Citation

Breitmeier D, Verner L, Albrecht K, Fieguth A, Geerlings H, Kleemann WJ, Panning B, Gebel M, Troger HD. Blutalkohol 2005; 42(3): 197-208.

Affiliation

Institut fur Rechtsmedizin, Medizinische Hochschule Hannover, 30625 Hannover, Germany

Copyright

(Copyright © 2005, International Committee on Alcohol, Drugs and Traffic Safety and Bund gegen Alkohol und Drogen im Straßenverkehr, Publisher Steintor Verlag)

DOI

unavailable

PMID

unavailable

Abstract

Percutaneous injection of ethanol (96 vol.%) into a liver tumor is one among several other alternative therapies for irresectable hepatocellular carcinomas (HCC). The absence of any ethanol loss due to resorption deficits or hepatic metabolism makes the injected amount of ethanol directly accessible to studies of its distribution between different blood compartments. Where should the blood sample be drawn from to calculate the amount of ethanol in the body? Blood samples from a peripheral vein, a central venous, and a radial artery catheter were drawn from altogether 20 patients at definite time intervals during and immediately after the injection of ethanol. The amount of injected ethanol ranged from 14.0 to 95.0 ml. The highest ethanol concentration was found at 1.47 g/kg in the radial artery, at 1.54 g/kg in the superior vena cava, and at 1.34 g/kg in the cubital veins. The ethanol concentrations in the arterial blood samples were significantly higher than in the peripheral and central venous blood samples during the time period until the maximum ethanol concentration was reached. These differences disappeared in the elimination phase. Our results showed that the distribution of ethanol injected directly into the HCC in patients with severe impairments of liver function parallels the distribution kinetics previously shown for ethanol in animals and humans during intravenous injection and in healthy volunteers after oral ingestion. In order to avoid a potential underestimation of the ethanol concentration under clinical conditions, because blood alcohol concentrations vary according to the sampling site with in a short time and alcohol intoxication (injected amount up to 95.0 ml) can likely occur, reached during and immediately after the intervention (PEIT), arterial blood samples should be drawn for ethanol testing. Time and place of sampling for alcohol have to be clearly described. If there are any other possibilities to monitor the patients without withdrawal of arterial blood they should be used. Taking into account legal aspects a patient could be legally disadvantaged especially in the absorption phase - contrary to the rule "in dubio pro reo" -, therefore in particular with traffic accident victims with multiple injuries by the clinicians blood samples should be taken from a vein.