Principles And Pitfalls in Alcohol Toxicity, Part 1

Drugs & AlcoholIntroduction to Alcohol Abuse Effects

Alcohol abuse effects are a major medical and social problem. Alcohol can be toxic to the brain. Driving or operating automobiles or any other vehicles while under the influence of alcohol is dangerous. Legislation around the country has enacted various rules mandating fines and penalties for driving under the influence of alcohol. In the worker’s compensation arena (as in the civil and criminal arena) work related injuries can result from intoxication with alcohol and drugs among others. When a worker is found to have a positive blood test for alcohol, the intoxication defense can be raised. The pharmacology and toxicology of alcohol differ from individual to individual and depends heavily on the forensic toxicology methods used to analyze the blood alcohol levels. There is the potential for errors in the process and as a result, some can be wrongfully convicted.

To assess the forensic analysis of alcohol abuse effects and intoxication, I will review here some important aspects of alcohol pharmacology, toxicology, and the scientific literature.

This article does not address the reasonable use of red wine on social events or daily with meals. This article addresses the unreasonable use (abuse) of alcohol.

Alcohol Absorption

Once ingested, alcohol (ethanol) is absorbed into the blood system and the fluids surrounding various tissue and inside of the cells. The concentration of alcohol in blood and tissue depends on the amount of total body water, since alcohol is soluble in water. Therefore, the weight of an individual is important in the analytical process of alcohol intoxication, since the water body content is a factor of total body weight. As an example if we do an experiment and place 100 ul of 8% alcohol into a container of 10 liters water, we will end up with a final content of alcohol in that container, different from a container with 9.75 liters of water. Once ingested, alcohol is absorbed mainly in the small intestine, and to some extent, in the stomach as well as the colon. A delay in stomach emptying will delay the absorption of the majority of alcohol into the patient’s system through the small intestine. This is an important point when assessing the blood alcohol contents (BAC) in relation to an occurrence of an accident since we have to assess BAC relative to time of consumption. BAC is a major tool in assessing alcohol abuse effects.

About Nachman Brautbar, M.D., F.A.C.P.

Experienced in internal medicine, toxicology, occupational medicine, alcohol, drugs, and nephrology, with a specialization in toxicology; evaluation, analysis & interpretation of urine drug/alcohol tests; drug/alcohol concentrations in the blood; findings in blood and urine samples; assessment of driving under the influence. His list of academic appointments includes Associate Professor of Pharmacology and Medicine, and Clinical Professor of Medicine at the University of Southern California, School of Medicine. Dr. Brautbar is a peer reviewer for the Department of Human Health Services, earlier Agency for Toxic Substances and Disease Registry (ATSDR). Dr. Brautbar has been on the faculty of the National Judicial College and has lectured to judges on the issue of scientific evidence. He has been a visiting professor at national and international scientific institutions and centers such as Yale, Harvard, Mayo Clinic, and NIH. Dr. Brautbar is a fellow of the Collegium Ramazzini. Dr. Brautbar has testified in the California State Senate and the United States Senate on toxic groundwater contamination.

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