Breath Ethanol Concentration Research Articles

A New Method for Breath and Blood Alcohol Determination in Rats Using a Breath Alcohol Meter: An Experimental Study.

The use of police breath alcohol detectors in rat breath alcohol detection experiments has always been a challenge because of the small lung capacity and inability of rats to actively inhale. However, the method of using gas chromatography to detect blood alcohol concentration is time-consuming, complex, relatively expensive, and cannot achieve on-site detection and multi-point unlimited non-invasive detection. In this study, a laboratory method was validated for rat breath ethanol concentration (BrAC) measurement to estimate blood ethanol concentration (BAC) in rats. The rats were placed in a gas collection bottle, the breath sample was drawn out with a syringe, and injected into the mouthpiece of the breath alcohol detector through a rubber tube. The results were immediately detected and automatically converted to BAC. Male rats were randomly divided into three groups. The control group received an intraperitoneal injection of normal saline, the liver injury group received an intraperitoneal injection of 50% Carbon tetrachloride (CCL4 1 mL.kg-1), and the induction group received an intraperitoneal injection of phenobarbital sodium (75 mg.kg-1). Western blot analysis was used to detect the protein expression of CYP2E1. Similar grouping and experimental methods were used for female rats. This method was reproducible. The metabolic activity of CYP2E1 was downregulated in the injury group and upregulated in the induction group, which was consistent with the results obtained for CYP2E1 protein expression. Our results confirmed that the rat gas cylinder breath alcohol assay can be used for multiple detections with immediate and non-invasive determination of alcohol metabolizing capacity. This is important for studies that require repeated assessment of blood alcohol levels.

Impact of vaping ethanol on the roadside field sobriety test in a clinical setting

Recent studies have shown that electronic cigarette (e-cig) liquid formulations (e-liquids) can contain ethanol, sometimes in concentrations greater than 20%. Ethanol, rarely listed as an ingredient in e-liquids, is often used as a thinning agent, to dissolve insoluble substances, or added intentionally for consumption. Ethanol in e-liquids has been demonstrated to be aerosolized by e-cigs. Ethanol within the aerosol can be absorbed across mucosal membranes in the mouth, and also within deep lung tissue based on mean-mass particle size diameter. Preliminary Breath Tests (PBT) and Evidentiary Breath Tests (EBT) are conducted to measure ethanol in exhaled breath, with a 15–20 minute wait period, and Standardized Field Sobriety Tests (SFST) evaluate several operant conditions to assess ethanol impairment. Literature on impacts of vaping ethanol is limited. An evaluation to assess the impact of vaping ethanol from e-liquids is essential for law enforcement officers (LEO), medical review officers, ethanol treatment and recovery providers, workplace drug testing, and court mandated drug testing. This study evaluated the impact of inhaled ethanol via vaping on the SFST, PBT, and EBT for thirteen participants using a blind two-by-two experimental design under Virginia Commonwealth University (VCU) IRB HM20015064 and in collaboration with the Virginia Department of Forensic Science, the Center for the Study of Tobacco Products at VCU, VCU Police Department, and City of Richmond Police Department. E-liquids were made by a commercial manufacturer at concentrations of 0% and 20% ethanol. Ethanol concentrations were verified in-house using a Shimadzu HS-20 headspace attached to a Nexis GC-2030 gas chromatograph with dual flame ionization detectors. Stability studies were performed monthly to ensure sample suitability prior to clinical use. Thirteen participants were enrolled into the study based on inclusion and exclusion criteria. They vaped either one or ten puffs of an e-liquid (0% or 20% ethanol). LEOs assessed indicators of impairment by following a study design incorporating SFSTs, PBTs, and EBTs at predetermined intervals. Ethanol concentrations within the e-liquids were determined to be stable at −20 °C for the duration of the study. Positive breath ethanol results ranged from 0.007–0.030 and 0.013–0.043 g/210 dL by PBT immediately after using a 20% ethanol e-liquid when vaping one-puff and ten-puffs, respectively. All subsequent PBTs were negative for ethanol. No ethanol or instrument error was detected by EBT for any vaping scenario, at any timepoint. Impairment was not indicated by SFST. A well-designed human clinical study with robust and relevant collaborations between a crime lab, police departments, and a research university is important to address pertinent questions to forensic science. Breath ethanol concentrations were detectable by PBT immediately after vaping an e-liquid containing 20% ethanol. The results demonstrated the standard wait period of 15–20 minutes employed by LEO before administering a PBT for roadside stops was effective in negating vaping-related false positive breath ethanol results. Vaping ethanol also did not impact SFST results. Results should be considered for other contexts of ethanol testing, such as workplace testing and vehicle ignition interlock systems.

An exploration of the impact of ethanol diluent on breath alcohol concentration in patients receiving paclitaxel chemotherapy.

This study aimed to provide a better understanding of the impact of paclitaxel chemotherapy on breath alcohol in an Irish population. Patients attending the Oncology Day Unit at Beaumont Hospital were invited to participate on the day of their treatment. The brand of paclitaxel used was Actavis Pharma Inc and contained 6mg/mL paclitaxel in 50% Ethanol/ 50% Cremophor EL. Breath alcohol concentration was measured using the AlcoSense ™ Breathalyser on three separate visits. The primary end-point was the number of patients who were above the legal threshold for drink driving in Ireland. In total, 50 patients were recruited. 36 (68%) were female. The most common diagnosis was breast cancer (56%). Ten (20%) patients had metastatic disease and 4 (8%) had liver metastases. The mean paclitaxel dose administered was 118mg. The mean amount of ethanol infused was 7.7g. 27 patients had a detectable breath alcohol level on at least one visit. The mean breath alcohol concentration was 2mcg/100mL or 0.02mg/L of breath. The maximum concentration of ethanol in exhaled breath was 11mcg/100mL or 0.11mg/L which is 50% of the statutory limit for drink driving in Ireland. A weak correlation was observed between ethanol concentration in exhaled breath and the total amount of ethanol administered. Although no patient exceeded the general limit for drink driving in Ireland, three (6%) participants had a breath alcohol concentration above the threshold for professional, learner or novice drivers. Although definitive conclusions are limited by relatively small numbers, it seems unlikely that weekly paclitaxel infusions pose any significant risk to patients driving.

Testing Antemortem Blood for Ethanol Concentration from a Blood Kit in a Refrigerator Fire

The stability of ethanol in antemortem blood stored under various conditions has been widely studied. Antemortem blood samples stored at refrigerated temperature, at room temperature, and at elevated temperatures tend to decrease in ethanol concentration with storage. It appears that the stability of ethanol in blood exposed to temperatures greater than 38°C has not been evaluated. The case presented here involves comparison of breath test results with subsequent analysis of blood drawn at the time of breath testing. However, the blood tubes were in a refrigerator fire followed by refrigerated storage for 5months prior to analysis by headspace gas chromatography. The subject's breath was tested twice using an Intoxilyzer 8000. The subject's blood was tested in duplicate using an Agilent headspace gas chromatograph. The measured breath ethanol concentration was 0.103g/210L and 0.092g/210L. The measured blood ethanol concentration was 0.0932g/dL for both samples analyzed. Although the mean blood test result was slightly lower than the mean breath test result, the mean breath test result was within the estimated uncertainty of the mean blood test result. Even under the extreme conditions of the blood kit being in a refrigerator fire, the measured blood ethanol content agreed well with the paired breath ethanol test.

Sensitive determination of ethyl glucuronide in serum and whole blood: detection time after alcohol exposure compared with urine

Abstract Objectives Ethyl glucuronide (EtG) is a conjugated, minor ethanol metabolite used as a biomarker for recent alcohol intake. EtG is commonly measured in urine as part of a drug testing service but has also attracted attention for measurement in blood. However, due to lower EtG concentrations in blood, the detection time is expected to be shorter. The present work aimed to improve the analytical sensitivity of EtG in blood, to prolong the detection time. Methods A liquid chromatography-tandem mass spectrometry method was developed for EtG in whole blood and serum, using protein precipitation with methanol, a deuterated internal standard, and selected reaction monitoring mode with negative electrospray ionization. No significant matrix effect was observed. The method generated linear results in the measuring range 1.0–50 μg/L, the accuracy was within ±10% and the imprecision <15%. Results In 46 patients followed with daily blood and urine sampling during alcohol detoxification, the mean (median) time to first negative serum EtG sample was 112 (111) h. This was slightly longer than for EtG in urine, using 100 μg/L as cutoff. The detection rate was 76% for serum EtG and 68% for urine EtG. In cases where serum EtG was positive but urine EtG negative, the urine samples tended to be more dilute as indicated by lower creatinine concentrations. On admission to hospital, the whole-blood and serum EtG concentrations correlated with the breath ethanol concentration (p = 0.012 and p = 0.027, respectively). In 100 patients sampled at admission to hospital for other reasons than substance abuse and with no ethanol detected in breath, 40% tested positive for EtG in serum and 43% in urine. In 79 paired urine and serum EtG measurements, the median urine/serum concentration ratio was 155. Conclusions A sensitive method was developed for EtG measurement in whole-blood and serum specimens, offering similar detection time for recent alcohol exposure compared with routine EtG measurement in urine.

Elimination Characteristics of the Alcohol Biomarker Phosphatidylethanol (PEth) in Blood during Alcohol Detoxification.

The study documented elimination characteristics of three phosphatidylethanol (PEth) homologs in serially collected blood samples from 47 heavy drinkers during ~2 weeks of alcohol detoxification at hospital. Venous whole blood and urine samples were collected every 1-2 days during treatment. Concentrations of PEth, and of urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS) to detect relapse drinking, were measured using liquid chromatography-tandem mass spectrometry. When included in the study, negative or decreasing breath ethanol concentrations demonstrated that the patients were in the elimination phase. The EtG and EtS measurements further confirmed alcohol abstinence during the study, with three exceptions. On admission, all patients tested positive for PEth, the total concentration ranging 0.82-11.7 (mean 6.35, median 5.88) μmol/l. PEth 16:0/18:1, 16:0/18:2 and 16:0/20:4 accounted for on average ~42%, ~26% and ~9%, respectively, of total PEth in these samples. There were good correlations between total PEth and individual homologs (P < 0.0001). There was no significant difference in PEth values between male and female subjects. During abstinence, the elimination half-life values ranged 3.5-9.8 days for total PEth, 3.7-10.4 days for PEth 16:0/18:1, 2.7-8.5 days for PEth 16:0/18:2 and 2.3-8.4 days for PEth 16:0/20:4. The results demonstrated a very high sensitivity (100%) of PEth as alcohol biomarker for recent heavy drinking, but considerable differences in the elimination rates between individuals and between different PEth forms. This indicates that it is possible to make only approximate estimates of the quantity and recency of alcohol intake based on a single PEth value.

Preliminary study of absorption of irrigation fluid occurs during 1470nm diode laser enucleation of the prostate

Objective To investigate absorption of irrigation fluid occur during 1470 nm diode laser enucleation of the prostate, and evaluate the safety of the operation. Methods We retrospectively analyzed the clinical data about 20 cases of benign prostate hyperplasia (BPH) treated by 1470 nm diode laser enucleation from July 2016 to October 2016.Intraoperative use of isotonic saline contained 1% ethanol as irrigation fluid, breath ethanol concentration of patients was observed, and irrigation fluid absorption was calculated. Results The operation time was 30-160 min, average(56.2±32.3 )min , irrigation fluid volume was 9-48 L, average(17.1±9.6)L, absorptive amount of Irrigation fluid absorption was 2089 mL in 10 cases.There was no significant difference in serum potassium or serum sodium before and after surgery of 20 patients, preoperative haemoglobin was(133.8±14.4)g/L, haemoglobin in postoperative 24 h was(121.2±18.7)g/L. Postoperative hemoglobin was decline (P=0.000) , especially postoperative hemoglobin of patients with irrigation fluid absorption was significantly decline. Three cases of sinus open and two cases prostate capsule perforate occurred during operation. One of them was happened dysphoric and shortness of breath at the end of the operation. Twenty patients were followed up for 3 months, which revealed that 3 patients with urinary incontinence in two months healing and significant reduction in IPSS and improvement in Qmax and PVR (P<0.05). Conclusions Transurethral enucleation of the prostate using 1470 nm diode laser is an effective method. But there is a certain proportion of irrigation fluid absorption, especially for patients with cardiopulmonary insufficiency, intraoperative monitoring has a necessity. Key words: Prostatic Hyperplasia; Lasers, Semiconductor; Perfusion

Parenteral Antipsychotic Choice and Its Association With Emergency Department Length of Stay for Acute Agitation Secondary to Alcohol Intoxication.

Acute agitation secondary to alcohol intoxication frequently requires parenteral sedatives for patient and caregiver safety. Antipsychotics play a prominent role; however, no consensus exists regarding the ideal agent. One important consideration when evaluating the choice of antipsychotic is its association with emergency department (ED) length of stay (LOS). We sought to determine the median ED LOS for patients receiving a single parenteral dose of an antipsychotic for acute agitation secondary to alcohol intoxication in an urban Level I trauma center. This was a retrospective review of patients receiving a single parenteral dose of droperidol, haloperidol, or olanzapine who were acutely intoxicated on alcohol from 2011 to 2016. Patients needing psychiatric assessment in our ED are discharged to a geographically separate department; thus, ED LOS is minimally impacted by waits for psychiatric assessment. Data were abstracted from the electronic medical record and are presented descriptively. A total of 40,601 patients were identified and screened; 24,319 patients were intoxicated but received no sedation. Of those remaining 4,495 received multiple drugs and/or benzodiazepines leaving 11,787 for analysis. Median age was 42 years, 76% were male, and 5% of patients were admitted. Mean breath ethanol concentration was 227 mg/dL. Antipsychotics administered were as follows: droperidol (n=3,790), haloperidol (n=1,449), and olanzapine (n=6,548). Median ED LOS was shortest for droperidol (499 minutes, 95% confidence interval [CI]= 493-506 minutes), which was significantly shorter than both haloperidol (524 minutes, 95% CI= 515-537 minutes) and olanzapine (533 minutes, 95% CI= 528-539 minutes). No cases of sudden cardiac death occurred. Droperidol, when given as monotherapy for sedation of acute agitation secondary to alcohol intoxication, was associated with significantly shorter ED LOS than either parenteral haloperidol or parenteral olanzapine. No difference in ED LOS was observed between haloperidol and olanzapine.

2375 Pharmacokinetics of phosphatidylethanol 16:0/20:4 homolog in human blood after consumption of 0.4 and 0.8 g/kg alcohol in a laboratory clinical study

OBJECTIVES/SPECIFIC AIMS: The purpose of this study was to characterize the pharmacokinetics of phosphatidylethanol (PEth) 16:0/20:4 homolog in uncoagulated, human blood samples taken from 18 participants in a clinical laboratory setting after consumption of 2 doses of ethanol. METHODS/STUDY POPULATION: Male and female participants received either 0.4 or 0.8 g/kg oral doses of ethanol during a 15-minute period. Blood samples were collected before and throughout 6 hours immediately after alcohol administration, then after 2, 4, 7, 11, and 14 days of administration day. PEth 16:0/20:4 levels were quantified by liquid mass spectrometry. Breath ethanol concentrations were measure concurrently with each blood collection during the administration day, as well as transdermal ethanol concentrations monitored constantly before, during and after ethanol administration day. RESULTS/ANTICIPATED RESULTS: (1) Single doses of 0.4 and 0.8 g ethanol/kg produced proportional increases in BrAC and PEth 16:0/20:4 levels; (2) the increase of Peth 16:0/20:4 from base line to Cmax was less than either PEth 16:0/18:1 or PEth 16:0/18:2 during the 6-hour period after ethanol administration; (3) the mean rate of formation of PEth 16:0/20:4 was lower than those of the other 2 homologs; (4) the mean half-life of PEth 16:0/20:4 was 2.18 days, which was shorter than that of either PEth 16:0/18:1 and PEth 16:0/18:2, which were 6.80 and 6.62, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of this study further confirm that PEth homologs are a sensitive biomarker for ethanol consumption. The measurement of three PEth homologs appears to provide additional information about the level and time frame of drinking.

Bacteria in the airways of patients with cystic fibrosis are genetically capable of producing VOCs in breath

Breath contains hundreds of volatile organic compounds (VOCs), the composition of which is altered in a wide variety of diseases. Bacteria are implicated in the formation of VOCs, but the biochemical mechanisms that lead to the formation of breath VOCs remain largely hypothetical. We hypothesized that bacterial DNA fragments in sputum of CF patients could be sequenced to identify whether the bacteria present were capable of producing VOCs found in the breath of these patients.Breath from seven patients with cystic fibrosis was sampled and analyzed by gas-chromatography and mass-spectrometry. Sputum samples were also collected and microbial DNA was isolated. Metagenomic sequencing was performed and the DNA fragments were compared to a reference database with genes that are linked to the metabolism of acetaldehyde, ethanol and methanol in the KEGG database.Bacteria in the genera Escherichia, Lactococcus, Pseudomonas, Rothia and Streptococcus were found to have the genetic potential to produce acetaldehyde and ethanol. Only DNA sequences from Lactococcus were implicated in the formation of acetaldehyde from acetate through aldehyde dehydrogenase family 9 member A1 (K00149). Escherichia was found to be genetically capable of producing ethanol in all patients, whilst there was considerable heterogeneity between patients for the other genera. The ethanol concentration in breath positively correlated with the amount of Escherichia found in sputum (Spearman rho = 0.85, P = 0.015). Rothia showed the most versatile genetic potential for producing methanol.To conclude, bacterial DNA fragments in sputum of CF patients can be linked to enzymes implicated in the production of ethanol, acetaldehyde and methanol, which are VOCs that are predictive of respiratory tract colonization and/or infection. This supports that the lung microbiome can produce VOCs directly.

Fluid absorption and the ethanol monitoring method.

Fluid absorption is a well-known complication of endoscopic surgeries, such as transurethral prostatic resection and transcervical endometrial resection. Absorption of electrolyte-free fluid in excess of 1 L, which occurs in 5% to 10% of the operations, markedly increases the risk of adverse effects from the cardiovascular and neurological systems. Absorption of isotonic saline, which is used with the new bipolar resection technique, will change the scenario of adverse effects in a yet unknown way. Hyponatremia no longer occurs, but marking the saline with ethanol reveals that fluid absorption occurs just as much as with monopolar prostate resections. Ethanol monitoring is a method for non-invasive indication and quantification of fluid absorption that has been well evaluated. By using an irrigating fluid that contains 1% of ethanol, updated information about fluid absorption can be obtained at any time perioperatively by letting the patient breathe into a hand-held alcolmeter. Regression equations and nomograms with variable complexity are available for estimating how much fluid has been absorbed, both when the alcolmeter is calibrated to show the blood ethanol level and when it is calibrated to show the breath ethanol concentration. Examples of how such estimations should be performed are given in this review article. The difficulty is that the anesthesiologist must be aware of how the alcolmeter is calibrated (for blood or breath) and be able to distinguish between the intravascular and extravascular absorption routes, which give rise to different patterns and levels of breath ethanol concentrations.

Uncertainty estimation of ethanol concentration in simulated breath using enzyme-based biosensors

Exhaled breath (EB) contains volatile and nonvolatile compounds that are correlated with physiological processes in the body, and these breath biomarkers hold enormous diagnostic potential when they are adequately measured and monitored. Thus, the development of instrumentation, including enzyme-based biosensors, for breath monitoring applications has been expanding rapidly. In this paper, the process of estimating the overall combined uncertainty in predicting ethanol concentration, u(Cv)pred, using a calibrated alcohol oxidase-based amperometric biosensor is presented. Components that contributed to u(Cv)pred were the standard uncertainties associated with simulation of a breath sample with trace ethanol concentration, sampling temperature, biosensor instrumentation, and regression analysis. In both EB and exhaled breath condensate (EBC) sensing, the largest contributor to overall uncertainty was the random effects captured by the regression model at 38.2 % and 39.8 %, respectively, for EB and EBC. This was followed by biosensor instrumentation (34.5 %) and simulation (25.3 %) in EB sensing. The trend was reversed in EBC sensing with EB simulation having a larger contribution (33.8 %) than biosensor instrumentation (25.5 %) owing to a better repeatability of amperometric measurements with aqueous samples. The remaining 2.0 % and 0.9 % were due to breath sampling temperatures in EB and EBC sensing, respectively. This study provides a framework for how to incorporate uncertainty estimation in both breath monitoring and is applicable to biosensing of other breath biomarkers.

Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the Prostate

Absorption of irrigation fluid was not detected during GreenLight™ laser vaporization of the prostate using the first generation 80 W laser. However, data are lacking on intraoperative irrigation fluid absorption using the second generation 120 W high power laser. We assessed whether fluid absorption occurs during high power laser vaporization of the prostate. We performed this prospective investigation at a tertiary referral center in patients undergoing 120 W laser vaporization for prostatic bladder outlet obstruction. Normal saline containing 1% ethanol was used for intraoperative irrigation. The expired breath ethanol concentration was measured periodically during the operation using an alcometer. The volume of saline absorption was calculated from these concentrations. Intraoperative changes in hematological and biochemical blood parameters were also recorded. Of 50 investigated patients 22 (44%) had a positive breath ethanol test. Median absorption volume in the absorber group was 725 ml (range 138 to 3,452). Ten patients absorbed more than 1,000 ml. Absorbers had a smaller prostate, more capsular perforation, higher bleeding intensity and more laser energy applied during the operation. Three patients (13%) had symptoms potentially related to fluid absorption. Hemoglobin, hematocrit and serum chloride were the only blood parameters that changed significantly in the absorber group. The changes were significantly different than those in nonabsorbers. Fluid absorption occurs frequently during high power laser vaporization of the prostate. This should be considered in patients who present with cardiopulmonary or neurological symptoms during or after the procedure.

Alcohol vapour detection at the three phase interface using enzyme-conducting polymer composites

Immobilisation of enzymes on a breathable electrode can be useful for various applications where the three-phase interface between gas or chemical vapour, electrolyte and electrode is crucial for the reaction. In this paper, we report the further development of the breathable electrode concept by immobilisation of alcohol dehydrogenase into vapour-phase polymerised poly(3,4-ethylene dioxythiophene) that has been coated onto a breathable membrane. Typical alcohol sensing, whereby the coenzyme β-Nicotinamide adenine dinucleotide (NADH) is employed as a redox-mediator, was successfully used as a model reaction for the oxidation of ethanol. This indicates that the ethanol vapour from the backside of the membrane has access to the active enzyme embedded in the electrode. The detecting range of the sensor is suitable for the detection of ethanol in fruit juices and for the baseline breath ethanol concentration of drunken driving. After continuous operation for 4.5h the system only showed a 20% decrease in the current output. The electrodes maintained 62% in current output after being refrigerated for 76 days. This work is continuing the progress of the immobilisation of specific enzymes for certain electrochemical reactions whereby the three-phase interface has to be maintained and/or the simultaneous separation of gas from liquid is required.

Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired‐breath ethanol measurements

To investigate if absorption of irrigation fluid occurs during bipolar plasma vaporisation (BPV) of the prostate. To examine the clinical predictors of increased risk of fluid absorption and to assess if changes in serum electrolytes, venous pH, haemoglobin or haematocrit are able to detect intra-operative fluid absorption. Over a 15-month period, 55 consecutive patients undergoing BPV of the prostate were investigated. The volume of intra-operative fluid absorption was measured using expired-breath ethanol measurements. Intra-operative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation and the volume of irrigation fluid absorption was calculated from these concentrations. Data on clinical (age, prostate volume, smoking status) and surgical variables (operation time, irrigation volume, appearance of capsular perforation) as well as intra-operative changes in serum electrolytes, venous pH, haemoglobin and haematocrit were recorded. The median (range) age of the patients was 67 (48-87) years and the median (range) prostate volume was 41 (17-111) mL. Nine patients (16%) showed a positive ethanol breath test during the procedure. The median (range) calculated fluid absorption in these patients was 346 (138-2166) mL. Three patients had a fluid absorption >500 mL. One patient with absorption of >2 L showed clinical symptoms (dyspnoea and agitation) during the operation under spinal anaesthesia. In the group of patients with fluid absorption, capsular perforation or injury to larger vessels was more often detectable. In the group of patients with fluid absorption, only venous pH showed a significant change during the operation (from median 7.41 to median 7.34, P = 0.02). The pH decrease was significantly greater in the fluid absorption group than in the group of patients without fluid absorption (0.09 vs. 0.02, P = 0.005). We have demonstrated that significant intra-operative fluid absorption can occur during BPV of the prostate. Care must be taken if using this procedure in patients with significant cardiovascular comorbidities. Respecting the anatomical borders of the prostate seems to play a relevant role in preventing fluid absorption during the procedure. Venous pH could be used to detect potentially dangerous fluid absorption if intra-operative monitoring with breath ethanol measurements is not available.

A direct gaseous ethanol imaging system for analysis of alcohol metabolism from exhaled breath

A non-invasive breath gaseous ethanol imaging system with an exhaled breath flow rate control has been developed. The system offers straight-forward, rapid, and painless sampling from patients, and can be applied to diagnose diseases. The system provides an image of ethanol concentration using chemiluminescence (CL) from an enzyme-immobilized support. The system measures ethanol concentrations as intensities of CL by luminol reaction induced by alcohol oxidase and horseradish peroxidase–luminol–hydrogen peroxide system. The spatio-temporal change in CL generates by ethanol in an exhaled breath is detected by an electron multiplier EM-CCD camera and analyzed. An ethanol skin patch test, a simple method of indicating aldehydehydrogenase 2 (ALDH2), is performed on healthy volunteers. Breath samples from volunteers with ALDH2(+) and ALDH2(−) are analyzed. The exhaled breath flow rate control unit can control and optimize the naturally unstable flow rate of human breath without a gas sampling bag. The coefficient of variance in the exhaled breath flow rate is estimated at 2.8% at a flow rate of 200mL/min. Exhaled gaseous ethanol obtained from volunteers is visualized and analyzed over a period of 300min following the oral administration of ethanol at 0.4g/kg body weight. A peak in the exhaled breath ethanol concentration appears at 30min for both ALDH2(+) and ALDH2(−) volunteers, the breath ethanol concentration then gradually decreases over the remainder of the 300min.

2006 IRRIGATION FLUID ABSORPTION DURING 120W HIGH-POWER GREENLIGHT LASER VAPORIZATION OF THE PROSTATE: RESULTS FROM A PROSPECTIVE INVESTIGATION USING EXPIRED BREATH ETHANOL MEASUREMENTS

INTRODUCTION AND OBJECTIVES: Greenlight laser vaporisation (LV) of the prostate has been shown to be a safe procedure even for high-risk patients with lower urinary tract symptoms caused by prostate enlargement. Intra-operative fluid absorption was not detectable during LV using the first generation 80W greenlight laser. For the more powerful 120W greenlight laser, a different spectrum of adverse events, including a higher rate of capsular perforations and more bleeding complications, has been reported. The aim of the present investigation was to assess if fluid absorption occurs during LV using the more powerful 120W laser. METHODS: A total of 50 consecutive patients was investigated during 120W greenlight LV of the prostate. Intra-operative irrigation was performed using isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min throughout the procedure with a conventional alcometer. The volume of fluid absorption was calculated from the results of these measurements. Intraoperative changes of haemoglobin, haematocrit, venous pH and serum electrolytes were also recorded. RESULTS: The median patients’ age was 69 y (range: 49-84) and the median prostate volume 41 mL (23-118). 25 patients (50%) were operated under thrombocyte aggregation inhibition and 8 (16 %) under anti-coagulation therapy. The median operation time was 70 min (30-170), the median irrigation volume 18 L (8-45) and the median applied laser energy 230 kJ (65-400). 22 patients (44 %) had a positive ethanol breath test. The median amount of fluid absorption in these patients was 1249 mL (138-3452). The surgeons reported intra-operative events in form of opened venous sinuses (n 2), capsular perforation (n 3) or a deep bladder neck incision (n 5) In 10 of these patients (45%). In the group of patients with a positive ethanol test, a significant decrease of the haemoglobin, haematocrit and venous pH and a significant increase of the serum chloride were detectable. CONCLUSIONS: Intra-operative fluid absorption was detectable in 44% of the patients undergoing 120W greenlight LV of the prostate. Absorption of isotonic saline does not result in a classical TUR-syndrome. However, care must be taken in cardiovascular highrisk patients because absorption of up to 3.5 liters of saline can result in serious complications in these patients. Intra-operative monitoring with venous pH or serum chloride might help to detect potentially dangerous fluid absorption if ethanol breath ethanol measurements are not performed.

A randomized, double-masked, placebo-controlled crossover trial on the effects of L-ornithine on salivary cortisol and feelings of fatigue of flushers the morning after alcohol consumption

BackgroundResidual alcohol effects on physiological and psychological symptoms are commonly experienced the morning after alcohol consumption. The purpose of this study was to assess the effects of L-ornithine on subjective feelings and salivary stress markers the morning after alcohol consumption and to investigate whether L-ornithine acutely accelerates ethanol metabolism.MethodsThis study had a randomized, placebo-controlled, double-masked crossover design. Subjects were all healthy Japanese adults with the ‘flusher’ phenotype for alcohol tolerance. In experiment 1, 11 subjects drank 0.4 g/kg body weight alcohol 1.5 h before their usual bedtime. Half an hour after drinking, they ingested either a placebo or 400 mg ornithine. The next morning on awakening, subjects completed a questionnaire containing a visual analog scale (VAS), the Oguri-Shirakawa-Azumi sleep inventory MA version (OSA-MA), and a profile of mood states (POMS) and collected a saliva sample for measurement of salivary stress markers (cortisol, secretory immunoglobulin A, and α-amylase). In experiment 2, placebo or 400 mg ornithine were administrated to 16 subjects both before and after drinking, and the feeling of drunkenness, breath ethanol concentration and one-leg standing time were repeatedly investigated until 180 min after alcohol consumption.ResultsThere were significant decreases in “awareness”, “feeling of fatigue” and “lassitude” VAS scores and in “anger-hostility” and “confusion” POMS scores and a significant increase in “sleep length” in the OSA-MA test. Salivary cortisol concentrations on awakening were reduced after ornithine supplementation. There were no differences between ornithine and placebo in any of the subjective or physiological parameters of acute alcohol metabolism.ConclusionsTaking 400 mg ornithine after alcohol consumption improved various negative feelings and decreased the salivary stress marker cortisol the next morning. These effects were not caused by an increase in acute alcohol metabolism.

Effect of Ethanol in Paclitaxel Injections on the Ethanol Concentration in Exhaled Breath

BackgroundEthanol is included in certain injectable preparations of anticancer drugs to increase their solubility. Since the volume of ethanol in these preparations is approximately half of the total injection volume, the potential inhibitory effects of ethanol on the central nervous system cannot be disregarded, especially considering that patients may drive immediately after administration of the medication. Therefore, the concentration of ethanol was examined in exhaled breath after administration of paclitaxel, an anticancer medication containing ethanol.MethodsThe ethanol concentration in exhaled breath immediately after an intravenous infusion of paclitaxel was measured in 30 patients, using a balloon-type gas detector tube. Correlations between the concentration of ethanol in exhaled breath and the total amount of ethanol administered or the intravenous infusion speed were calculated.ResultsThe mean ethanol concentration in exhaled breath was 0.028 ± 0.015 mg/L. The correlation between the ethanol concentration in exhaled breath and the total dose of ethanol was weak (R2 = 0.25; p = 0.055), while the intravenous infusion speed showed a stronger positive correlation with the concentration of ethanol in the breath (R2 = 0.49; p = 0.11). The maximum concentration of ethanol measured in exhaled breath (0.06 mg/L) was equivalent to 40% of the threshold for drunk driving, as specified in the Road Traffic Act in Japan.ConclusionIn this study, no patient had a breath ethanol concentration exceeding the legal threshold for drunk driving. However, it is still advisable for patients to avoid driving after receiving paclitaxel injections. When driving cannot be avoided, patients should wait for a sufficient time after receiving the injection before driving.

Effect of Ethanol in Paclitaxel Injections on the Ethanol Concentration in Exhaled Breath

BackgroundEthanol is included in certain injectable preparations of anticancer drugs to increase their solubility. Since the volume of ethanol in these preparations is approximately half of the total injection volume, the potential inhibitory effects of ethanol on the central nervous system cannot be disregarded, especially considering that patients may drive immediately after administration of the medication. Therefore, the concentration of ethanol was examined in exhaled breath after administration of paclitaxel, an anticancer medication containing ethanol.MethodsThe ethanol concentration in exhaled breath immediately after an intravenous infusion of paclitaxel was measured in 30 patients, using a balloon-type gas detector tube. Correlations between the concentration of ethanol in exhaled breath and the total amount of ethanol administered or the intravenous infusion speed were calculated.ResultsThe mean ethanol concentration in exhaled breath was 0.028 ± 0.015 mg/L. The correlation between the ethanol concentration in exhaled breath and the total dose of ethanol was weak (R2 = 0.25; p = 0.055), while the intravenous infusion speed showed a stronger positive correlation with the concentration of ethanol in the breath (R2 = 0.49; p = 0.11). The maximum concentration of ethanol measured in exhaled breath (0.06 mg/L) was equivalent to 40% of the threshold for drunk driving, as specified in the Road Traffic Act in Japan.ConclusionIn this study, no patient had a breath ethanol concentration exceeding the legal threshold for drunk driving. However, it is still advisable for patients to avoid driving after receiving paclitaxel injections. When driving cannot be avoided, patients should wait for a sufficient time after receiving the injection before driving.