 60, 75, 90, 105, 120, 135, 195, and 255 minutes following EOD using a fuel-cell based breath instrument (Intox ECIR®). Breath results were then computed using two different data treatment methods. The first method averaged duplicate three-digit breath measurements and reported results to the third digit. The second method used the lower of the two duplicate measurements and reported results to the truncated second digit. The results of the two data treatment methods were then compared using general statistics and alcohol concentration-time profiles. The overall rise in BAC following EOD for three-digit results was 0.009 g/210L with a range of 0.000–0.030 g/210L (standard deviation 0.008 g/210L). When breath measurements where truncated, 25 of the 27 subjects had a rise in BAC of 0.02 g/210L or less. In total, 6 subjects had no rise in BAC following the EOD when evaluating the three-digit results. In contrast, when BAC results were truncated, 11 subjects exhibited no increase in BAC following EOD. The overall Tmax was reduced from 41 minutes to 26 minutes, and overall PLAT durations were extended from 22 to 39 minutes, when the breath measurements were truncated.

Population pharmacokinetics of alcohol on Chinese subjects using breath measures

Alcohol is a widely used drug. Our objective was to examine alcohol pharmacokinetics in Chinese subjects through the breath measurement of blood alcohol concentration (BAC) to identify any measurable covariates that may help explain variability between subjects. Breath-alcohol measurements of 184 healthy Chinese subjects were collected. Compartmental models including one- and two-compartment process were examined. First-order kinetics was applied to model alcohol absorption and elimination phases. For the sake of simplicity, only the subject's body weight, sex and stomach condition were investigated as covariates in our random effects modelling. The body as a whole behaves as a single compartment, with the suggested one-compartment model being good enough to characterize the biological process. In line with other studies, food ingestion before/with the dose slowed down alcohol absorption into the central compartment. Female subjects exhibited a significantly higher BAC elimination rate than that of males. Body weight also contributed to the observed inter-subject variability in alcohol clearance. We present a model for estimating blood-alcohol levels from breath-alcohol measurements. The results of our study are useful particularly in relation to drink-driving prosecutions because of the routine use of breath-alcohol measurements as evidence in such cases through the world.