Correction: Terpstra et al. Prevalence of Hangover Resistance According to Two Methods for Calculating Estimated Blood Alcohol Concentration (eBAC). J. Clin. Med. 2020, 9, 2823

The authors wish to make the following corrections to the original article [...]

Is sobriety from alcohol necessary for evaluation of patients presenting with suicidal ideation?

BackgroundIt is commonly assumed that patients intoxicated with alcohol are unreliable with respect to their statements of suicidal intent, however no prior literature evaluates the impact of sobriety on suicidal ideation (SI). In typical emergency department (ED) settings, a common practice is to wait until intoxicated suicidal individuals have reached a legally sober limit (ethanol level less than 80 mg/dL) to evaluate safety. We are not aware of any study that establishes the diagnostic reliability of the clinical suicidal ideation evaluation as a function of alcohol intoxication.MethodsThis study is a retrospective review of medical records for patients evaluated in a pre-COVID Midwestern ED for one calendar year. Cases were generated for review based on criteria of having a Psychiatric SW (Social Work) consult and blood alcohol level drawn while in the ED on every Wednesday and Friday of 2017 which produced 1084 cases for review. Chi-square analysis was used for comparison of variables of suicidal ideation with or without alcohol intoxication as defined by blood alcohol level (BAL) ≥80 mg/dL.ResultsIn reference to our initial hypothesis, patients presenting with suicidal ideation and concurrent alcohol intoxication were no longer reporting suicidal ideation at sobriety in 69% of cases, compared to 38% for patients without alcohol levels on presentation. Chi-square analysis demonstrated p=0.000012.ConclusionThe goal of the present study was to demonstrate, with empirical data, a relationship between alcohol intoxication and suicidal ideation. Our data suggests that patients presenting to the ED with complaints related to suicidal behavior who are found to have concurrent alcohol intoxication are more likely to deny suicidal ideation when sober than patients with similar presenting complaints and no alcohol intoxication.

Cost-Effective Foam-Based Colorimetric Sensor for Roadside Testing of Alcohol in Undiluted Saliva

A novel foam-based colorimetric alcohol sensor was developed for the detection of alcohol in saliva. Detection was based on the color change of a potassium dichromate-sulfuric acid solution absorbed by melamine foam. In the presence of alcohol, the orange colorimetric sensor changed color to brown, green and, ultimately, blue, depending on the concentration of alcohol in the sample. The response of the proposed sensor toward alcohol was linear from 0.10 to 2.5% v/v. The limit of detection was 0.03% v/v. Alcohol concentration could be determined using the naked eye in the range of 0.00 to 10% v/v. The developed alcohol sensor presented good operational accuracy (RSD = 0.30–1.90%, n = 8) and good stability for 21 days when stored at 25 °C and 75 days when stored at 4 °C. The results of alcohol detection with the developed sensor showed no significant difference from the results of spectrophotometric detection at a 95% confidence level (p > 0.05). The sensor was easy to use, small, inexpensive and portable, enabling drivers to accurately measure their own blood alcohol level and providing convenient speed in forensic applications.

Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization

BackgroundEleven states have instituted laws allowing recreational cannabis use leading to growing public health concerns surrounding the effects of cannabis intoxication on driving safety. We hypothesized that after the 2016 legalization of cannabis in California, the use among vehicular injury patients would increase and be associated with increased injury severity.MethodsSan Diego County’s five adult trauma center registries in were queried from January 2010 to June 2018 for motor vehicle or motorcycle crash patients with completed toxicology screens. Patients were stratified as toxicology negative (TOX−), positive for only THC (THC+), only blood alcohol >0.08% (ETOH+), THC+ETOH, or THC+ with any combination with methamphetamine or cocaine (M/C). County medical examiner data were reviewed to characterize THC use in those with deaths at the scene of injury.ResultsOf the 11,491 patients identified, there were 61.6% TOX−, 11.7% THC+, 13.7% ETOH+, 5.0% THC+ETOH, and 7.9% M/C. THC+ increased from 7.3% to 14.8% over the study period and peaked at 14.9% post-legalization in 2017. Compared with TOX− patients, THC+ patients were more likely to be male and younger. THC+ patients were also less likely to wear seatbelts (8.5% vs 14.3%, p<0.001) and had increased mean Injury Severity Score (8.4±9.4 vs 9.0±9.9, p<0.001) when compared with TOX− patients. There was no difference in in-hospital mortality between groups. From the medical examiner data of the 777 deaths on scene, 27% were THC+.DiscussionTHC+ toxicology screens in vehicular injury patients peaked after the 2016 legalization of cannabis. Public education on the risks of driving under the influence of cannabis should be a component of injury prevention initiatives.Level of evidenceIII, Prognostic

The Auto-Brewery Syndrome: A Perfect Metabolic “Storm” with Clinical and Forensic Implications

Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.

Aspiration risk in relation to Glasgow Coma Scale score and clinical parameters in patients with severe acute alcohol intoxication: a single-centre, retrospective study

ObjectivesIn alcohol intoxicated patients, the decision for or against airway protection can be challenging and is often based on the Glasgow Coma Scale (GCS). Primary aim of this study was to analyse the aspiration risk in relation to the GCS score and clinical parameters in patients with severe acute alcohol monointoxication. Secondary aim was the association between the blood alcohol level and the GCS score.SettingSingle-centre, retrospective study of alcoholised patients admitted to a German intensive care unit between 2006 and 2020.ParticipantsA total of n=411 admissions were eligible for our analysis.Clinical measures and analysisThe following data were extracted: age, gender, admission time, blood alcohol level, blood glucose level, initial GCS score, GCS score at admission, vital signs, clinical signs of aspiration and airway management measures. The empirical distribution of continuous and categorical data was calculated. Binary multivariable logistic regression analysis was used to identify possible risk factors for aspiration.ResultsThe mean age was 35 years. 72% (n=294) of the admissions were male. The blood alcohol level (mean 2.7 g/L±1.0, maximum 5.9 g/L) did not correlate with the GCS score but with the age of the patient. In univariate analysis, the aspiration risk correlated with blood alcohol level, age, GCS score, oxygen saturation, respiratory rate and blood glucose level and was significantly higher in male patients, on vomiting, and in patients requiring airway measures. Aspiration rate was 45% (n=10) in patients without vs 6% (n=3) in patients with preserved protective reflexes (p=0.0001). In the multivariate analysis, only age and GCS score were significantly associated with the risk of aspiration.ConclusionAlthough in this single-centre, retrospective study the aspiration rate in severe acute alcohol monointoxicated patients correlates with GCS and protective reflexes, the decision for endotracheal intubation might rather be based on the presence of different risk factors for aspiration.