• BA
• Blood alcohol
• Ethyl alcohol
• EtOH
• Alcohol (Ethanol) level

• Red or gray top tube
• 5 mL of venous blood

Additional information

• Do not use alcohol swab to clean the venipuncture site, instead use povidone iodine swab
• Do not freeze the blood sample
• Send sample to lab immediately, if delayed separate serum or plasma from cells immediately after collection and transfer to a tightly-capped tube (to minimize alcohol loss)
• Handle sample gently to prevent hemolysis
• Follow the chain of custodyprotocol, if required for medicolegal purpose (protocol may vary by institution)

• This test measures the amount of ethanol in the blood
• Ethanol is absorbed rapidly from the gastrointestinal tract, with peak blood levels usually occurring within 40-70 mins of ingestion on an empty stomach
• Food in the stomach slows the rate of alcohol absorption
• Once peak blood ethanol levels are reached, disappearance is linear; usually at a rate of 20 mg/dL/hr (in chronic alcoholics may be as rapid as 30 mg/dL/hr)
• Ethanol is metabolized to acetaldehyde in the liver

• Quantification of blood alcohol level may be performed in the following conditions:
• To diagnose alcohol intoxication for both medical and legal purposes
• To screen for alcoholism
• To monitor ethanol levels when administered to treat methanol intoxication and ethylene glycol poisoning
• To evaluate possible cause of unknown coma as alcohol intoxication mimics certain conditions such as:
• Alcohols; Other (Methanol, isopropyl alcohol)
• Benzodiazepines
• Brain tumor
• Carbon monoxide poisoning
• Cerebral trauma
• Dextromethorphan
• Encephalopathy
• Endocrine (Thyroid disease)
• Gamma Hydroxybutyrate
• Heavy metal toxicity
• Hypercarbia
• Hypertensive crisis
• Hyperthermia
• Hypoglycemia
• Hypotension
• Hypothermia
• Hypoxia
• Infections (CNS, Systemic)
• Narcotics
• Psychiatric disorders
• Seizure (Post ictal)
• Stroke
• Toxic ingestions
• Vasculitis (of CNS)
• Mandatory ethanol abuse testing in various situations such as:
• Pre-employment
• Prior to transfers or promotions
• Post-accident
• Reasonable suspicion
• Return-to-duty
• Periodic follow-up
• Random
• Symptoms of intoxication in the presence of low blood alcohol could indicate a serious medical problem requiring immediate medical attention
• Toxic effects of ethyl alcohol level in blood (Blood alcohol level/BAL or blood alcohol content/BAC) for nontolerant individuals include
• <50 mg/dL - Limited muscular incoordination, driving not seriously impaired
• 50-100 mg/dL - Incoordination, driving increasingly dangerous
• 100-150 mg/dL - Mood, personality, and behavior changes, driving is dangerous
• 150-200 mg/dL - Prolonged reaction time, driving is very dangerous
• 200-300 mg/dL - Nausea, vomiting, diplopia, and marked ataxia
• 300-400 mg/dL - Hypothermia, dysarthria, and amnesia
• 400-700 mg/dL - Coma, respiratory failure leading to death
• Critical values of blood ethanol levels are >300 mg/dL (>64.8 mmol/L)

Additional information

• Other laboratory tests which can be abnormal in alcoholism include:
• Acid-base changes (respiratory alkalosis & metabolic acidosis)
• Hypertriglyceridemia
• Hyperuricemia
• Hypoglycemia
• Hypokalemia
• Hypomagnesemia
• Hypophosphatemia
• Leukopenia
• Testosterone levels decreased
• Thrombocytopenia
• Chronic moderate to heavy alcohol use potentiates the toxic effects of acetaminophen
• The serum alcohol levels are 20% higher than blood alcohol levels (BAL, range 9-35%)
• Other markers of alcohol consumption include:
• Serum osmolality may be used as a screening test for alcohol
• Carbohydrate-deficient transferrin (CDT)
• Urinary 5-hydroxytryptophol (5-HTOL)
• Fatty acid ethyl esters (FAEEs)
• Erythrocyte acetaldehyde
• Acetaldehyde adducts
• Factors interfering with test results include:
• Ingestion of other alcohols, such as isopropanol or methanol
• Increased blood ketones as in diabetic ketoacidosis (false positive)
• Related laboratory tests include:
• Alanine aminotransferase (ALT/SGPT)
• Arterial blood gas
• Aspartate aminotransferase (AST/SGOT)
• Blood glucose
• Blood urea nitrogen (BUN)
• Complete blood count (CBC)
• Creatinine
• Drugs of abuse screen
• Electrolytes
• Gamma-glutamyl transpeptidase (GGT/SGGT)
• Isopropyl alcohol level
• Methanol level
• Serum osmolality
• Urinalysis

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

Elevated results are consistent with consumption of ethyl alcohol.

Drugs which may increase ethanol levels include:

• Aspirin
• Chloral hydrate
• Cimetidine
• Metoclopramide
• Ranitidine

Low results are consistent with no consumption of ethyl alcohol.

Drugs which may decrease ethanol levels include:

• Ascorbic acid
• Atropine
• Phenobarbital
• Propantheline

• ARUP Laboratories®. Ethanol, Serum or Plasma - Medical. [Homepage on the internet]©2006. Last accessed on May 14, 2007. Available at URL: http://www.aruplab.com/guides/ug/tests/0090120.jsp
• Carriere M et al. Low density lipoprotein receptor transcripts correlates with liver hepatitis C virus RNA in patients with alcohol consumption. J Viral Hepat. 2006 Sep; 13(9): 633-42.
• eMedicine from WebMD®. Toxicity, Alcohols. [Homepage on the Internet] ©1996-2007. Last updated on January 4, 2007. Last accessed on May 14, 2007. Available at URL: http://www.emedicine.com/EMERG/topic19.htm
• Hietala J et al. IgAs Against Acetaldehyde-Modified Red Cell Protein as a Marker of Ethanol Consumption in Male Alcoholic Subjects, Moderate Drinkers, and Abstainers. Alcohol Clin Exp. Res. 2006 Oct; 30(10): 1693-8.
• Kuzdak K et al. [Percutaneous ethanol injections in the treatment of secondary hyperparathyroidism] [Article in Polish]. Endokrynol Pol. 2005 Nov-Dec; 56(6): 891-6.
• LabTestsOnline®. Ethanol. [Homepage on the Internet] ©2001-2006. Last reviewed on September 15, 2006. Last accessed on May 14, 2007. Available at URL: http://www.labtestsonline.org/understanding/analytes/ethanol/sample.html
• Sandhir R et al. Influence of ethanol on methanol-induced oxidative stress and neurobehavioral deficits. J Biochem Mol Toxicol. 2006 Sep 28; 20(5): 247-254 [Epub ahead of print].
• Shormanov SV et al. [Structural alterations in the human brain in chronic alcohol intoxication] [Article in Russian]. Sud Med Ekspert. 2006 Jul-Aug; 49(4): 3-6.
• Sood B et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics. 2001 Aug; 108(2): E34.
• ZavrasAI et al Interaction between a single nucleotide polymorphism in the alcohol dehydrogenase 3 gene, alcohol consumption and oral cancer risk. Int J Cancer. 2002 Feb 1; 97(4): 526-30.