Breath Ethanol Concentration Research Articles

Comparison of urological irrigating fluids containing glycine and mannitol in volunteers

BACKGROUND We compared symptoms and indices of fluid distribution after experimental administration of glycine and mannitol solutions, since these irrigating fluids are sometimes absorbed by the patient during genitourinary surgery. METHODS Glycine 1.5% and mannitol 3%, both with ethanol 1% added, were given by intravenous infusion at a rate of 0.5 ml/kg/min during 30 min to 12 male volunteers. Symptoms, cognitive status, hemodynamics, electrocardiogram during 24 hr, computerized tomography of the brain, bioimpedance, blood chemistry, and breath ethanol concentrations were recorded. RESULTS Glycine was associated with more symptoms than mannitol (P< 0.006), but the cognitive status, computerized tomography examinations, electrocardiograms, and breath ethanol concentrations did not differ between the solutions. The urinary excretion of fluid and sodium was greater after mannitol (P< 0.04), while only the glycine infusions hydrated the cells (P< 0.05). For both fluids, the intravascular and interstitial volumes were below baseline 3 hr after the experiment started (P< 0.01). CONCLUSIONS Glycine 1.5% had a higher tendency than mannitol 3% to cause symptoms and to accumulate in the cells. Prostate 41:89–98, 1999. © 1999 Wiley-Liss, Inc.

Intramuscular pressure and fluid absorption during arthroscopic acromioplasty

During arthroscopic acromioplasty a high level of irrigation fluid pressure is sometimes required to obtain an adequate visual field. To evaluate the influence of bursa pressure level on the blood circulation of the shoulder muscles, we measured the intramuscular pressure (IMP) in the supraspinatus and deltoid muscles with the microcapillary infusion technique during surgery. Eleven patients with impingement syndromes Neer I–III and rotator cuff tendinitis were examined at subacromial bursa pressures of 100 or 150 mm Hg. In another 11 patients the amount of irrigation fluid absorbed into the circulatory system was evaluated with the use of 2% ethanol NaCl irrigation fluid. At bursal pressures of 100 or 150 mm Hg, the absorbed volume was calculated from the expiratory breath ethanol concentration at the termination of surgery. The IMP in both the supraspinatus and the deltoid muscle varied considerably regardless of bursal pressure. In 50% of the recordings a considerable increase was seen in IMP pressure (>15 mm Hg) when the arthroscope was redirected from the intra-articular position to the subacromial bursa. The mean IMP in both muscles was less than 60 mm Hg during the major portion of the bursoscopy regardless of the infusion pressure level. The fluid absorption was 100 mL (0 to 229 mL) in the 100 mm Hg group and 37 mL (0 to 180 mL) in the 150 mm Hg group. All values were well below the 1000 mL absorption limit regarding the risk of development of a hyperhydration syndrome. In arthroscopic acromioplasty a bursal pressure of 100 or 150 mm Hg will result in similar IMP levels, in most cases below the threshold for muscle blood circulation. The amount of fluid absorbed to the circulatory system will be harmless.

No Evidence of Fluid Absorption during Continuous Low-Pressure Transurethral Resection of the Prostate: Assessment by Measuring Expiratory Breath Ethanol Concentrations

Objective: Measurement of the ethanol concentration in expired breath during transurethral resection of the prostate (TURP). Methods: TURP is a noninvasive method to estimate the amount of irrigant absorbed. The expiratory breath ethanol concentrations (EBEC) were measured with a standard alcohol breath analyzer in 35 patients in the course of TURP. All interventions were performed with a 27-french continuous flow resectoscope using a solution of 1.5% glycine + 1% ethanol as irrigating fluid. Serum sodium and osmolality were measured pre- and postoperatively. No patient developed signs of transurethral resection syndrome; no significant changes in serum sodium, osmolality and EBEC were found throughout the operation. Conclusion: Absorption of irrigant fluid during TURP with continuous low-pressure irrigation seems to be extremely slight (if not absent) as measured by expired breath ethanol method.

A plastic plate facilitating the monitoring of fluid absorption during general anaesthesia

A plastic plate facilitating the monitoring of fluid absorption during general anaesthesia

Effects of Menstrual Cycle and Female Sex Steroids on Ethanol Pharmacokinetics

This study investigated the influence of menstrual cycle and female sex steroid levels on ethanol pharmacokinetics. In a within-subjects design, 24 female volunteers each consumed 0.67 g x kg(-1) ethanol during the menstrual and luteal phases of their menstrual cycle. On each test day, we collected blood samples before ethanol administration to determine estradiol (E2) and progesterone (P) levels and to confirm ovulation. We took 20 or more postdrink breath ethanol concentration readings and examined pharmacokinetic differences between the two phases, using classical pharmacokinetic measures, as well as Michaelis-Menten measures. Despite highly significant differences in measured E2 as well as P levels on the 2 test days, and despite excluding subjects with anovulatory cycles from the analysis, there were no significant differences between menstrual and luteal phases for any of the pharmacokinetic variables. We found no correlation between E2 or P levels and any of the pharmacokinetic measures. In summary, we found no evidence that the tested menstrual cycle phases or varying E2 and progesterone levels significantly influence ethanol pharmacokinetics. Because previous studies about the topic have used few subjects and revealed controversial results, we consider our negative findings based on 24 subjects meaningful.

Effects of Menstrual Cycle and Female Sex Steroids on Ethanol Pharmacokinetics

This study investigated the influence of menstrual cycle and female sex steroid levels on ethanol pharmacokinetics. In a within-subjects design, 24 female volunteers each consumed 0.67 g. kg-1 ethanol during the menstrual and luteal phases of their menstrual cycle. On each test day, we collected blood samples before ethanol administration to determine estradiol (E2) and progesterone (P) levels and to confirm ovulation. We took 20 or more postdrink breath ethanol concentration readings and examined pharmacokinetic differences between the two phases, using classical pharrnacokinetic measures, as well as Michaelis-Menten measures. Despite highly significant differences in measured E2 as well as P levels on the 2 test days, and despite excluding subjects with anovulatory cycles from the analysis, there were no significant differences between menstrual and luteal phases for any of the pharmacokinetic variables. We found no correlation between E2 or P levels and any of the pharmacokinetic measures. In summary, we found no evidence that the tested menstrual cycle phases or varying E2 and progesterone levels significantly influence ethanol pharmacokinetics. Because previous studies about the topic have used few subjects and revealed controversial results, we consider our negative findings based on 24 subjects meaningful.

Electrophysiological Assessment (The Multiple Sleep Latency Test) of the Biphasic Effects of Ethanol in Humans

The Multiple Sleep Latency Test (MSLT) was used to assess the effects of ethanol at the peak and descending phases of the breath ethanol curve. Ethanol (0.75 g/kg) was administered (at 0900 hr) to 8 healthy, normal-sleeping men, aged 21 to 45 years old after 8 hr of sleep the previous night. MSLTs were conducted and breath ethanol concentrations (BrECs) were measured at 15, 45, 75, 105, 225, and 345 min after drinking was completed. Subjective measures were administered immediately before each sleep latency test. BrECs over the first 75 min (tests 1 to 3) peaked and differed from all subsequent tests (tests 4 to 6) over which BrECs declined. Sleep latency and subjective measures were averaged over tests 1 to 3 and 4 to 6. There was a significant increase in mean sleep latency relative to placebo for tests 1 to 3 and a significant reduction for tests 4 to 6. The subjective measure of stimulation sedation, the Biphasic Alcohol Effects Scale, showed lessened sedation after ethanol versus placebo on tests 1 to 3, compared with tests 4 to 6. This study confirmed the presence of a biphasic ethanol effect using an electrophysiological method (MSLT), showing increased physiological alertness on the peak phase of the BrEC curve and increased sedation on the descending phase. Relative to the effects observed on the MSLT with other low-dose stimulant drugs, the stimulatory effect of ethanol was mild.

Monitoring fluid absorption using 1% ethanol-tagged glycine during operative hysteroscopy

To assess the value of expired breath ethanol as a marker of irrigating fluid absorption during hysteroscopic surgery using 1% ethanol-tagged 1.5% glycine. Prospective analysis. Endoscopy training center of a university hospital. Forty-eight women undergoing major hysteroscopic surgery for menorrhagia (40 transcervical endometrial resections, 8 rollerball endometrial ablations). Expired breath ethanol and venous blood samples were taken before and at 10-minute intervals during surgery. Volumetric absorption of irrigating fluid was checked at the same time. Expired breath ethanol concentration, serum ethanol, several biochemical variables, and volume of absorbed irrigating fluid (direct and indirect) were measured. There was a linear positive correlation (r = 0.86, p <0.001) between direct vascular absorption of the irrigating fluid and expired breath ethanol concentration. Prediction can be given with 95% confidence that if the alcolmeter reading is below 0.45%, the volume of irrigating fluid absorbed is below 2000 ml. No significant correlation was seen between expired breath ethanol and indirect fluid absorption. As it is not possible to distinguish direct and indirect fluid absorption during hysteroscopic surgery, measuring expired breath ethanol is insufficient to assess overall fluid balance, and continuous volumetric assessment is still required.

Calculation of lavage volume in transurethral prostate resection (TURP)

Evaluation of the relationship between ethanol concentration in expired air and the amount of absorbed irrigation fluid in patients who undergo a transurethral resection of the prostate. 76 patients were evaluated in a prospective study. The irrigation fluid contained 1.92 w/w% of ethanol. The ethanol concentration in breath was measured at least every 10 minutes with a Alcotest 7410 (Dräger) or a Biomed 3010 (Biotest). Documented values: breath ethanol concentration, mean arterial pressure, heart rate, haemoglobin concentration, serum sodium concentration, the amount of irrigation fluid, the time of operation, special events, therapeutic interventions. A modification of the Widmark formula was used for calculating the amount of absorbed irrigation fluid from the breath ethanol concentration. A rise of the ethanol level above 0.2/1000 was observed in 10 patients. No clinically significant difference in heart rate and blood pressure during surgery between the 24 patients with no alcohol in breath and the 10 patients with more than 0.2/1000 was observed. Prolonged duration of resection and greater amount of used irrigation fluid correlated with higher ethanol concentration in breath. During the study period no patient developed the clinical features of a transurethral resection syndrome. If 2 w/w% of ethanol is added to the irrigation fluid, breath ethanol concentration under 0.2/1000 may be considered harmless, while values above 0.2/1000 are predictors of massive absorption of irrigation fluid. In our patients, the addition of ethanol to the irrigation fluid has been a suitable and easy way to monitor the absorption of irrigation fluid, if the ethanol concentration in the breath is measured every ten minutes. If 2 w/w% of ethanol have been added to the irrigation fluid, the absorbed volume (E) can be estimated using the formula: E = 37.5 x body weight (kg) x ethanol concentration (/1000).

The use of glycine‐ethanol irrigating fluid for the early detection of fluid absorption during endometrial resection

Objective To evaluate the use of 1.5% glycine with 1% ethanol as a marker to detect fluid absorption during endometrial resection. Design Prospective study. Setting Department of Obstetrics and Gynaecology, Wycombe General Hospital, High Wycombe, UK. Subjects 60 women having an endometrial resection for menorrhagia under general anaesthesia. Intervention 1.5% glycine and 1% ethanol solution for irrigation. Main outcome measures Breath ethanol concentration preoperatively, at 5‐min intervals during endometrial resection and 30 and 60 min postoperatively as measured by a hand‐held breath alcohol meter. Blood ethanol concentration, urea and electrolytes and serum ammonia were analysed at the start and the end of the procedure, and at 30 and 60 min postoperatively. Results There was a strong positive correlation (rs=0.93, P&lt;0.000001) between the breath ethanol concentration at the end of the procedure and the total fluid absorbed. Breath ethanol measurements were able to detect absorption of 130 ml or more. Blood ethanol measurements showed the breath ethanol measurements to be reliable. There were no adverse effects attributable to the alcohol. The fall in serum sodium from the start of the operation to the end was the most useful biochemical marker of fluid absorption (rs=0.86, P&lt;0.000001). The rise in serum ammonia from the start of the endometrial resection to the end correlated relatively poorly with fluid absorption (rs=0.44, P=0.00058) and there was no correlation between the ammonia level at the end of the procedure and fluid absorption (rs=0.06, P=0.64). Conclusions 1.5% glycine with 1% ethanol solution provides a safe, effective and noninvasive screening test for the detection of fluid absorption during endometrial resection.

The safety of ethanol-tagged glycine for monitoring fluid absorption during hysteroscopy

We assessed the value of expired breath ethanol as a marker of 1% ethanol-tagged 1.5% glycine irrigating fluid absorption during hysteroscopic surgery in a prospective analysis of 48 women. Expired breath ethanol and venous blood samples were taken before and at 10-minute intervals during surgery. Volumetric absorption of irrigating fluid was checked at the same time. There was a linear positive correlation (r = 0.86, p <0.001) between direct absorption of the irrigating fluid and expired breath ethanol concentration. Prediction can be given with 95% confidence that if the alcohol meter reading is below 0.45 mg/ml, the volume of irrigating fluid absorbed is below 2000 ml. There was no significant correlation between expired breath ethanol and indirect fluid absorption. As it is not possible to distinguish direct and indirect fluid absorption during hysteroscopic surgery, the measurement of expired breath ethanol is insufficient to assess overall fluid balance, and continuous volumetric assessment is still required.

ADH2 gene polymorphisms are determinants of alcohol pharmacokinetics.

The class I hepatic alcohol dehydrogenases (ADHs) are primarily responsible for ethanol metabolism in humans. Genetic polymorphism at the ADH2 locus results in the inheritance of isozymes of strikingly different catalytic properties. The most common ADH2 allele, ADH2*1, encodes the low K(m) isozyme subunit beta 1. The ADH2*3 allele encodes a high-activity isozyme subunit of alcohol dehydrogenase, beta 3, identified in approximately 25% of African-Americans. The Vmax of beta 3 beta 3-ADH is 30 times greater than that of the beta 1 beta 1-ADH. Therefore, we hypothesized that the rate of ethanol metabolism, an important factor in the toxicity of ethanol, in persons with beta 3-containing ADH, either beta 3 beta 3- or beta 1 beta 3-ADH, would be faster than that of persons with only beta 1 beta 1-ADH. We tested this hypothesis with ethanol administered orally to healthy, young African-Americans. Three hundred and twenty-six African-American men and women were genotyped using polymerase chain reaction amplification of their leukocyte DNA followed by hybridization with allele-specific probes. One hundred twelve volunteers, selected by genotype, received an oral dose of ethanol designed to produce a blood ethanol concentration of 80 mg/dl (0.080 g/dl), when the blood alcohol concentration-time curve was extrapolated back to time 0. Ethanol metabolic rates (beta 60s) were determined in the 112 subjects from the slope of the pseudolinear portion of the blood ethanol concentration-time curves. The mean beta 60 of African-Americans having beta 3-containing ADH isozymes had significantly faster ethanol elimination rates than those with only beta 1 beta 1-ADH isozymes. There were no significant differences in body weight, ethanol intake in the week before testing, peak breath ethanol concentration, time to peak, or volume of distribution between the genotype groups. Within each of these groups, men had lower ethanol disappearance rates than women. These results demonstrate in vivo the kinetic differences of ADH2 isozymes that may influence individual risk for the effects of ethanol.

Elevation of Breath Ethanol Measurements by Metered-Dose Inhalers

Study objective: Metered-dose inhalers (MDIs) may contain as much as 38% ethanol. We evaluated the effects of ethanol-containing MDIs on breath alcohol testing. Design: Prospective, single-blind, crossover, controlled study. Participants: Three healthy male volunteers 29 to 36 years old. Intervention: We studied three brands: Tornalate, (38% ethanol), Bronkometer, (30% ethanol), and Alupent, (0% ethanol). The effects of each MDI on breath and blood ethanol measurements were evaluated separately. Two puffs of each brand of MDI were administered. Breath ethanol measurements were obtained at baseline and .25, .5, 1, 2, 3, 5, and 10 minutes after MDI use. Blood ethanol measurements were obtained at baseline and 1 and 10 minutes after MDI use. Results: Overall, Tornalate had the highest breath ethanol readings, with a mean ethanol level of 189 mg/dL recorded just after MDI use. Breath ethanol levels subsequently decreased rapidly over time. Mean breath ethanol concentrations were lower after the use of Bronkometer and undetectable after the use of Alupent. Blood ethanol levels were undetectable at all times tested. Conclusion: MDIs may cause elevations of breath alcohol above the legal criteria for intoxication. These effects are transient and may be prevented by a 10-minute interval between the use of an MDI and breath alcohol testing. [Gomez HF, Moore L, McKinney P, Phillips S, Guven H, Brent J: Elevation of breath ethanol measurements by metered-dose inhalers. Ann Emerg Med May 1995;25:608-611.]

Modeling the concentration of ethanol in the exhaled breath following pretest breathing maneuvers.

A previously developed mathematical model that describes the relationship between blood alcohol (ethanol) concentration and the concentration of alcohol in the exhaled breath at end-exhalation (BrAC) has been used to quantitate the effect of pretest breathing conditions on BrAC. The model was first used to "condition" the airways with different breathing maneuvers prior to simulating a single exhalation maneuver, the maneuver used in standard breath alcohol testing. On inspiration, the alcohol in the air reaches local equilibrium with the alcohol in the bronchial capillary bed prior to entering the alveolar region. On expiration, approximately 50% of the alcohol absorbed on inspiration is desorbed back to the airways. BrAC correlates with the amount of alcohol that is desorbed to the airways. The six pretest breathing conditions and the percent change in BrAC relative to the control maneuver were: hyperventilation (-4.4%), hypoventilation (3.7%), hot-humid air (-2.9%), hot-dry air (0.66%), cold-humid air (0.13%), and cold-dry air (0.53%). The mechanism underlying these responses is not due to changes in breath temperature, but, rather to changes in the axial profile of alcohol content in the mucous lining of the airways.

Nocturnal and next‐day effects of ethanol and basal level of sleepiness

AbstractFive healthy young men (mean age 25.6 years) consumed ethanol (0.8 g/kg producing breath ethanol concentration (BEC) of 0.06 per cent on average 30 min post‐consumption) and placebo at 2200–2230 h after 4 and 8 h in bed (TIB) the previous night. Standard sleep recordings were collected from 2300 to 0700 h. The next‐day latency to sleep onset was tested at 1000, 1200, 1400 and 1600 h and divided attention performance and hangover symptoms were assessed 30 min after each latency test. The 4 h TIB increased sleep efficiency, but did not interact with the effects of ethanol. Ethanol altered sleep staging. In analyses of ethanol effects by halves of the night, ethanol increased percentage stage 3/4 sleep in the first half and increased percentage stage 1 sleep in the second half. The following day, mean daily sleep latency (MSLT) was reduced and mean divided attention tracking errors were increased with ethanol. Ethanol effects (mild) on the hangover questionnaire were detected only on the 0800 h assessment.

The transurethral resection syndrome

The transurethral resection syndrome ("TUR syndrome") is caused by absorption of electrolyte-free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life-threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhaled breath.

Monitoring of irrigating fluid absorption during transurethral prostatectomy

A simple, reliable method to detect absorption of irrigating fluid during transurethral prostatectomy is to tag irrigating fluids with 1% ethanol and monitor expired breath ethanol concentrations. This method correlated well (n = 0.79) with other existing methods of absorption monitoring in 20 anaesthetised patients. Ethanol (1%) tagging does not alter the optical quality of the irrigating fluid and is harmless to the patient. The technique is non-invasive, repeatable, cheap and gives instant results. It can be used in anaesthetised or awake patients and can detect absorption of as little as 100-150 ml in any 10-minute period.

The Response of the Intoxilyzer 4011AS-A® to a Number of Possible Interfering Substances

Five Intoxilyzer 4011AS-As were tested for their response to eleven chemicals and one mixture of chemicals. The air/water partition ratios were also determined for these eleven chemicals and one mixture. The chemicals tested and their approximate partition ratios were the following: acetaldehyde (190:1), acetone (341:1), acetonitrile (578:1), isoprene (1:1), isopropanol (1671:1), methanol (3229:1), methylene chloride (11:1), methyl ethyl ketone (229:1), toluene (5.5:1), 1,1,1-trichloroethane (14:1), trichloroethylene (20:1), and a 50:50 mixture of 1,1,1-trichloroethane and trichloroethylene (14:1). Of the eleven chemicals and one mixture studied during this experiment, only three, isopropanol, toluene, and methyl ethyl ketone, could reasonably interfere with the test, and then only under unusual circumstances--those circumstances being a slight additive effect to a breath ethanol concentration near the level required for prosecution. Any substantial additive effect from these three substances would illuminate the interference light which invalidates the test. The mean illumination point of the interference light was 0.0286 g/210 L for methyl ethyl ketone, 0.0294 for toluene, and between 0.0116 and 0.0292 for the apparent alcohol concentration for isopropanol, depending on the amount of isopropanol metabolized to acetone. Even with these unusual circumstances considered, the Intoxilyzer 4011AS-A must be viewed as an effective way of determining the ethanol concentration in human breath for evidential purposes.

Individual Differences in the Sedating Effects of Ethanol

Twenty-four healthy, normal-sleeping, males aged 21-35 were screened for basal levels of sleepiness using the Multiple Sleep Latency Test (MSLT). Twelve subjects had basal average daily sleep latencies of less than or equal to 6 min (sleepy) and 12 had latencies of greater than or equal to 16 min (alert) on the MSLT. Subjects consumed either ethanol (0.75 mg/kg) or placebo at 0900-0930 after spending 8 hr time in bed (TIB) the previous night. Sleep latency was measured at 1000, 1200, 1400, and 1600 hr. Divided attention performance and the Stanford Sleepiness Scale (SSS) were assessed at 1100 hr. Breath ethanol concentration (BEC) was determined prior to each latency test. Ethanol decreased average daily sleep latency, divided attention scores and SSS ratings. There were individual differences in the sedating and impairing effects of ethanol, related to subjects' basal level of sleepiness/alertness. The alert subjects exhibited longer sleep latencies and higher performance scores after ethanol administration than the sleepy subjects after placebo. Subjectively the groups had a similar level of sleepiness on placebo and were similarly sedated with ethanol.

Increased daytime sleepiness enhances ethanol??s sedative effects

Thirty healthy men, 21 to 35 years old, received either 8.7, 13.0 or 17.4 mmol/kg (0.4, 0.6, or 0.8 g/kg) ethanol after 8 hours time in bed (TIB), one night of 5 hours TIB, and four nights of 5 hours TIB. Ethanol, administered as 80-proof vodka mixed 1:4 with tonic water, was consumed over 30 minutes (0900 to 0930 hours). Sleep latency was measured at 1000, 1200, 1400, and 1600 hours using standard sleep laboratory methodology. Breath ethanol concentration (BEC) was determined prior to each latency test. Mean latency to sleep on the four tests decreased from day 1 (8 hours TIB) to day 5 (fourth day of 5 hours TIB). On day 1 mean latency after 8.7 mmol/kg differed from that after 17.4 mmol/kg, with the 13.0 mmol/kg latency intermediate between the other two. On day 2 and day 5 during sleep restriction these dose differences were diminished. Latency on day 5 after 8.7 mmol/kg was similar to that of 13.0 mmol/kg on day 2, which was similar to that of 17.4 mmol/kg on day 1. The BEC did not change from day 1 to day 5 and significant dose differences between each dose remained consistent from day to day. These data show that increased basal levels of sleepiness enhance ethanol's sedative effects for even moderate ethanol doses.