PARALLEL BREATH ALCOHOL CURVES AND BLOOD ALCOHOL CURVES WITH TEST PERSONS UNDER ALCOHOL INFLUENCE

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1 PARALLEL BREATH ALCOHOL CURVES AND BLOOD ALCOHOL CURVES WITH TEST PERSONS UNDER ALCOHOL INFLUENCE O. Griiner, N. Bilzer, M. Kramer Abteilung Rechtsmedizin I, University of Kiel, Hospitalstr. 17/19, 2300 Kiel According to the results of the in vitro experiments presented by Mr. Bilzer (BILZER et al), there exists a good correspondence between the 'Alcytron' results and the values determined by the gas chromatographic method. In further experiments we performed in vivo alcohol studies. It was our intension to determine how the Alcytron values and the gas chromatographically determined values, that is, the relative blood alcohol concentrations behave under different conditions, determined blood alcohol concentrations. compared with the directly A total of 18 subjects took part in the experiments, 8 participating in a preliminary experiment (Series A) and 10 in the general experiment (series B). The general experiment was conducted under 3 different temperature conditions: a) room temperature (20 C/68 F), b) near freezing (4 C/39 F), and c) somewhat warmer (27 C/ 81 F). Twenty-four blood alcohol curves, with six blood samples apiece, were analysed in series B. In series A, forty- eight relative values were evaluated, in each case with one directly and two indirectly determined blood alcohol concentrations. Methods: The subjects of the preliminary experiments (A), one female and seven males, were placed under no special 570

2 requirements concerning last meal, behaviour during the experiments, and so forth. They were permitted to drink as much beer and 'korn', the beloved North German 76 - proof wheat spirits, as they pleased. The experiments were conducted one afternoon after 4 p.m. The imbibition time was not restricted. The blood samples, coupled with the ensuing breath sampling, were taken 60 minutes after starting drinking, and at 30 minute intervals thereafter. A total of 29 blood samples were analysed, in general 3 or 4 samples per person. In the general experiments (B), the subjects had fasted 3 1/2 hours before starting to drink. Some of the 3 female and 7 male subjects (age range years) took part in the experiments more than once. They were given Bacardi and cola highballs to drink. Each received 1 g alcohol per kilogram body weight. The drinking time was restricted to one hour. The first blood sample was taken at the end of the hour. The mouth was subsequently rinsed and 3 breath samples were taken 5-10 minutes later. One sample was gathered with the help of the 'Alcytron1 device, the other two according to the gas sampling (GS) system. This procedure was repeated every 30 minutes until 3 1/2 hours had elapsed since the start of drinking. A continual exchange between the 2 breath sampling methods was undertaken. Eleven tests were conducted at room temperature, ten at 4 C and three additional tests at 27 C. Only the breath sampling itself took place at the different temperatures. The blood samples for both series A and B were taken from the median cubital vein. The serum alcohol concentrations were determined seven-fold: three times with the automatized Widmark-Griiner technique (GRUNER, 1953, 1967, LUNDT and JAHN), twice with the ADH and twice with the GC procedures. The Widmark technique was coupled with a serum water determination in series B. The ascertained 571

3 serum alcohol concentration was converted to a whole blood alcohol concentration, using this serum water content and assuming a whole blood alcohol concentration of 80 % (see GRUNER, 1967). The reported values represent the so corrected average of the 7 analyses. The breath J alcohol analysis was always made with the infrared measuring device 'Alcytron' manufactured by the Drager Company in Lubeck, West Germany, as well as gas chromatogra- phically as described. Results; The indirectly with the 'Alcytron' device determined blood alcohol concentrations in the preliminary experiments (series A) exhibited a frequently reported picture up to about 100 minutes after starting drinking. The directly determined concentrations were lower in the resorption phase. Later on, a considerable correspondence between the directly and indirectly determined results was ascertained. In keeping with the usual procedure, the serum analysis values were converted to whole blood values by multiplying them with the factor 1.2 (see illustration 1). In the general experiments (series B), the directly determined blood alcohol conentrations were higher than the ones obtained through breath analyses. The curve in illustration 2 will serve as an example. The difference can be better recognized by performing a regression analysis on the directly and indirectly determined blood alcohol concentrations from the definite elimination phase so that 3 regression lines result for each test. The average concentration difference in each of the 3 curves can clearly be seen (illustration 3). The concentrations shown in illustration 3 result when applied to 120 minutes after starting drinking. 572

4 573

5 / Ethanol At room temperature, the median values of the differences between the directly determined blood alcohol concentrations and the breath analyses of the 'Alcytron' device, calibrated to blood alcohol, amount to 0.15 o/oo. The median values for the GS values, also converted to blood alcohol, amount to 0.23 o/oo. At near freezing the median values are 0.25 o/oo and 0.30 o/oo respectively. The deviations between the directly and indirectly determined blood alcohol concentrations are significant above the 5 % level using t tables. However, a significance for the group deviations determined between the temperatures a) and b) could not be shown. In the additional tests at 27 C, almost all of the indirectly (breath analysis) determined blood alcohol concentrations were lower than the direct results. Because of a technical defect, it is not possible to discuss the GS results, which were lower than the Alcy- 574

6 tron values, without restrictions. As it only had to do with 3 additional tests,' the calculated mean difference of 0.23 o/oo is of no decisive importance. Discussion To begin with, the most important result is that all of the indirectly from the breath analysis determined blood alcohol concentrations and curves were lower than the directly determined ones. First of all, it must be remembered that the breath analyses were always made somewhat later than the blood samples taken. Because the test persons in series B were almost always in the elimination phase when the blood samples were taken, a certain deviation could hereby originate. It must be taken into consideration that even an average slope descent of 0.20 o/oo (hours-beta according to Widmark), a difference in time of 5 to 10 minutes would only be equivalent to o/oo. PRIBILLA et al found a very good correspondence between the breath and blood alcohol concentrations in the regression analyses of field studies done with the 'Alcytron1 device. These results can only be compared to ours in a limited sense. A part of their test persons, which were brought in for blood alcohol determination by the police, was probably still in the resorption phase. On the other hand, the use of the conversion factor 1.2 was probably used in determining the blood alcohol concentration. The results of our preliminary experiments speak for this interpretation, in which we converted in the above mentioned manner. The whole blood concentrations, calculated from the serum alcohol concentrations by using the factor 1.2 are too low. Numerous authors after Widmark have called attention to this. According to our calculations, the water distribution proportion between serum and whole blood corresponds to a conversion factor of about 1.13 to 1.15 (see GRUNER, 1967). 575

7 Conspicuous is the fact, that the gas chromatographically determined breath alcohol concentrations are also lower than the directly determined concentrations, although an entirely different analytical method was applied. The techniques used - Alcytron and GS System - differ regarding end-ekpirational analysis-air quantities, trapping of the air specimen, and analysis methodics, but nevertheless they present the same deviational tendency. The fact that in both methods the differences to the directly determined blood alcohol concentrations near freezing are even larger than those at room temperature brings us to consider the importance of the temperature influence on the alcohol concentration of the expirational air. Many authors have already called attention to this. Of course, the possibility has to be examined that the discarded breath volumes - according to the important findings of DUBOWSKI - were so small that the analysed breath air did not correspond to the alveolar air, although with the GS technique, the air specimen is only taken after air has been expired for 10 seconds. The question arises, if it is at all permissible to make binding conclusions about the expirational air using the results of in vitro studies about the distribution of alcohol between air and water or blood, and the calculated distribution coefficients. Especially, it does not appear to us to be certain enough that the expirational air, even the end-expirational part, corresponds to the alveolar air. This could soonest be expected from rebreathed air under certain requirements concerning temperature, breathing technique, etc. In any case, it is apparent that numerous authors, working with very different apparatus and using the usual distributional proportion of 1:2100, have calculated blood alcohol concentrations that are too low. The problematic nature of calibration must be additionally examined. 576

8 BOSCHE (1977) has pointed out that the watery simulation solution had to have 1.21 o/oo alcohol in it so that at 34 C, 1 mg alcohol would be contained in 2100 mis air as Well as in 1 ml of blood. This corresponds to the generally accepted partition ratio between breath air and blood. A general difficulty in the assessment seems to be, in our opinion, that the expirational air concentration between 32 and 35 C has to be deduced from the alveolar air concentration at 37 C. Up to now, this has been deduced without the changes that the examined air volume is subject to on its way from the alveoli until it exits the body being fully clear. It seems that the question has not been sufficiently answered as to whether the composition of the end*expirational air volume, should, even that the very last part of it be examined, really always correspond to the alveolar air. Finally, we wish to call attention to the results of our animal experiments in this direction. In these, the lung water alcohol concentration was shown by comparison to have lower concentrations than the blood water alcohol concentrations from the peripheral regions (KUHNHOLZ and BILZER). Although it cannot be asserted from these results that comparable conditions exist in humans, our findings, which will be presented by Ms. KUHNHOLZ, do deserve consideration in the context of the depicted development of the directly and indirectly determined blood alcohol curves. Summary 1) Indirect blood alcohol concentration, determined through breath alcohol analysis, was compared with direct concentration determination using venous blood in 32 drinking experiments conducted with 18 test persons. The behaviour of the indirectly determined concentrations and curves collected with the help of the a) ALCYTRON device and b) the gas sampling system, two different techniques, in comparison with directly determined concentrations 577

9 and curves derived according to WIDMARK-GRONER with the GC-technique and the ADH-method was examined. 2) The experiments were divided into preliminary (series A) and general (series B) experiments. 8 persons participated in series A, 10 in series B. After being put under the influence of 1 g alcohol per kilogram body weight, a) 11 experiments at room temperature (20 C/68 F), b) 10 experiments at near freezing (4 C/39 F), and c) 3 additional experiments at a warmer temperature (27 C/81 F) were made. 3) In series B all the indirectly (breath analysis) determined blood alcohol concentrations and curves were lower than the directly determined ones. The results at near freezing were even lower than the ones determined at room temperature. The difference between the direct and indirect concentrations were significant (5 % level). Group differences for the different temperatures of a) and b) could not be significantly determined. 4) The possibilities of explanation for the determined differences touch upon the general problematic nature of the indirect blood alcohol concentration determination, and especially its physiologic variables. 578

10 Literature: BILZER, N., M. KRXMER and O. GRUNER: BOSCHE, J.: DUBOWSKI, K.M.: GRUNER, O.: GRUNER, 0.: GRUNER, 0. and N. BILZER: A method for the determining of breath alcohol with Multifract (Gas Chromatography) Vortrag auf der 8. Internat. Conference on Alcohol, Drugs and Traffic Safety; Stockholm, June, 1980 Obereinstimmung zwischen Blut- und Atemalkoholkonzentrationen: Erste Untersuchungen am Testgerat nach Adrian. Unfall- und Sicherheitsforschung, Strassenverkehr (Hrsg. v.d. Bundes- anstalt fur Strassenwesen, Bereich Unfallforschung, Koln) H.10, S. 415 (1977) Studies in Breath-Alcohol Analysis: biological factors. Z. Rechtsmedizin 7_6, 93 (1975) Ein photometrisches Verfahren zur Blutalkoholbestimmung. Arch. Toxicol. _L4, 362 (1953) Der gerichtsmedizinische Alkohol- nachweis. Koln,Berlin,Bonn,Miinchen: Carl Heymanns Verlag KG 1967 Zur Brauchbarkeit eines automati- sierten Messplatzes ('Substratmess- platz') bei der routinemassigen Alkoholbestimmung nach Widmark- Gruner. Blutalkohol 12, S. 319 (1975) 579

11 KUHNHOLZ, B. and N. BILZER: LUNDT, P.V. and E. JAHN: PRIBILLA, 0., TH. SCHULTEK and J. WEISSMANN: Relation between arterial, venous and lung tissue alcohol levels. A study on rabbits. Vortrag auf der 8. Internat. Conference on Alcohol, Drugs and Traffic Safety; Stockholm, June, Gutachten des Bundesgesundheitsamtes zur Frage Alkohol bei Verkehrsstraftaten. Bad Godesberg: Kirschbaum-Verlag 1966 Uber Feldversuche mit dem 'Alcytron'. Blutalkohol 17, 177 (1980) 580

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