Evaluating alleged drinking after driving--the hip-flask defence. Part 2. Congener analysis.

The second part of this review describes the principles and practice of forensic congener analysis as an alternative way to evaluate claims of drinking alcohol after driving. Congener analysis was developed, perfected and practised in Germany as a way to evaluate hip-flask defences. This kind of defence challenge arises frequently when the drunk driving suspect is not apprehended at the wheel and especially after hit-and-run incidents. Besides ethanol and water, alcoholic beverages contain trace amounts of many other low-molecular substances, known collectively as the congeners, which impart the characteristic smell and taste to the drink. Importantly, the congener profile can be used to identify a particular kind of alcoholic beverage. Forensic congener analysis entails making a qualitative and quantitative analysis of ethanol, methanol, n-propanol and the isomers of butanol in blood and urine from the apprehended driver and comparing the results with the known congener profile of the alcoholic beverage allegedly consumed after driving. Interpreting the results of congener analysis requires knowledge about the absorption, distribution and elimination pattern of the congener alcohols, including their oxidation and conjugation reactions, and any metabolic interactions with ethanol. Complications arise if drinks with widely different congener profiles are consumed or if the same beverage was ingested both before and after driving. Despite these limitations, congener analysis can furnish compelling evidence to challenge or support claims of drinking alcohol after driving.

Evaluating alleged drinking after driving--the hip-flask defence. Part 1. Double blood samples and urine-to-blood alcohol relationship.

This two-part article examines the strengths and weaknesses of various ways of investigating claims of drinking alcohol after driving, commonly known as the hip-flask or glove-compartment defence. In many countries the onus of proof in hip-flask cases rests on the prosecution. With good co-operation from the police and timely sampling of body fluids, such as blood and urine for forensic analysis of ethanol, useful evidence can be mustered to support or challenge the truthfulness of alleged drinking after driving. The person's blood-alcohol concentration (BAC) can be compared with values expected on the basis of the amount of alcohol consumed after driving, according to theoretical Widmark calculations. The actual BAC measured is then adjusted for the additional amount of alcohol consumed in the after-drink. Double blood samples, that is, taking two specimens of venous blood about 30-60 minutes apart and looking at the magnitude and direction of change in BAC provides little or no more information than a single blood specimen. However, the relationship between alcohol in blood and urine is very useful in hip-flask cases whereby the concentration expected in the primary urine is compared with the concentration in the bladder urine voided. The concentration of alcohol determined in a second urine sample collected 30-60 min later gives supporting evidence in hip-flask cases. A graphical method, which entails plotting ethanol concentrations in blood and urine as a function of time provides a robust and practical way to investigate hip-flask defences. In the second part of the review, congener analysis is presented, which entails comparing the concentrations of n-propanol, isobutanol and occasionally other congeners in the alcoholic beverage allegedly consumed after driving with the volatiles present in the suspect's blood and urine determined by headspace gas chromatography.

Survival from a lethal blood concentration of cyanide with associated alcohol intoxication.

We present a patient with a lethal blood concentration of cyanide. Additionally, he was found to have an alcohol blood level of 270 mg. dl-1, but made a complete recovery following administration of the antidotes dimethylaminophenol and thiosulphate. It is postulated that the patient may have been able to detoxify himself as a result of metabolism of cyanide to the non-toxic form, thiocyanate.

The permeability of dental procedure and examination gloves by an alcohol based disinfectant.

OBJECTIVES: The usage of gloves in dentistry has increased greatly over the last 10 years and this has highlighted certain problems when gloves are being worn extensively. While skin irritations and allergies caused by latex proteins and accelerators have been the main focus of attention, dental materials such as disinfectants have also become known as a source of skin reactions. This study was performed to evaluate the permeability of various gloves by ethanol. METHODS: The tip of the middle finger of 13 glove brands (natural latex gloves (NLG) powdered or unpowdered, powdered vinyl, nitrile and synthetic elastomer) was exposed to 5 ml of a hand disinfectant (Desderman). After a penetration time ranging from 2 min to 8 h the permeation of Desderman was detected with a gas chromatograph. RESULTS: Only one component of the disinfectant (ethanol) could be detected to have gone through the gloves. After only 2 min the vinyl and one nitrile glove and after 10 min all glove types were permeated. Powder seemed to have no real influence on the penetration of ethanol. Some natural latex gloves showed a low rate of leakage, while vinyl and nitrile gloves were penetrated quickly and to a great extent. The synthetic elastomer (Biogel Neotech) was the only one with a significantly lower penetration even after 2-8 h. SIGNIFICANCE: While there are reports of adverse skin reactions to alcohol the amount of ethanol (up to 40 microliters after 2 h) detected in this study is much too low to cause irritations and certainly not toxicity, but it could possibly initiate allergic reactions.

Assessment of postmortem blood alcohol concentrations by ethanol levels measured in fluids from putrefactive blisters.

It was the aim of the present study to investigate whether the postmortem blood alcohol concentration (BAC) can be assessed by means of ethanol values measured in fluids from putrefactive blisters. Fluids from one or two putrefactive blisters were collected in 45 putrefied corpses (postmortem interval: 3-23 days, graduation of the degree of decomposition into four stages) and compared with femoral vein blood or femoral muscle. Ethanol and so-called putrefactive alcohols were determined in all samples by double GC-measurements. The results were converted to the medium water content of blood of 80%. The investigations revealed a significant correlation between the ethanol values of femoral blood/muscle and putrefactive blister fluid (PBF) (r = 0.725, P < 0.001). With the exception of one case, PBF values of 0.11% or more (n = 11) corresponded to minimum blood/muscle concentrations of 0.085%; PBF values of more than 0.15% (n = 8) corresponded to blood/muscle levels of at least 0.159%. Regression analysis revealed the formula BAC (in %) = 0.785 X ethanol (PBF) +0.011. Relevant concentrations of putrefactive alcohols such as 1- and 2-propanol and l-butanol only occurred in cases with far advanced decomposition. Ethanol levels determined in fluids from different putrefactive blisters of the same body also demonstrated a significant correlation (r = 0.791, P < 0.001). Ethanol concentrations determined in PBF must be judged with caution, but PBF values > 0.15% point to corresponding blood levels with a high degree of probability, at least where advanced putrefaction is excluded.

New ways to use biochemical indicators of alcohol abuse to regrant licences in a fairer manner after drunken driving in Germany.

The failure of medical-psychological examination to provide convincing recommendations concerning the regranting of licences in a significant number of cases illustrates the need for objective laboratory testing. Experience in Germany shows that blood-alcohol concentration alone could lead to misleading recommendations, and suggests that laboratory testing is best done on samples taken at the time of the offence, rather than subsequently at medical-psychological investigation.

[Indicators for alcohol abuse in female drunk drivers. (Comparative study with alcohol intoxicated male automobile drivers)]. / Indikatoren für Alkoholabusus bei Trunkenheitsfahrerinnen. (Vergleichsstudie mit alkoholauffälligen männlichen Pkw-Fahrern).

Women account for about 12% of all cases of drink driving in German cities. Little is known about their drinking behaviour and the extent of their alcohol misuse. In order that these questions may be clarified, three major studies were evaluated. In these studies, additional indicators for alcohol misuse such as GGT or methanol and acetone+isopropanol or indeed CDT, GGT, methanol and acetone+isopropanol were measured in blood samples. The results were compared with studies of the same kind on male car drivers. There were no significant differences in the ages of males and females. However, there were no differences at all regarding the frequency of the blood alcohol levels or the CDT. Indicators levels of chronic alcohol abuse, such als GGT levels above 70 U/L, methanol levels above 10.00 mg/kg or acetone+isopropanol concentrations above 9.00 mg/kg were approximately the same with women as they were with men. This demonstrates an increasing similarity amongst male and female DWI drivers regarding the drinking behaviour and alcohol abuse.

[Repeated ingestion with suicidal intent of potentially lethal amounts of thallium]. / Wiederholte Ingestion potentiell letaler Thalliummengen in suizidaler Absicht.

30 minutes after drinking half a cup of rat poison a 16-year-old girl was admitted to hospital. In addition to various enteric detoxification measures forced dialysis was instituted and, after the urinary thallium level had become known (9 mg/l), haemodialysis was begun and ferric ferrocyanide (Prussian blue) administered (0.5 mg daily for six days). She had no symptoms at any time. After 10 days she was discharged. Five days after discharge she was again admitted, with colic-like abdominal pain, vomiting, paraesthesias of the hands and feet, and in a state of agitation. She had once again ingested rat poison, about one cup. Physical examination revealed little of consequence, except diffuse alopecia. Urinary thallium concentration was 37 mg/l. In the electrocardiogram the P-R interval was shortened to 0.11 s and T waves inverted in leads III and V1. Electronmicroscopy of cardiac and skeletal biopsies revealed lipid droplets, increased sarcoplasm and widening of some of the tubules. Treatment consisted of haemodialysis, forced diuresis (1 l urine/h), administration of ferric ferrocyanide, orthograde intestinal infusions and potassium substitution (serum level: 5 mmol/l). After 28 days the patient was discharged into psychiatric care.

[Epidemiologic study of CDT (carbohydrate-deficient transferrin) and other indicators of alcohol problems in high blood alcohol German automobile drivers]. / Epidemiologische Untersuchung zum CDT und anderen Indikatoren für Alkoholprobleme in Blut alkoholauffälliger deutscher Pkw-Fahrer.

Alcoholism indicators like CDT, GGT, methanol and acetone + isopropanol were measured in blood samples of male German alcoholized car drivers who were at least 18 years old and had a minimum BAC of 0.80 g/kg (per mille). The investigation of 534 cases reflects German conditions. The study proves that a BAC of 1.60 g/kg (per mille) is no appropriate criterion for the assumption of alcohol problems. Alcohol problems appeared significantly more often in cases where BAC levels were 2.0 g/kg (per mille) or higher. It is thought that a total of 20 to 25% of the alcoholized drivers have serious alcohol problems. Amongst those the proportions were as follows: 8% amongst the under 30s and one third amongst tho over 30s. 40% of all drivers with alcohol problems had BACs below 1.6 g/kg (per mille) during the offence. CDT has proved to be a valuable addition to the other indicators when detecting alcoholism in DWI drivers.

Age-related calcium/magnesium ratio in the ligamenta flava.

The Ca/Mg ratio in fibrous connective tissue may be related to its elastic property. Ligamenta flava were obtained from 76 patients during lumbar disc surgery, and Ca and Mg levels were determined by atomic absorption spectrometry. The Ca/Mg ratio was almost constant throughout all age groups. It is concluded that the constancy of the Ca/Mg ratio throughout the lifetime is an integral quality of elastic fibers which may be explained by the biological long half-life of elastin.

[Evaluation of an increased blood level of GGT, CDT, methanol, acetone and isopropanol in alcohol intoxicated automobile drivers. Alcoholism indicators instead of medical-psychological examination]. / Zur Wertung erhöhter Spiegel von GGT, CDT, Methanol, Aceton und Isopropanol im Blut alkoholauffälliger Kraftfahrer. Alkoholismusindikatoren anstelle medizinisch-psychologischer Untersuchungen?

Several thousand blood samples were taken from alcoholized drivers at the Blood Alcohol Examination Centre of the Institute of legal Medicine at Cologne University. These samples showed blood alcohol contents (BAC) as well as GGT, CDT, methanol, acetone and isopropanol levels which indicated alcohol addiction. The blood samples were selected by the drivers' ages and their BAC, but in some cases the GGT also played a role. In the majority of cases 1 or 2 parameters were measured. In 200 cases all four indicators were determined. The four parameters characterize a different problematic drinking behaviour. GGT characterizes chronic, long-term misuse, CDT characterizes occasional misuse, methanol characterizes current addicted drinking and acetone and isopropanol characterize metabolic disorders caused by alcohol. The importance of parameters is thoroughly discussed, also in relation to incorrectly measured positive values and the relation between alcohol consumption and -problems. Methanol values above 10 mg/kg, GGT activities above 100 U/l and CDT levels above 60 U/l provide sufficient proof of there being an alcohol problem which requires treatment. The levels of other indicators need not be above normal to determine this. The proportion of drivers under the influence of alcohol with problematic alcohol levels increases significantly when the BAC is above 2.0 per mille. However, there have been drivers with alcohol problems with lower BAC levels. DUI offenders addicted to alcohol are quite frequently over 40 years old. A correlation between the single indicators and the BAC is rarely found. If a correlation is to be found, it would be most likely with drivers whose BAC lies above 2.0 per mille. The mentioned indicators would detect an alcohol problem from the blood sample taken for the blood alcohol test. Alcohol problems may be detected and treated shortly after the DUI offence. This method is comparatively cheaper than medical-psychological-examinations as well as being based on objective and verifiable parameters.

[Gamma-glutamyltransferase and blood alcohol level--criteria for alcohol risk in automobile drivers. A critical comment on the guidelines for medical-psychological studies of first-time alcohol offenders]. / Gamma-Glutamyltransferase (GGT) und Blutalkoholspiegel-Kriterien für die Alkoholgefährdung von Kraftfahrern. Eine kritische Auseinandersetzung mit den Richtlinien für medizinisch-psychologische Untersuchungen (MPU) bei erst-malig alkoholauffälligen Kraftfahrern.

GGT and blood alcohol concentration (BAC) were measured of 2,655 male car drivers using alcoholized their cars during the year 1991 in the area of the city of Cologne. The results were evaluated statistically together with other parameters like age, time of taking blood sample and behaviour while drunken. BAC was 1.6% and more in 30.5% of all cases. Half of them had levels of 2.0% and higher. GGT in serum was increased (> 28 U/l) at 29.5% of the drivers, in 6% even above 100 U/l. 53% were younger than 31 years. Medium BAC and part of GGT higher than 28 U/l were remarkable lower in this group than at the older ones. 50% of all car drivers with blood alcohol levels above 2.0% have alcohol problems regarding GGT. Problem drinkers were found among the younger ones to an extent of 15%, but of 50% among the drivers older than 40 years. But also 25% of all with a BAC lower than 1.6% showed increased GGT levels. They remain undetected on account of the present instructions of MPA though there is a great danger repeating drunken driving. On the other side nearly 50% of those driving with an BAC of 1.6% or more are no driving drinkers regarding GGT but have to undergo MPA. The recommendation of the 30. German Traffic Courts Meeting in 1992 to determine other indicators of alcohol habituation in the blood samples taken after drunken driving like GGT and methanol should be taken in a corrected setting of the instructions. This would regard fairer the problems of an individual case. The connection of MPA with the height of BAC and other circumstances seen as indicators for extraordinary alcohol habituation is a wrong way and unnecessary if alcoholism markers are used like GGT, CDT and methanol.

Relationship between magnesium and elastic fibres.

The presence of magnesium was demonstrated by histochemical methods in elastic fibres from different locations. After pretreatment with elastase a positive reaction could no longer be detected. Microfibrils which enclose the elastin core of the elastic fibres gave no positive reaction. These results support the supposition of a close relationship between Mg and elastin. Determination of the Ca/Mg ratio by atomic absorption spectrometry in variants of fibrous connective tissue showed a decreasing Ca level with increasing elasticity. The Ca/Mg ratio in lattices containing rubber-like particles disclosed striking diminution of Ca. These data support the speculation that the antagonism of Mg to Ca plays a fundamental role in the maintenance of elasticity. The special interaction of the Mg2+ ion with water molecules is very probably a further prerequisite for elasticity in natural elastic materials.

[Plasma levomethadone level and concomitant use of sedatives in a methadone test program]. / Levomethadon-Plasmaspiegel und Beigebrauch von Sedativa im Methadon-Erprobungsprogramm.

Treatment of heroin addicts with levomethadone as an alternative to the clinically performed withdrawal gains in significance more and more. Just for that reason accompanying scientific programs guided along criterions of therapy research are essential. Results of an evaluation which is to be regarded as preliminary showed no correlation between methadone plasma levels and dosage. Additional consumption of opiates, barbiturates, and benzodiazepines was observed to a high degree. The efficiency of methadone treatment is to be valued only under consideration of criterions of admission to the program as for instance a drug abuse of many years or multiple unsuccessful treatments by withdrawal.

Interaction of magnesium and calcium in meningioma.

Ca and Mg contents were determined in 57 meningiomas. Techniques included atomic absorption spectrometry, topochemical detection and electron probe analysis. Elastic fibres demonstrated positive reaction with reagents for detection of Mg. One third of the tumours showed Mg levels higher than Ca levels. The findings gave rise to discussion on the importance of competition and antagonism between Ca and Mg for the formation of calcified structures. As the collagen producing propensity of meningiomas is mediated by interaction with Mg, we speculate that, in addition to the amount of Mg required for basic cell functions, increased Mg levels are needed, especially in the fibromatous variant.

Metals in tumors of the sellar region.

The contents of the metals Ca, Mg, Zn, Cu, Cr, and Mn in 7 different entities of tumors of the sellar region were evaluated by atomic absorption spectrophotometry. Increased values of Mg in coincidence with high Ca contents are explained by the competition of Mg to Ca and its potency to inhibit mineralization. Reports on the frequent coincidence of increased Zn levels with increased Ca levels were confirmed. The pattern of metal contents encountered in some tumors was rather related to the biological state of the tissue than to morphogenesis or descent from any specific embryonic layer. Regressive transformation like calcification or liquefaction had a distinct bearing on the distribution of metals.

Alcoholism detection markers in blood samples of road users.

Alcoholics as participants in road traffic are an international problem. In Germany a confiscated driving licence is only given back by the road traffic authorities to suspected alcoholics after a medico-psychological examination. The problem is: "How can alcoholics be detected among drunken road users." Traffic authorities use as a marker of alcoholism only the height of the blood alcohol concentration. The limit is a level of 1.6 g alcohol per kg blood, in some regions a level of 2.0 g/kg. Our studies show that the blood alcohol level is a very weak marker for alcoholism. Better markers are beside the GGT the alcohols methanol and isopropanol. They can be detected by congener alcohol analysis. Their concentrations are significant elevated by long-lasting drinking like it is typical for alcoholics.

[Reducing the serum volume for forensic blood alcohol determination]. / Zur Reduzierung der Serummengen für die forensische Blutalkoholbestimmung.

It is possible to reduce the necessary volumes of samples for the determination of blood alcohol to a high degree. The available analysing and filling instruments allow this in enzymatic and gaschromatographic methods without a loss of precision. The instructions of the German federal health employment for blood alcohol determinations for forensic purposes are observed.

[Incorrect blood specimen collection for forensic blood alcohol determination]. / Zur Problematik fehlerhafter Blutentnahmen für forensische Blutalkoholbestimmungen.

Blood to measure the level of bloodalcohol will be taken usually by tapping veins. Sometimes vessels are brought with blood diluted by other solvents. It is possible to determine bloodalcohol levels also in these cases.

[Measuring carbon monoxide content in muscles]. / Zur Messung des Kohlenmonoxidgehaltes in der Muskulatur.

A method ist described to determine the CO-content in the tissue of muscles. The prepared tissue is pulverized in a swinging mill at the temperature of liquid nitrogen. Parts of the powder are weighed into headspace vessels. Carbon monoxide ist ejected by a formerly described method and measured gaschromatographically. The Fe-content is determined after an acid disintegration by AAS. Acute intoxications lead to higher CO-contents in heart than in periphere muscles. Chronic exposure to carbon monoxide does not produce these differences.