Washout kinetics of ethanol from the airways following inhalation of ethanol vapors and use of mouthwash

Abstract

Introduction: Breath analyzers are commonly used to test for alcohol intoxication, i.e., elevated systemic levels of ethanol, at workplaces and among vehicle drivers. However, local low-dose exposure to ethanol in the mouth or airways may temporarily increase the breath-alcohol concentration (BrAC) without the systemic ethanol level being affected, leading to false positive test results. The aim of this study was to assess the impact of local ethanol exposure on the BrAC. Methods: Eleven healthy adults (six women) were exposed to on average 856 mg/m3 ethanol vapor for 15 min, followed by repeat collection of exhaled breath in Tedlar bags. One hour later, the subjects washed their mouth for 30 s with a typical mouthwash containing 22% ethanol and post-exposure breaths were again collected repeatedly. Negligible systemic uptake of ethanol was confirmed by analysis of blood sampled before, between and after the exposures. Ethanol in breath and blood was analyzed by gas chromatography. Results: No or very low levels (less than 0.002 mg/g) of ethanol were detected in blood at any time point, indicating negligible systemic uptake. The decline in breath was mono-exponential after both exposures with average half times of 0.4 (range 0.3–0.8) min after inhalation exposure and 1.9 (1.1–3.0) min after mouthwash. BrAC levels in the first sample, collected a few seconds after exposure, were 0.14 (0.07–0.13) mg/L after inhalation and 4.4 (2.7–6.0) mg/L after mouth wash. On average, it took 0.5 (0.06–0.7) min and 11 (6–15) min, respectively, for the BrAC to fall below the Swedish statutory limit of 0.1 mg/L air. Conclusion: In practice, use of breath analysis should not be a problem even if the subject inhaled ethanol vapors before the test. In contrast, use of ethanol-containing mouthwash results in a false positive test if sampling is done within 15 min.