# Blood alcohol

1. A question I was actually thinking was to silly to ask a coworker so I thought I'd ask here..

When we get results for blood alcohol, it's an actual number, not a concentration. How is one determined intoxicated or sober? I just know when Pts come in and smell like alcohol, the result is typically over 250. Family members always ask in terms of BAC and I have no idea.
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Joined: Jun '06; Posts: 572; Likes: 700
RN; from US
Specialty: 11 year(s) of experience

3. For legal purposes, it depends on the state, but people are considered intoxicated if their level is above .08 or 80. So, if they were pulled over and they blew a .09, they would be arrested DUI (also depending on field sobriety).

Our docs wouldn't release someone until their level was below 80 (approx).

One beer, one glass of wine, one shot of liquor will raise the BAL 15-20 points. And a person will metabolize alcohol approx 15-20 points per hr. So if they had 4 beers, that would equal 80. If they had 10 beers, that would equal about 200.

You can say the number of beers equals the number of hrs to metabolize. 10 beers=10 hrs. But we cut off at 80. So, if someone had 10 beers, the number would be 200, which means they can go home in 6 hrs (down to 80) if no one can drive them home.

For the public, the term intoxication and sober, describes how drunk they feel. For the legal system, those terms describe a lab value, regardless of how drunk they feel. Functioning alcoholics don't feel drunk when their BAL is 150, but they are considered intoxicated by the state.

No one really uses the term sober unless there is no etoh in their system. Be careful when you use the term sober. Family members always ask if the pt was sober. All you say is the etoh level and what level the state considers people intoxicated. If the pt goes to court and the family states that you said the pt was sober, there better not be any alcohol in the level.

You'd be surprised how low an alcohol level can be when a trained nurse smells it. For the ER nurses that have been around a while, we can smell a drop of alcohol a mile away. As time goes on, you'll be able to pick up on it with just one or two beers.

fyi...every pt has always had only two beers. It might have been an entire keg, but it's always just two.
4. Thanks for the response. This cleared things up for me too....
5. What a great explanation! Thanks hodgieRN!

So 80 is the magic number. I had no clue. I saw 477 the other day and everyone's eyebrows went up and I just kinda went yaa. (Clueless, but ok)

I also learned to never write etoh but possible etoh because other health conditions can mimic intoxication.

Most of my Pts (thankfully) have been more than honest about intake and very cooperative, I still have a spot on my lip from where the 1 kicked me in the face a few weeks ago
7. 80 = 0.08
250 = 0.25

etc.

So your 477 patient was .477. Pretty impressive, and unless the patient had a pretty reliably confirmed story of being an infrequent binge drinker I certainly hope s/he got discharged well before getting to the "clinically sober" level of below 100 or 80. A chronic drinker will likely seize before s/he gets to a "normal" level.
8. No problem! Glad to help!

So 477 divided by 20 = 24 beers or 24 ounces of liquor. That is eye brow raising! That's definitely in the alcohol poisoning range.

Yes, it is good to write possible etoh instead of intoxication. You can also Etoh ingestion. That just means they drank something and that you are not implying anything definitive, just that they drank it.

Known drinkers tend to be truthful about how much they drank that night, but they tend to lie more with how often they drink. When you ask "Do you drink everyday, " there's a lot of hesitation because that when the denial starts talking.

Another fyi....etohers should usually be on dextrose containing fluids after any normal saline boluses. They can have severe issues with hypoglycemia.
9. Had a guy come in by squad last night, moved himself from their cot to our stretcher without assistance. Slurred speech but otherwise totally oriented and actually pretty funny. Told me exactly what he drank, how often and when his last was, able to rattle off his home meds including dosages (his pharmacy confirmed everything he told me) and was in general very pleasant. BAL came back at .40 which may be where he is on a daily basis.

I kept looking up to see if his liver and pancreas had jumped out of his body and went screaming down the hall.
10. We are the trauma floor so we get falls and MVAs r/t ETOH and I've seen some high numbers, I think 500 or so was the highest. I have always wondered what that meant in terms of BAC so this was very informative!
11. We had a record the other day: 584, and he was oh so jolly.
12. 584??!!
13. I've seen a 609! In a female patient, no less! And she wasn't totally out, either. I was amazed.
14. Quote from LunahRN
I've seen a 609! In a female patient, no less! And she wasn't totally out, either. I was amazed.
wow... the highest I have seen was 500 and the patient was still with it...obviously drunk, but with it. I was very surprised.