Higher Blood Alcohol Concentration Research Articles

Alcohol related emergencies among adolescents admitted in a referral acute-care center for adults in Genoa, northwest Italy

Abstract Background As a result of underage drinking, adolescents have an increased risk of physical, mental, emotional, and social harm. Methods In order to assess the emergencies for alcohol use, data of the emergency department (ED) of San Martino Hospital - the referral acute-care center for adults in Genoa, Northwest Italy - was analyzed retrospectively. 330 records of 320 adolescents visiting the ED between 2014 and 2023 were considered. Results The median age of access was 16 (IQR 2), 54.8% were males, 17.4% had foreign nationalities, and the average blood alcohol concentration (BAC) was 1.8 g/L (SD 0.7), with 14.7% testing positive for other substances (6.1% benzodiazepines and 11.2% other drugs). 16.8%, 46.6% and 36.6% were assigned an emergency, urgent, and not-urgent acuity code. 2.8% had a repeated episode, 3.4% had to be removed for inappropriate behavior, 7.8% left spontaneously, 13.1% were hospitalized for additional care (5.5% in the Psychiatry ward). The average length of stay was 1.24 days (SD 5.86). Multivariable logistic regression showed that higher age, an emergency code and the use of other substances were positively associated with hospitalization [ORs 1.74 (95%CI 1.1-2.7), p 0.01; 7.1 (95%CI 2.2-22.4) p < 0.001; and 15.6 (95%CI 6.8-35.6) p < 0.001, respectively]. Admission in Psychiatry, in particular, was strongly associated with the use of other substances [OR 11.8 (95%CI 3.8-36.6), p < 0.001]. Multivariable linear regression showed that, in comparison with other access reasons, accidents and decreased consciousness were associated with higher BAC [beta 0.6 (95%CI 0.1-1.1), p 0.01; beta 0.8 (95%CI 0.3-1.2) p < 0.001]. Length of stay, however, was associated with lower BAC [beta -0.2 (95%CI -0.3 -0.01), p 0.04]. Conclusions In Italy, binge drinking affects 120,000 adolescents aged 11-17. Our findings highlight the harm of this practice and support the need for prompt interventions to reduce the onset and prevalence of adolescent alcohol use.

Suicidal ideation in the context of alcohol use among college students: differences across sexual orientation and gender identity

PurposeThere is a dearth of research on suicidal ideation (SI) that occurs specifically in the context of drinking alcohol. Alcohol use and binge drinking are both elevated among college students, among whom sexual and gender minority (SGM) students are at particular risk for SI. This manuscript examines alcohol use, SI, and SI specifically in the context of alcohol use among a large sample of undergraduate students and examines differences across sexual and gender minority groups.MethodsData were drawn from ~ 300,000 students who completed the American College Health Association National College Health Assessment (ACHA-NCHA) between Spring 2019 and Fall 2022. Participants reported identity variables and information about drinking behaviors and suicidal ideation over the past year. Multilevel models were used for all analyses.ResultsRisky drinking behaviors and higher blood alcohol content during the last episode of social drinking were associated with higher odds of SI while drinking. Rates of risky drinking behaviors, SI, and SI while drinking were elevated among SGM students with SGM men and nonbinary students reporting the highest rates across groups.ConclusionSI while drinking, which is seldom assessed in measures of either measures of suicidal thoughts or alcohol use behavior, is an important construct for further research to improve our understanding of high risk states for suicide. Given elevated rates of alcohol use and SI among college students, providing education and resources to reduce SI while drinking is a critical target for universities, particularly to reduce risk among vulnerable SGM students.

Positional Asphyxia: Remains Hard to Diagnose?

Positional asphyxia is a type of asphyxia where the position of an individual compromises the ability to breathe. It is commonly caused by accidents due to alcohol or drug intoxication, diseases, and/or being in a confined space. In this study, the authors reviewed autopsy cases at their institute over the past 5 years where positional asphyxia is suspected as a contributing factor or cause of death. The autopsy cases (n=24) were divided into three groups: positional asphyxia was the cause of death (n=15); unknown cause of death but positional asphyxia was considered (n=4); and positional asphyxia was suspected to be a contributing factor (n=5). All cases of group A included postures that could interfere with breathing, but the typical jackknife or head-down postures were seen in approximately half of the cases; “classic signs of asphyxia” were also observed in approximately half of the cases. They shared features such as high blood alcohol concentration, therapeutic levels of drugs, various disease, minor head trauma, and morbid obesity; however, no definite diagnostic criteria have been established for forensic practice. Positional asphyxia is a form of mechanical asphyxia which must be differentiated from traumatic asphyxia. In addition to a complete autopsy, thorough laboratory tests and understanding of the circumstances of the case and the situation at the death scene are required for diagnosis. Special attention is required for the diagnosis of special types of positional asphyxia such as death during institutional restraint or prone restraint.

No Association of Blood Alcohol Concentration on Burn Patient Outcomes

IntroductionAlcohol abuse is common among burn patients. Burn patients under the influence of alcohol are at risk for developing organ failure, prolonged hospital duration, and increased intensive care unit (ICU) resources. Our study aims to analyze the association between presenting alcohol levels and the outcomes of burn patients. MethodsA retrospective analysis of admitted burn patients was performed from 2016 to 2021. Patients were divided into two groups based on blood alcohol content (BAC), low (<80), and high (≥80) mg/dL. Data included demographics, comorbidities, and outcomes. Univariate analyses were performed, and a P value <0.05 was significant. ResultsA total of 197 patients were included (32.5% females, mean age 47.2 ± 15.2, 26.9% smokers, 28.4% illegal drug abuse, and 56.3% no comorbidities). Mortality was 7.6%, morbidity 20.8%, 39.1% required burn ICU admission, and 25.9% were intubated. When comparing BAC groups, we found no differences in demographics, comorbidities, inhalational injury incidence, carbon monoxide level, intubation, or burn ICU admission rates. The high-BAC group had longer ventilator days (high BAC 16.7 ± 19.3 versus low BAC 7.5 ± 9.1, P = 0.026) and longer stays in the ICU (18.6 ± 21.8 versus 10.7 ± 15.4, P = 0.075). The low-BAC group had more 3rd-degree burn percentage (5.0 ± 15.3 versus 15.4 ± 27.5, P = 0.024). Both morbidity and in-house mortality rates were similar for both groups (23.8% versus 16.0%, P = 0.192, and 6.6% versus 9.3%, P = 0.476, respectively). ConclusionsBurn patients with higher BAC had significantly longer mechanical ventilator days. However, higher alcohol concentrations had no association with regard to mortality, overall length of stay, or complication rates.

Impaired face symmetry detection under alcohol, but no 'beer goggles' effect.

The 'beer goggles' phenomenon describes sexual attraction to individuals when alcohol intoxicated whom we would not desire when sober. One possible explanation of the effect is that alcohol impairs the detection of facial asymmetry, thus lowering the drinker's threshold for physical attraction. We therefore tested the hypotheses that higher breath alcohol drinkers would award more generous ratings of attractiveness to asymmetrical faces, and be poorer at discriminating bilateral facial asymmetry than less intoxicated counterparts. Ninety-nine male and female bar patrons rated 18 individual faces for attractiveness and symmetry. Each type of rating was given twice, once per face with an enhanced asymmetry and once again for each face in its natural form. Participants then judged which of two same-face versions (one normal, the other perfectly symmetrised) was more attractive and, in the final task, more symmetrical. Alcohol had no influence on attractiveness judgements but higher blood alcohol concentrations were associated with higher symmetry ratings. Furthermore, as predicted, heavily intoxicated individuals were less able to distinguish natural from perfectly symmetrised face versions than more sober drinkers. Findings therefore suggest alcohol impairs face asymmetry detection, but it seems that this perceptual distortion does not contribute to the 'beer goggles' phenomenon.

Sober up: Time from last drink to a road traffic injury

PurposeThere is no intervention that quickly reduces a person's blood alcohol content (BAC). “Sober up before you drive” may prevent road traffic injury (RTI) caused by alcohol consumption. The aim of this study was to analyze the risk of RTI on an hourly basis (1–6 h) after the last drink and the determinants of this risk. MethodsThis was a case-crossover study of alcohol consumption among 430 patients who suffered an RTI and arrived at an emergency department in a large hospital in Mexico City from January to April 2022. ResultsOf the 430 patients studied, 46 reported drinking within 1 h before the RTI, for a risk ratio (RR) of 7.7 (95% CI [5.6, 10.4]). This RR decreased to 2.2 (95% CI [1.3, 3.7]) for the 12 patients drinking in the second hour before the RTI and was null for those drinking earlier (p ≤ 0.001 for the trend). The induction time was 3 h among those with higher BAC and intoxication levels. The RR for an RTI decreases 71% from the first to second hour from the last drink and 32% from the second to third hour. This decrease was similar among those intoxicated and those with increased BACs. In multiple regression models, higher levels of intoxication and higher BACs remained associated with higher RRs. DiscussionPeople should avoid driving after drinking. Waiting to drive, walking, or riding after drinking reduces the risk of an RTI, especially for people with higher BAC and intoxication levels.

Verbal memory and executive components of recall in adolescent binge drinkers.

Binge drinking (BD) is a common health-risk behavior among young people. Due to the incomplete maturation of the adolescent brain, BD can lead to structural and functional changes that impact neurocognitive processes, particularly executive functioning and verbal memory. This study aimed to investigate the influence of executive components, such as mnemonic strategies and error avoidance, on performance in a verbal memory test and the potential effects of BD on this performance. A sample of 160 college students (51.55% female) with a mean age of 18.12 ± 0.32 years completed assessments for alcohol use disorders using the Alcohol Use Disorder Identification Test (AUDIT), as well as psychopathological (Symptom Checklist-90-R) and neuropsychological evaluations (Verbal Learning Test Spain-Complutense and WMS-III Logical Memory). The Intensive Drinking Evaluation Instrument (IECI) was utilized to gather detailed information about binge drinking habits, including the calculation of the highest blood alcohol concentration (BAC) during an episode of intake. Correlation and clustering analyses revealed a negative association between BAC values and verbal memory performance, as well as the use of memory strategies. The high BAC group (BD) exhibited negative values in verbal memory variables, higher accuracy errors, and less efficient strategy usage, while the low BAC group (No BD) demonstrated better memory test performance, fewer precision errors, and superior use of memory strategies. These findings support the hypothesis that, when solving tests requiring verbal memory, adolescents reporting a BD consumption pattern show fewer executive skills in their resolution and, therefore, achieved poorer performance than non-binge drinkers. Addressing excessive alcohol consumption in young individuals is crucial for safeguarding their cognitive development and overall well-being.

Preanalytical factors influencing the results ofethanol analysis inpostmortem specimens.

Excessive drinking and drunkenness are underlying factors in many fatal accidents, which make the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons although the interpretation of the results is more complicated in medical examiner cases owing to various preanalytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem ingestion of ethanol from PM synthesis. One approach involves the determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid, vitreous humor and/or urine, and comparison of results with blood alcohol concentration (BAC). Another approach involves the analysis of various alcohol biomarkers, such as ethyl glucuronide, ethyl sulfate and/or phosphatidylethanol or the urinary metabolites of serotonin 5-hydroxytryptophol/5-hydroxyindoleacetic acid (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as an enzyme inhibitor, in all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 to 0.02 g% when PM blood is analyzed. During putrefaction low BACs are more often produced after death than high BACs. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.

Autopsy study of alcohol-associated unnatural deaths in Thailand, 2007-2019.

To date, there have been no major studies of alcohol-associated unnatural deaths in Thailand or South East Asia. Thailand leads South East Asia in per capita alcohol consumption. The objectives of this study were to determine the incidence of alcohol-associated unnatural deaths in Thailand and their relation to post-mortem blood alcohol concentration (BAC); to investigate correlations between BAC and selected demographic variables; and to evaluate the incidence of co-use of alcohol and illicit substances. We conducted a retrospective register-based study of alcohol-investigated unnatural deaths in Thailand for the period 2007-2019. The core study sample (n = 77,006) was derived from a Thai government computerized database of unnatural-death autopsies. Of the total autopsy sample 32.49% was alcohol positive (BAC ≥0.20 g/L). The rate at which male autopsy cases were alcohol positive (35.52%) was approximately twice that of female autopsy cases (16.62%), with males having significantly higher median BAC levels, 1.64 and 1.31 g/L, respectively. The incidence of female alcohol-positive cases with extremely high BACs (≥3.50 g/L) was comparable to that of male alcohol-positive autopsies. The rates at which victims of accidents, homicides, and suicides were alcohol positive were 42.44%, 38.81%, and 33.25%, respectively. Drowning fatalities had the highest rate of alcohol detection (49.12%) and the highest median BAC (2.47 g/L). The next highest rate (48.47%) was among road traffic fatalities (RTFs, BAC 1.92 g/L), which accounted for about one-half of all RTFs and one-third of all alcohol-positive autopsies. Of the total alcohol-positive population, 8.33% tested positive for illicit substances, most commonly methamphetamine/amphetamine. BAC results for the majority of male and female alcohol-positive victims exceeded the generally accepted threshold for Heavy Episodic Drinking (0.8 g/L) and provided a rare BAC-documented (≥3.50 g/L) example of gender parity in the incidence of heavy alcohol consumption. The median BAC value for alcohol-positive RTFs (1.92 g/L) was about 10% higher than in studies in most other countries and about four times greater the Thai legal limit for motor-vehicle operation (0.50 g/L).

Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015-2021.

Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.

Estimating alcohol-attributable injury deaths: A comparison of epidemiological methods.

Injuries often involve alcohol, but determining the proportion caused by alcohol is difficult. Several approaches have been used to determine the causal role of alcohol, but these methods have not been compared directly with one another. Such a comparison would be useful for understanding the strengths and comparability of different approaches. This study compared estimates of average annual alcohol-attributable deaths in the United States from injuries during 2015-19 using a blood alcohol concentration (BAC) method compared with a population attributable fraction (PAF) approach. For the BAC method, we used a direct method involving the proportion of decedents with a high blood alcohol concentration (BAC; e.g. ≥ 0.10%). For the PAF approach, we compared the use of unadjusted survey data with average consumption data adjusted using alcohol sales data to account for underreporting and also accounting for the underreporting of binge drinking. Survey data were from the Behavioral Risk Factor Surveillance System and mortality data were from the National Vital Statistics System. The number of alcohol-attributable injury deaths using the direct method (48 516 deaths annually) was similar to that using PAF methods (47 879 deaths annually), but only when alcohol use measures were adjusted using alcohol sales data. Furthermore, estimates were similar for cause-specific categories of deaths, including non-motor vehicle unintentional injuries and motor vehicle crashes. Among PAF methods, excessive drinking accounted for 38.3% of injury deaths using unadjusted survey data, but 64.8% of injury deaths using adjusted data. Estimates of alcohol-attributable injury deaths from a direct method and from a population attributable fraction method that adjusts for alcohol use based on alcohol sales data appear to be comparable.

Alcohol and fatal penetration of the cranium by an airgun pellet—a case study from Poland

BackgroundAirguns with the energy of ejected pellets below 17 J are not considered weapons in Poland, can be purchased without permission, and do not require registration. The mere possession of this kind of airgun does not entail any legal consequences, unless it is used for an unauthorized purpose. Sports and recreational shooting do not have to take place within shooting ranges. However, the improper use of this type of weapon can lead to serious injuries and death. In addition, the impact of high blood alcohol content on pain perception can lead to a lack of awareness of the gunshot.Case presentationA 36-year-old woman died a few hours after a head injury inflicted by a 5.50-mm caliber pellet fired from an air gun. The first pellet penetrated perpendicularly through the left temporal bone to the brain. The gunshot tract of this head wound was 6 cm long and ran horizontally and perpendicularly to the surface of the squamous part of the temporal bone. The tract ran through the skin of the skull, the left temporal muscle, and the squamous part of the temporal bone (where the bone was only 1.5 mm thick). The pellet then penetrated the cerebral dura mater, cerebral pia mater on the borderline of the left temporal and frontal lobes, and left lateral wall of the sphenoidal sinus. The victim did not complain of pain due to a high level of alcohol intoxication (0.35 blood alcohol content). The pellet from the second shot (on the foot) penetrated the right foot and was inflicted by the victim.ConclusionThe victim died not earlier than 3 h after being shot as a result of intracranial injuries that caused hemorrhage. The outcomes of this study indicated that high alcohol content resulted in reduced awareness of the victim and no apparent symptoms of developing intracranial injuries.

Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication

This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 − 126.08). Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents’ muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents’ muscle tissue.What is Known:• Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal).• Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct “muscular” toxicity” (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma.What is New:• Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I).• There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.

Comparative evaluation of toxicology and sociodemographic characteristics in homicide and suicide victims

Background/Aim. Suicide and homicide are crucial social problems, especially frequent among the population younger than 40 years. The aim of this study was to assess the influence of different sociodemographic factors and relevant psychoactive substances on the difference between homicide and suicide victims. Methods. A cross-sectional study analyzed autopsy reports of 714 suicide and 166 homicide cases autopsied in five years (2011?2016). Out of these, 666 suicide and 127 homicide cases met the inclusion criteria for this study. Blood-ethanol concentration was determined by headspace gas chromatography with flame ionization detection. Analysis of substances other than ethanol was accomplished by gas chromatography-mass spectrometry and liquid chromatography with tandem mass spectrometry. Results. There was a significant difference in age, level of education, and employment rate between suicide and homicide cases (p &lt; 0.05). The distribution of suicide and homicide cases differed significantly on weekdays compared to week-ends [odds ratio(OR) = 1.5; 95 % confidence interval (CI) = 1?2.3; p &lt; 0.05]. The presence of a psychoactive substance remained a nonsignificant predictor of whether a person would become a homicide or suicide victim (p &gt; 0.05). Homicide victims were more likely to have significantly higher blood alcohol concentration (0.2?0.3 g/dL) than suicide victims (OR = 2.2; 95 % CI = 1?5; p &lt; 0.05). Conclusion. The age, level of education, employment status, and high blood alcohol concentration (0.2?0.3 g/dL) of the victim were significantly different between suicide and homicide cases.

Homicide mechanisms, weapon types and causes of death in the autopsy material of the Department of Forensic Medicine Medical University of Gdańsk Poland in the years 2010–2019

The study objective was the analysis of homicides based on reports of 107 medicolegal autopsies of victims, which were carried out in 2010–2019 at the Department of Forensic Medicine of the Medical University of Gdańsk, Poland. The study focused on the analysis of homicide mechanisms, on the weapon type, injuries characteristics, and both pathomechanisms and causes of death. Alcohol and illicit drugs abuse, which is a predisposing factor, was also assessed. In the analysed cohort, 70.1% were males and 29.9% females. The most frequently used weapon was a blunt instrument (accounting for 47.7% of homicides), while the least common was a firearm (accounting for 4.7% of homicides). There were significant differences in homicide mechanisms related to victims’ gender. In males, blunt or sharp instruments predominated, while in females violent suffocation and chop injuries were more frequent. Fatal head injuries and their consequences predominated in the pathomechanisms of death (32.7% of cases). It was shown that the highest blood alcohol concentration (BAC) was found in homicides due to violent strangulation and sharp instrument use, while the lowest BAC was found in gunshot victims. Toxicological tests were performed in 18 cases and in 7 cases showed positive results for illicit drugs. The analysis of various elements involved in homicide may contribute to a conceptual framework for preventive measures aiming at the reduction of homicides number.

A 20-Year Review of Recumbent Pedestrian Fatalities (2001-2020).

A retrospective study was performed in the Northern Territory of Australia of all cases of pedestrian fatalities where the decedents had been sitting, crouching, sleeping, or lying on or next to a road, over a 20-year period (January 1, 2001 to December 31, 2020). Of the 865 road traffic fatalities, 161 (19%) were pedestrians, and 42 of these were recumbent at the time of the incident (26% of all pedestrians). The most common age range was 30 to 39 years with a male to female ratio of 25:17. No individuals younger than 15 years were involved. Acute alcohol intoxication played a role in death in all of the cases with medium to high range blood alcohol concentrations. In addition, cannabis or its metabolites were detected in 6 cases, and methylamphetamine in 1 case. A history of chronic alcohol use or dependence was known in 6 (14%) of cases. In no case was an underlying medical condition contributory to death. The majority of incidents occurred at night. This study has shown a very high incidence of recumbent pedestrian deaths in an Australian subpopulation related to acute alcohol intoxication, decreased visibility, and vulnerability because of their position on or proximate to a road.

On Detecting Drunk Drivers in Mixed Autonomous Platoons Using Vehicles Velocity Measurements

Drunk drivers, who critically and continuously threaten road safety, are usually detected using biological sensors within the same vehicle or after drunk driving behavior is observed by police patrols. Observing an obvious drunk driving behavior indicates a relatively high blood alcohol concentration, and thus, detecting drunk drivers with a relatively low blood alcohol concentration is difficult. This study uses output-only measurements available from motion sensors in the longitudinal drive of mixed autonomous and human-driven platoons to detect drunk drivers’ behavior in human-driven vehicles within the same platoon. The human-driven vehicle is assumed to be between two autonomous vehicles that are able to share information with each other. The proposed approach relates a set of motion sensor measurements with another within the platoon and does not require the knowledge of the excitation signal or the dynamics of the platoon. Numerical simulations are first implemented to test the proposed approach, and then, VISSIM software is implemented to simulate realistic road topography. Further validations on laboratory mobile robots are presented in this article, where a class of abnormal driving conditions that includes human-driven vehicles is simulated. Experiments are carried out by measuring abnormal human-driven vehicles within connected autonomous robots. This method is shown to deal with various system uncertainties, and the approach can deal with the drunk driver case. The drunken driving conditions are modeled mathematically with different blood alcohol concentration levels, which correspond to different effects and different drunk driving behaviors. The proposed transmissibility-based drunk driver detection algorithm is shown to detect drivers with risky relatively low alcohol concentrations.

S3412 Functional Medicine Approach to Care Improves Quality of Life and Blood Alcohol Levels in a Patient With Autobrewery Syndrome

Introduction: Autobrewery syndrome, or gut fermentation syndrome (GFS), is a rare condition characterized by elevated blood alcohol concentration (BAC) in the absence of alcohol consumption. Treatment involves antifungals and a low carb diet, which are often ineffective. In this case, we describe a patient with GFS who failed traditional therapy, was unable to complete activities of daily living due to high BAC, and responded well to a functional medicine approach to care with sustained improvement in BAC. Case Description/Methods: In 7/2020, a 58-year-old man with T2D, obesity, HTN and gout developed recurrent episodes of dysarthria, behavioral changes, and somnolence. On multiple occasions in the ER, his BAC level was found to be elevated. The patient and family denied alcohol use. He was ultimately diagnosed with GFS. He self-initiated a strict low-carb diet with initial success in controlling his BAC from 11/2020 to 12/2020. From 10/2020 to 10/2021, he underwent multiple courses of antifungal medications (nystatin, fluconazole, micafungin, and oral amphotericin). The longest period of remission (BAC 0) was 41 days while on micafungin. After 41 days on micafungin and a restricted diet, his BAC increased. Over this time, he lost 80 lbs. In 11/2021, he established with a functional medicine GI and dietitian. Stool metabolomics showed no obvious abnormalities. The 5 R protocol (remove, replace, repair, reinoculate, rebalance) was introduced. He started with an aggressive bowel regimen with prucalopride and lactulose. He completed 15 days of high-potency Bacillus subtilis probiotic, followed by a transition to a more diverse probiotic. He added daily intake of a medical food to his restricted diet. New foods were then introduced, one at a time, in the evening, with subsequent monitoring of BAC. In 2/2022, he started Undecylenic acid (10-Undecenoic Acid) as fatty acid support. Lifestyle modifications were added to emphasize more exercise, daily outdoor walks, optimal sleep, and decreasing stress. He did well until BAC levels spiked in 3/2022 due to consumption of alcohol, triggered by cravings that developed when the gut production of alcohol decreased. After alcohol cessation, BAC levels have remained undetectable for 60+ days with continued diet modifications and supplements (Figure). Discussion: GFS is difficult to treat with minimal traditional treatment options. This case is a patient with GFS that failed all medical options and is now thriving after a functional medicine approach to care.Figure 1.: BAC levels continued to spike with medical therapies and have sustained improvement with functional medicine care.

New evidence of high association between carbohydrate deficient transferrin (CDT) and alcohol-related road traffic accidents. A retrospective study on 929 injured drivers

BackgroundIt is well known that traffic injuries still represent one of the main causes of death and that high blood alcohol concentrations while driving significantly increase the occurrence of accidents. However, only limited literature on the correlation between chronic alcohol abuse and accident risk is available. The aim of the present study was to investigate the hypothesis of an association between elevated concentrations of carbohydrate deficient transferrin (CDT) and the occurrence of alcohol-related traffic accidents. MethodsThe analytical determinations of BAC and CDT were performed following certified methods in HS-GC-FID and HPLC, respectively. For BAC, 0.50 g/L was used as cut-off, whereas 2.0% was used for CDT, according to the standardisation proposed by IFCC. A total of 929 drivers, tested for BAC at the time of hospital admission after a traffic accident, were classified into two groups: InjDr 1 (BAC ≤ 0.50 g/L) and InjDr 2 (BAC>0.50 g/L); all drivers were also tested for CDT. ResultsInjDr 1 included 674 individuals, only 2.5% showing a CDT above the cutoff, whereas InjDr 2 group consisted of 255 subjects, 28.6% testing positive for CDT (Odds Ratio 15.5). When subdividing the InjDr group into increasing classes of CDT, a steady increase in the percentage of BAC-positive drivers was appreciated. Moreover, average BAC was found to parallel each class of CDT. ConclusionsThe reported data strongly support the use of CDT as a biomarker of increased risk of alcohol-related traffic accidents in the procedures of re-granting of the driving license upon confiscation for “drink driving”.

Alcohol intake during pregnancy and fetal alcohol syndrome

Alcohol intake during pregnancy is a major public health challenge because of the numerous deleterious effects on a developing fetus. A range of contextual and structural factors such as poverty, histories of trauma and violence, physical and mental health concerns, sociocultural and economic vulnerabilities, and child welfare involvement are influences the utilization of alcohol consumption during pregnancy. Binge drinking; which means an intake of greater or equal to 5 drinks on a single occasion is the most hazardous pattern of alcohol drinking that can cause high blood alcohol concentration and injuries the unborn fetus by passing across the placenta. Fetal alcohol syndrome can be described by a specific pattern of abnormal facial features, growth retardation, and central nervous system abnormalities which frequently result in behavioral and/or cognitive disabilities. Teratogenic effects of fetal alcohol exposure may lead to actual and potential challenges, instantly after birth, at infancy, or even later, leading to anatomical abnormalities, behavioral problems, and mental impairment in life. Bilateral renal agenesis is occurred during the second month of pregnancy; if the pregnant women consume the alcohol heavily. The deformities of cardiac abnormalities demonstrated from prenatal alcohol exposure are plastic kidneys, dysplastic kidneys, ureteral duplications, hypoplastic kidneys, hydronephrosis, and horseshoe kidneys.