Could Nyquil cause this positive alcohol test?

[TMB]

For cause test performed on employee, showed elevated alcohol level at 0.149 (cut off 0.010). The issue is the employee did record on med/substance list that he had taken Nyquil for cold symptoms. Nyquil does contain alcohol, but this level seems higher than I would expect from regular doses of Nyquil. How would you interpret this? Any advice?

[Robert Swotinsky MD]

1. One would have to take an enormous volume of Nyquil to get to this alcohol level. One can do the calculation by looking at the alcohol content of Nyquil and calculating how much Nyquil is equivalent to the volume of ethanol that would be required to get to this level. By comparison, a BAC of .149 is roughly equivalent to what one might achieve 15-30 minutes after chugging 6 beers.

2. In workplace testing, having an alcohol content at or above the company's policy is by itself an infraction. There is no "interpretation" of the result for alternative medical explanations.

3. Many employers do not ask about medication use at the time of the test. (e.g., Per your "med/substance list") Asking about medication use is considered a medical inquiry, and can be conducted only in limited circumstances per the Americans With Disabilities Act.

4. 0.010 is an unusually low threshold for taking action. The evidential breath test devices are certified to distinguish between acetone and ethanol (i.e., are certified as accurate) to the 0.02 level but not below. Thus, measurements below 0.02 are open to potentially successful challenge. The federal government defines 0.04 and above as "positive." Not a concern for this particular result of 0.149, but may be something to consider going forward.