Breath alcohol test and diuretics

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DrCRZ

Breath alcohol test and diuretics

Post by DrCRZ » Mon Aug 05, 2019 9:52 am

How would you fairly handle a .058 breath alcohol result from a donor who drank the night prior to the test (exact time undefined). Understood that regardless of the source a positive breath alcohol test is reported as such if it violated regulations or company policy. Would anybody handle this differently?



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Re: Breath alcohol test and diuretics

Post by Robert Swotinsky MD » Mon Aug 05, 2019 12:44 pm

One Internet dictionary defines fair as, "in accordance with the rules or standards; legitimate."

The rules and standards are to report the result as is, and to help assure that at the result is legitimate, e.g., performed on a calibrated device, and after a 15-30 minute interval between tests #1 and 2, etc.

If asked, an MRO could do the math to estimate what the alcohol result might have been at prior points in time. If the test was performed in the morning, this estimate will often arrive at a sky-high estimate for BAC the evening before if one assumes there was no further consumption.

(The subject line says "... and diuretics." What's up with diuretics?)

mikesuls

Re: Breath alcohol test and diuretics

Post by mikesuls » Fri Aug 16, 2019 10:19 pm

.04 or greater is a regulatory violation pursuant to DOT regulations, and the donor is well above that threshold. Retrograde extrapolation may be used for purposes of litigation in, for example, an unemployment hearing. But, for the purposes of becoming medically re-qualified to perform safety-sensitive duties, the donor must go through the SAP process. I too am wondering what the diuretic issue is about.

DrCRZ

Re: Breath alcohol test and diuretics

Post by DrCRZ » Tue Sep 10, 2019 11:53 am

Arch Kriminol. 2015 May-Jun;235(5-6):172-81.

[Diuretics and their potential effect on breath-alcohol concentration--a case report].

[Article in German]

Schmitt G, Skopp G.

Abstract

Many objections were raised to breath-alcohol analysis upon its introduction in the field of traffic law enforcement in Germany, but in the meantime this issue has become less relevant in forensic routine work. In the present case, the defending lawyer claimed that the ethanol concentration in the blood and hence in the breath of his client, which was 0.35 mg/l according to the Dräger Alcotest 7110® Evidential and thus above the legal limit of 0.25 mg/l, had been changed by diuretics taken 4 hours before the breath alcohol test, viz. 10 mg of torasemide, a loop diuretic, and 50 mg of spironolactone, a competitive aldosterone antagonist. According to the literature, the maximum urinary output in healthy subjects within the first 4 hours after 10 mg torasemide was 1450 ml. In patients suffering from heart failure, the urinary volume was reduced by a factor of 2.5-3; after chronic intake of torasemide, water loss did not differ from placebo. Spironolactone, which acts on the distal tubule, has little effect on urinary output. In a publication, the loss of water in excess within 24 hours was 90 ml. Co-administration of 100 mg spironolactone and 20 mg furosemide, which roughly compares to 10 mg torasemide, resulted in a mean urinary volume of 1566 ml within the first 4 hours. In terms of the reported case and provided that no compensatory fluid had been taken, a purely theoretical maximum shift of 0.007 mg/ may occur in the breath-alcohol concentration due to the smaller distribution volume even considering maximum urinary excretion values. On the other hand, already mild levels of dehydration may be associated with negative symptoms affecting driving ability.
Just wondering if anybody has seen more studies on this.

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