steve0413

Thanks, that is very clear and I really appreciate it. You are correct that I want "it" to be true but I'm still looking for "it". You didn't give me the answer I wanted to hear, but at least I can look elsewhere now. As I've said before, I know the facts of this case and how they don't add up to the final result. Since I've found where the human body and it's organs go through such dramatic changes after a burn, I had just assumed that hidden in there somewhere was the answer, all the while knowing that "it" could be something as simple of getting the blood sample mixed up (but very unlikely). Would you know the answer to my previous post about the BAC reading including the components of metabolism or unmetabolized alcohol only? That would be using a gas chromatograph. This will be my last question......thanks for all the help.

The first two stages of alcohol metabolism as I understand it, is the alcohol being converted to acetaldehyde, then acetone. Does anyone know if the acetaldehyde and/or acetone would be part of the BAC result or does the BAC mean unmetabolized alcohol only? The reason I ask, is because I also understand that acetaldehyde attaches to red blood cells. Therefore, if the number of red blood cells increased as a total of the whole blood, wouldn't that make the BAC test higher? As for drinking the day before, the answer is no. Do I know if he metabolizes alcohol slower than others, I don't know. There has never been any indication of that. I know a burn physician personally but I'm not allowed to consult with him just yet. I just can't believe that this question has not been studied before. There are studies that show that burns heal slower and more infections in persons who consumed alcohol prior to being burned. Why would this be? As much as I do appreciate you guys replying to my questions, please don't waste your time if you can't make the assumptions that my alcohol numbers are correct. I'm four years past that. Something caused the elevated BAC number and it wasn't the amount consumed. It's burn trauma and the bodily changes that go with it that caused it. Sounds like I'm in unexplored territory.

Thanks ECOLI. I do know the details of everything except for his BAC at the time of the burn. As I said before I KNOW how much was drank, his weight, and the time period. From that, yes, I can only guess (but reasonably) what his BAC was. But I know there is a reason that it was 10 times what would be expected and I know that it's a biology/chemistry thing and not errors in the other items mentioned above. If a person is not familiar with burn trauma, I've found that they tend to think of it as "just" trauma. It is unique. How the body deals with burns is even different in the first 24 hours than it is in the following 24+ hours. What happens in the blood, liver, lungs, gut, etc. are all altered from what is normal or what would be expected in "just" trauma. I'm sure I'll have to get someone that is very familiar with burns to give me a hint where to start looking or to give me the magic answer to how this happened. When I find that person and that answer, I'll let you know. I do appreciate your time and opinions.

Okay, I'm still not getting my point across very well. I apologize for that. There is a country we'll call WB (whole blood). It is made up of 100 subjects (volumn). Forty-Five (45%) of the subjects are females (blood cells). Fifty of the subjects (50%) are male (plasma). Five (5%) are martians (alcohol). There is a war (burn trauma) in a far away land. The president of WB decides to send the males to fight the war. The martians refuse to go even though they are all male. They now make up 10% of the country of WB. There were no new martians but their percent of subjects increased. Not meant to be sexist either. LOL. Sorry for the analogy, but this is similar to how the BAC could increase without any new alcohol being added to the blood stream. It's identical to the fact that the hemacit (red blood cells count) will increase without the subject being given a transfusion after burn trauma. You'll just have to take my word on it that the amount of alcohol is correct and everything else. This is the case, this is what happened and this is the result. How could it be? That's the puzzle. Somebody out there knows how this can happen, I just have to find them. Maybe it's a case for some more research. The following is from the American Journal of Nursing. Though it is incomplete, it very clearly explains how and why the blood makeup will be changed dramatically (their word) and is unique to burn trauma. http://www.jstor.org/pss/3424042 Thanks again for your thoughts.

I'm not suggesting that the test was wrong. I believe the blood tested correctly for a BAC of .08. I'm suggesting that before the accident, he had a BAC much less than .08 but the burn trauma which according to EVERY article I've read causes a DRAMATIC change in the makeup of the blood, altered his blood in a way to where the blood volume 2 hrs after the accident did indeed read .08. Again to keep it simple for me, lets say that at the time of the accident he only registered .04. Two hours after the accident his blood volume is now only 50% of what it was at the time of accident due to MASSIVE shifts of plasma from intravascular to intercellular. Again this is well documented in severe burns. Again to keep it simple if ALL the alcohol shifted with the plasma then we would expect his BAC to register .00, but if ALL the alcohol stayed with the blood cells, then we would expect his BAC to register .08. One has to first acknowledge that after severe burn trauma the blood makeup wouldn't even be close to what it was 2 hrs earlier just before the accident. Correct? So why am I to believe that everything else EXCEPT the BAC changed? One is making a big mistake if their assumptions are that the BAC would be unchanged. I can assure you that the amount of alcohol consumed is accurate and that there is absolutely nothing in his medical history that would lead one to believe that his liver, etc. were anything but normal. There was a chemical reaction in his body brought on by the burn trauma that caused an abnormally high BAC reading. I have to find someone who can tell me why that is the case. Thanks His BAC changed from accident time till the blood was drawn.

Thanks, that's what I was thinking. So, any idea on why the BAC registered 10X what would have been expected? Do gas chromatographers measure the components of alcohol metabolism such as Acetaldehyde to determine the blood alcohol level? Or is it strictly methanol that is measured? I ask this because I do know that acetaldehyde binds with the red blood cells hence making an artificially high reading if included. I am missing something, somewhere. There is simply no way this persons BAC would have been .08 without some dramatic change in the makeup of his blood due to the burns. I have to find out why this is. Thanks for everyones help and brainstorming.

One has to keep in mind that the bodies response to burn trauma is totally different than from other trauma. Within a short period, you become hypovolumic (low blood volume) because the intravascular blood has lost plasma and lots of it.....not blood cells. So, to keep this simple for me, let's say he had a BAC of .08 at the time of the burn. Two hours later, his blood was drawn. At the time it is drawn, his blood contains all the red and white cells that it contained at the time of the burn but it only contains 10% of the original plasma. Would you expect the BAC to register higher or lower now that his total whole blood volume is only 55-60% of the whole blood volume at the time of the burn when it registered .08? Would you expect the alcohol to have left the blood stream with the plasma, or would it remain in the blood stream with the red and white blood cells? If it remained with the red and white cells, he would now register a higher BAC because the alcohol is a larger percentage of the whole blood. But, if the alcohol left the blood stream with the plasma, then the BAC taken from the blood stream would register lower because it contains less alcohol. Am I making myself clear? Basically, in this type situation, will alcohol bond to red and white blood cells or would it "leak" into the skin/muscles that were burnt? I have to explain why a person who should have registered .008-.010 registered a .080 instead.

If you will read in my original post, 75% of the plasma will leave the blood stream on only a 40% burn. He had a 55% burn. It's not the whole blood that leaves the blood stream, just the plasm in burns. That's what is unique to burn trauma. This is well documented. What's not documented that I can find, is where did the alcohol go? Would it go with the plasma or would it stay in the blood stream attached to the blood cells causing a false high BAC reading?

I can't verify that one way or the other. He was very normal and healthy in everyway. Can't we agree that on a 55% burn patient with mostly 3rd and some 4th degree burns, two hours post burn, that the blood would be DRAMATICALLY altered? So far, everything I've read would indicate that.

Bump....hoping for more input:-)

If the BAC that he registered were just a few points off I would say he's within the norm. But he registered almost 10 times what would be expected. He was VERY healthy. To me, being it's a fact that 2-3 hours post severe burn trauma, the blood is altered so dramatically (that's well documented), then I have to assume there is something in the way it's altered that totally skewed the test. For instance, normally his whole blood would be 45% blood cells and 55% plasma and he's lost 70 or 80% of the plasma before the blood was drawn, then there will most definitely be a skewed result. The only thing I can think of at this point is that somehow, the alcohol remained with the red blood cells instead of the plasma. If that's so, what in a burn trauma would cause that? Thanks for your reply.

I hope this is the correct Forum for this question. 24 yr old male, 240lbs, drank 6 12oz regular beers. Five hours after first drink, 2 1/2 hrs after last beer he was involved in a motor vehicle accident. He was not injured but was trapped for about 10-15 minutes before help came. After help arrived, they called 911 and went to their truck to get something to pry the door open. While doing this, the subject yelled that he was smelling gasoline. When they turned around, they saw the truck erupt in flames. They ran to the truck, kicked in the back glass and reaching through fire they managed to pull the now unconcious subject out and tossed him to the ground where he regained conciousness. He was taken to the hospital where his blood was drawn for a BAC test. The blood was drawn 7 hours after the first drink, two hours after the accident. His blood registered a BAC of .08. According to every BAC calculator/estimator on the internet including some by the state police, his BAC based on his sex, age, weight, perfect health, 6 beers and 7 hours, his BAC should not have been >.01 or even >.03 at the time of the accident. He was burnt 55% TBA, mostly 3rd and even some 4th degree. He lost an arm and a leg from the burns. I have discovered that burn trauma is different than any other trauma in that during the first 2-3 hrs the plasma will leave the blood stream and go to the burn area's such as you would see with clear blisters in a 2nd degree burn, etc. On just a 40% burn as much as 70% of ones plasma will seive from the blood stream. So I'm assuming that 55% burn would be even more. It is very clear from everything that I've read so far that your blood will be altered dramatically during this early stage. That's one of the reasons that this individual required 9 liters of IV fluids during the first 8 hrs post burn. Here's the problem. I haven't ran across any studies that address this particular issue. I have found some that study BAC during the hypermetabolic stage that usually starts peaking about 24 hrs post burn. Example: heart rate of 180+ for weeks in this case. But the initial 24 hrs (called the resuscitation period) and especially during that first 2-3 hrs the patient will become hypovolemic (low blood volume). All indications are that the alcohol dissolves readily in the plasma so you would think the alcohol would have seived from the whole blood with the plasma which should make the BAC register lower than expected. But it didn't, it registered almost 10 times higher than what it actually should have been based on all the parameters noted above. I know your first thought is well the amount of beers consumed was incorrect. That would be a wrong assumption. As a matter of fact, witnesses said the 6 would evern be higher than what they thought and the victim said it was either 5 or 6 because that's all he had with him. So, the amount is correct. Since I know that the whole blood is altered dramatically post burn, I'm assuming there is some process that happens that caused this BAC to register abnormally high. Has anyone ever heard of a study that has been done on this or can you think of how this could possibly be explained? I'm no expert anything, just trying to help. Also know that there are no criminal charges involved so don't worry about that part. Okay you smart folks, what am I missing? Thanks in advance.