Burn Trauma and Blood Alcohol Content

[steve0413]

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.

[iNow]

Has anyone verified that he doesn't have low levels of (or insensivity to) alcohol dehydrogenase?

 

http://en.wikipedia.org/wiki/Alcohol_dehydrogenase

 

 

Those data about the metabolization of alcohol in the blood stream speak of averages, and not everyone fits so neatly into that center portion of the bell curve.

[steve0413]

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.

[steve0413]

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

[iNow]

Do you have an answer to my post #2?

[steve0413]

Do you have an answer to my post #2?

 

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.

[ecoli]

I suppose its possible that, with that much trauma, the body could have diverted resources to the immune system rather than alcohol detox. In addition, as a part of the normal inflammation response, blood would have been sent to his skin to start healing. Perhaps the alcohol remain and concentrated at the surface blood vessels due to these factors.

 

That's just speculation, however.

[steve0413]

I suppose its possible that, with that much trauma, the body could have diverted resources to the immune system rather than alcohol detox. In addition, as a part of the normal inflammation response, blood would have been sent to his skin to start healing. Perhaps the alcohol remain and concentrated at the surface blood vessels due to these factors.

 

That's just speculation, however.

 

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?

[ecoli]

In a non-specific inflammatory response, blood vessels dilate so that more blood (and more white blood cells) can reach the wounded area.

 

I'm not talking about blood leaving the blood vessels. If blood was drawn to measure the BAC, it wouldn't have been taken from the blister of a burn, but from a vein from a (relatively) unaffected area, hopefully.

[steve0413]

In a non-specific inflammatory response, blood vessels dilate so that more blood (and more white blood cells) can reach the wounded area.

 

I'm not talking about blood leaving the blood vessels. If blood was drawn to measure the BAC, it wouldn't have been taken from the blister of a burn, but from a vein from a (relatively) unaffected area, hopefully.

 

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.

[ecoli]

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.

 

I think you mean hypovolemic.

 

 

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.

You asking would the alcohol diffuse with the water to the site of the burns or would it stay in the blood vessels?

 

I don't really know, and it would depend if he got medical attention before they checked his BAC, especially if they started replacing his fluid intravenously right away.

[Glider]

It is unlikely that blood plasma could diffuse from the central compartment and leave alcohol behind (and so increase relative concentration).

 

The nature of ethyl alcohol (soluble in both water and lipids) means that it can diffuse through the endothelial cells that form capillary walls. Hence, for example, the blood brain barrier is no barrier to alcohol, whereas even glucose requires active transport across it.

 

So, wherever plasma can go, alcohol can go with it.

[steve0413]

It is unlikely that blood plasma could diffuse from the central compartment and leave alcohol behind (and so increase relative concentration).

 

The nature of ethyl alcohol (soluble in both water and lipids) means that it can diffuse through the endothelial cells that form capillary walls. Hence, for example, the blood brain barrier is no barrier to alcohol, whereas even glucose requires active transport across it.

 

So, wherever plasma can go, alcohol can go with it.

 

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.

[Glider]

I'm afraid I have no idea why that could be the case. Blood tests are acknowledged as being the most accurate method of testing for blood alcohol.

 

There are a few things that can affect the reading in blood tests, fermentation, clotting and contamination, but these days samples aren't usually left too long before testing. Also, they're usually taken using pre-prepared tubes (e.g. vacutainer) containing EDTA (anticoagulant) and such phlebotomy tubes are also pre-sealed and sterile and not opened until they reach the lab.

 

I have taken blood tests for alcohol and there is a specific procedure. For example, the venipuncture site should never be swabbed using sterets (they contain isopropyl alcohol) or any alcohol swab (for obvious reasons). We use iodine based pre-injection swabs in these cases.

 

There is a possibility of messed up results if: The sample was taken in A&E (ER) by an idiot house officer or SHO who used an alcohol swab. They used a standard syringe and decanted into a plain tube with no anticoagulant. They left the sample laying around a long time at room temps or higher before testing.

 

However, it is often police medics who take such samples and they 'should' know what they're doing.

 

Other than that, I know blood chemistry is affected by trauma, but it is unlikely the effects would alter the concentrations of alcohol. However, I really don't enough about it to comment.

 

If all procedures were followed correctly and all other things being equal, it would leave two probable situations: 1) The person drank more than they said they did. 2) The person drank exactly what they said they did, but had drunk a lot more the previous night and the 6-12oz beers were simply 'topping up' already elevated levels. After that, it gets less probable, such as: the person has a liver disease and cannot metabolise alcohol effectively.

[steve0413]

I'm afraid I have no idea why that could be the case. Blood tests are acknowledged as being the most accurate method of testing for blood alcohol.

 

There are a few things that can affect the reading in blood tests, fermentation, clotting and contamination, but these days samples aren't usually left too long before testing. Also, they're usually taken using pre-prepared tubes (e.g. vacutainer) containing EDTA (anticoagulant) and such phlebotomy tubes are also pre-sealed and sterile and not opened until they reach the lab.

 

I have taken blood tests for alcohol and there is a specific procedure. For example, the venipuncture site should never be swabbed using sterets (they contain isopropyl alcohol) or any alcohol swab (for obvious reasons). We use iodine based pre-injection swabs in these cases.

 

There is a possibility of messed up results if: The sample was taken in A&E (ER) by an idiot house officer or SHO who used an alcohol swab. They used a standard syringe and decanted into a plain tube with no anticoagulant. They left the sample laying around a long time at room temps or higher before testing.

 

However, it is often police medics who take such samples and they 'should' know what they're doing.

 

Other than that, I know blood chemistry is affected by trauma, but it is unlikely the effects would alter the concentrations of alcohol. However, I really don't enough about it to comment.

 

If all procedures were followed correctly and all other things being equal, it would leave two probable situations: 1) The person drank more than they said they did. 2) The person drank exactly what they said they did, but had drunk a lot more the previous night and the 6-12oz beers were simply 'topping up' already elevated levels. After that, it gets less probable, such as: the person has a liver disease and cannot metabolise alcohol effectively.

 

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.

[Glider]

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.

Trauma does indeed cause a change in blood chemistry, but it can't add something that the body does not naturally produce in measurable quanitities, like alcohol.

 

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.

In this case, as plasma shifted from the central compartment to the peripheral around the trauma site, any alcohol it contained would go with it, as I have said. Thus, the alcohol concentration of the plasma remaining in the central compartment would remain the same as before the loss imn volume.

 

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,

There is no reason at all why all the alcohol would shift. That would be like all the dye in a tank of water spontaneously moving to one end. Not impossible, but so improbable as to completely discount.

 

but if ALL the alcohol stayed with the blood cells, then we would expect his BAC to register .08.

It wouldn't happen, for the same reason as above.

 

Alcohol is soluble in both water and lipid and can more freely across plasma membranes. Thus, it tends to find equilibrium between blood plasma in the central compartment and interstitial fluid. There is no physical reason that all the alcohol would spontaneously move from the central to the peripheral compartment, or vise versa, trauma or no trauma.

 

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?

Yes, the endogenous blood chemistry would change.

So why am I to believe that everything else EXCEPT the BAC changed?

Because an endogenous change in blood chemistry can only put into the blood what the body synthesises, stores or in some way uses. There would be changes in pH, elevations in potassium, endorphines, prostoglandins, histamine (associated with inflammatory response) and so on and probably a shift in electrolyte balance (calcium, sodium etc.), but all these changes involve natural physiological mechanisms and involve substances the body itself synthesises, stores or uses. The body does not naturally synthesise, store or use alcohol, it only metabolises it as a toxin to remove it from the system. Alcohol has to be introduced from the outside.

 

One is making a big mistake if their assumptions are that the BAC would be unchanged.

How so? This is the crux. You need to show how it is a mistake. As far as I know, it isn't.

 

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.

Did somebody spike his beer with shots?

 

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.

You are jumping the gun.

 

Any explanation why that would happen, is predicated on the assumption that it does happen. Before you seek explanations concerning why, you need to establish that it does, or at least that it can happen.

 

As far as I know it doesn't, and there is nothing about a burns trauma that would cause alcohol to appear in the blood where previously there was none (or more, where previously there was less). Alcohol in solution will find equilibrium and its movement in solution is not hindered by cell membranes. If a person has a BAC of .04 and loses half his blood volume from the central compartment, the remaining blood will have a BAC of .04.

 

 

His BAC changed from accident time till the blood was drawn.

To know this, you would need to have taken a test prior to, or immediately after the accident. Did you?

Edited August 7, 2008 by Glider

[steve0413]

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.

[ecoli]

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're missing the point steve.

 

We know how the concentration of alcohol could increase. The question is did it?

 

Alcohol is pretty polar, and dissolves in water (or plasma). Therefore, wherever water goes, the alcohol is going to go too. Therefore, plasma leaving the blood vessels would not increase the concentration of alcohol. The same concentration of molecules will stay and the same concentration will leave.

 

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.

There are too many unknowns to tell for sure. You can't be sure what the victims BAC was before the crash. You didn't take a reading. Therefore you can't really know if his BAC was unusual during the time of the crash. How much did the person actually drink? How can you be sure he's telling the truth?

 

There are lot of factors that are going on, and we can only guess at a few of them. without knowing more detail, we can only speculate.

 

The difficultly is not that we don't understand the situation or the biology. We just don't have all the details.. and chances are, you don't either.

 

This is one mystery that will probably stay one.

[steve0413]

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.

[ecoli]

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.

Even if you're 100% certain of how much this persona drank today, do you know how much he drank yesterday? Do you know if he can normally break down ethanol?

[steve0413]

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.

[ecoli]

I'm sure there have been plenty of burn victims that have ingested alcohol. I'm sure you'll find information if you look in the right places.

[Glider]

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.

You have made your point well. I understand the analogy. The point I am trying to make is that it is fundamentally flawed. 45% of whole blood is cells, the rest is water, anionic proteins (albumin), glucose, carbon dioxide, clotting factors, hormones etc., and in this case, alcohol.

 

By comparison to everything else, the cells are huge. You can’t consider blood cells females and plasma males. It would be more sensible to think of it as neutrally buoyant basketballs suspended in muddy water, where the basketballs are cells and the muddy water is plasma and its dissolved constituents (including alcohol).

 

Now, in the case of burns trauma, according to the paper you provide, “Increased capillary permeability is the most significant physiological alteration”. It goes on to say “It allows the sieving or leaking of protein-rich plasma from the vascular into the interstitial spaces. One study revealed that proteins with a molecular weight of 300,000 daltons can escape from the vascular bed following thermal injury. (The molecular weight of albumin is 69,000 and IgG, one of the immunoglobulins is 160,000 daltons.)”

 

Albumin at 69,000 daltons is tiny compared to a red cell. One transmembrane protein in a red cell is 95,000 daltons. More to the point, compared to alcohol (CH3CH2OH) albumin is truly immense! So, as I keep saying, even if alcohol was not able to cross capillary walls freely under normal conditions (which it is), under conditions which result in increased capillary permeability (such as burns trauma), wherever plasma leaks to, alcohol is going to go with it.

 

Thus, your analogy of alcohol as ‘aliens’ which implies they are particles equivalent to blood cells rather than a completely miscible substance which, once in the system, forms a completely dissolved constituent of plasma, is flawed.

 

As for the martians ‘refusing’ to go, that just makes no sense at all. You might just as well pour a cup of coffee through a garden sieve and expect the coffee to be caught whilst only the water passes through.

 

 

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 mean ‘haematocrit’ (or ‘hematocrit’ for those in the US) and no, it isn’t similar to any such thing. This explanation would make sense only if alcohol molecules were the same size as erythrocytes (or at least greater than 300,000 daltons). They’re not. Really, you have to believe that. They’re very much smaller and wherever plasma goes, alcohol dissolved in it will go also.

 

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.

We don’t know how it could be. That’s what we’ve been saying.

 

What I am saying is that your suggestion as to how it might be, does not work. It contradicts what is already known about physiology and chemistry. That’s all I’m saying. I get the feeling that you very much want it to be true, but I’m afraid it isn’t. You will have to look for an alternative. I can’t think of one.

 

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.

It does, but it does not support your case.

[steve0413]

You have made your point well. I understand the analogy. The point I am trying to make is that it is fundamentally flawed. 45% of whole blood is cells, the rest is water, anionic proteins (albumin), glucose, carbon dioxide, clotting factors, hormones etc., and in this case, alcohol.

 

By comparison to everything else, the cells are huge. You can’t consider blood cells females and plasma males. It would be more sensible to think of it as neutrally buoyant basketballs suspended in muddy water, where the basketballs are cells and the muddy water is plasma and its dissolved constituents (including alcohol).

 

Now, in the case of burns trauma, according to the paper you provide, “Increased capillary permeability is the most significant physiological alteration”. It goes on to say “It allows the sieving or leaking of protein-rich plasma from the vascular into the interstitial spaces. One study revealed that proteins with a molecular weight of 300,000 daltons can escape from the vascular bed following thermal injury. (The molecular weight of albumin is 69,000 and IgG, one of the immunoglobulins is 160,000 daltons.)”

 

Albumin at 69,000 daltons is tiny compared to a red cell. One transmembrane protein in a red cell is 95,000 daltons. More to the point, compared to alcohol (CH3CH2OH) albumin is truly immense! So, as I keep saying, even if alcohol was not able to cross capillary walls freely under normal conditions (which it is), under conditions which result in increased capillary permeability (such as burns trauma), wherever plasma leaks to, alcohol is going to go with it.

 

Thus, your analogy of alcohol as ‘aliens’ which implies they are particles equivalent to blood cells rather than a completely miscible substance which, once in the system, forms a completely dissolved constituent of plasma, is flawed.

 

As for the martians ‘refusing’ to go, that just makes no sense at all. You might just as well pour a cup of coffee through a garden sieve and expect the coffee to be caught whilst only the water passes through.

 

 

You mean ‘haematocrit’ (or ‘hematocrit’ for those in the US) and no, it isn’t similar to any such thing. This explanation would make sense only if alcohol molecules were the same size as erythrocytes (or at least greater than 300,000 daltons). They’re not. Really, you have to believe that. They’re very much smaller and wherever plasma goes, alcohol dissolved in it will go also.

 

We don’t know how it could be. That’s what we’ve been saying.

 

What I am saying is that your suggestion as to how it might be, does not work. It contradicts what is already known about physiology and chemistry. That’s all I’m saying. I get the feeling that you very much want it to be true, but I’m afraid it isn’t. You will have to look for an alternative. I can’t think of one.

 

It does, but it does not support your case.

 

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.

[ecoli]

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).

It seems like you're looking for a solution that is cool and complicated, while purposefully ignoring the simple answers. My advice to you, friend, is stick to the principles of Occam's razor.

 

You're already ruling out the simple (and thus most likely) explanations before testing them, hoping you'll find something new and interesting.

 

While I admire your enthusiasm, that's not how science works. If you can't rule out the simple answers, I feel you are going to be wasting time searching for more complicated ones.

 

Good luck, either way.