which of the following is a key factor that influences bac?

Blood alcohol content , also called blood alcohol concentration, blood ethanol concentration, or blood alcohol level is most commonly used as a metric of alcohol intoxication for legal or medical purposes Blood alcohol content is usually expressed as a percentage of alcohol (generally in the sense of ethanol) in the blood in units of mass of alcohol per volume of blood or mass of alcohol per mass of blood, depending on the country

For instance, in North America a BAC of 010 (010% or one tenth of one percent) means that there are 010 g of alcohol for every dL of blood Estimated blood ethanol concentration (EBAC) To calculate estimated peak blood alcohol concentration (EBAC), a variation, including drinking period in hours, of the Widmark formula was used

The formula is: where 0806 is a constant for body water in the blood (mean 806%), SD is the number of standard drinks containing 10 grams of ethanol, 12 is a factor to convert the amount in grams to Swedish standards set by The Swedish National Institute of Public Health, BW is a body water constant (058 for men and 049 for women), Wt is body weight (kilogram), MR is the metabolism constant (0017) and DP is the drinking period in hours Regarding metabolism (MR) in the formula; Females demonstrated a higher average rate of elimination (mean, 0017; range, 0014-0021 g/210 L) than males (mean, 0015; range, 0013-0017 g/210 L) Female subjects on average had a higher percentage of body fat (mean, 260; range, 167-368%) than males (mean, 180; range, 102-253%) Additionally, men are, on average, heavier than women but it is not strictly accurate to say that the water content of a person alone is responsible for the dissolution of alcohol within the body, because alcohol does dissolve in fatty tissue as well When it does, a certain amount of alcohol is temporarily taken out of the blood and briefly stored in the fat For this reason, most calculations of alcohol to body mass simply use the weight of the individual, and not specifically his water content Finally, it is speculated that the bubbles in sparkling wine may speed up alcohol intoxication by helping the alcohol to reach the bloodstream faster

A study conducted at the University of Surrey in the United Kingdom gave subjects equal amounts of flat and sparkling Champagne which contained the same levels of alcohol After 5 minutes following consumption, the group that had the sparkling wine had 54 milligrams of alcohol in their blood while the group that had the same sparkling wine, only flat, had 39 milligrams Examples: 80 kg male drinking 3 standard drinks in two hours: 70 kg woman drinking 25 standard drinks in two hours: Binge drinking In most jurisdictions a measurement such as a blood alcohol content (BAC) in excess of a specific threshold level, such as 005% or 008% defines the offense Also, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) define the term “binge drinking” as any time one reaches a peak BAC of 008% or higher as opposed to some (arguably) arbitrary number of drinks in an evening Pleasure zone Known as pleasure zone, the positive effects exceed the negative at concentrations typically between 0030–0059% blood ethanol concentration (BEC), but the contrary becomes true at higher volumes (008% as defined by NIAAA); especially concentrations typical of binge drinking Units of measurement There are several different units in use around the world for defining blood alcohol concentration Each is defined as either a mass of alcohol per volume of blood or a mass of alcohol per mass of blood (never a volume per volume) 1 milliliter of blood is approximately equivalent to 106 grams of blood Because of this, units by volume are similar but not identical to units by mass In the US the concentration unit 1% w/v (percent mass/volume, equivalent to 10g/l or 1 g per 100 ml) is in use

This is not to be confused with the amount of alcohol measured on the breath, as with a breathalyzer The amount of alcohol measured on the breath is generally accepted as proportional to the amount of alcohol present in the blood at a rate of 1:2100 Therefore, a breathalyzer measurement of 010 mg/L of breath alcohol converts to 0021 g/210L of breath alcohol, or 0021 g/dL of blood alcohol (the units of the BAC in the United States) While a variety of units (or sometimes lack thereof) is used throughout the world, many countries use the g/L unit, which do not create confusion as percentages do Usual units are highlighted in the table below Legal limits For purposes of law enforcement, blood alcohol content is used to define intoxication and provides a rough measure of impairment Although the degree of impairment may vary among individuals with the same blood alcohol content, it can be measured objectively and is therefore legally useful and difficult to contest in court

Most countries disallow operation of motor vehicles and heavy machinery above prescribed levels of blood alcohol content Operation of boats and aircraft are also regulated The alcohol level at which a person is considered legally impaired varies by country The list below gives limits by country These are typically blood alcohol content limits for the operation of a vehicle

It is illegal to have any measurable alcohol in the blood while driving in these countries Most jurisdictions have a tolerance slightly higher than zero to account for false positives and naturally occurring alcohol in the body Some of the following jurisdictions have a general prohibition of alcohol Australia- Learner drivers or those drivers with a Provisional/Probationary Licence Bangladesh Brazil Brunei Canada—new drivers undergoing graduated licensing in Ontario or British Columbia, drivers under the age of 22 in Alberta, Manitoba, New Brunswick, Northwest Territories, Nova Scotia, Ontario, Saskatchewan and Quebec Croatia—professional drivers, driving instructors and drivers of the vehicle categories C1, C1+E, C, C+E, D, D+E and H; the limit for other drivers is 050 mg/g, but they do get an additional separate fine if they cause an accident while having a blood alcohol level between 0 and 0,50 mg/g Czech Republic Estonia Fiji Hungary Israel 24 mg per 100 ml (0024%) of breath (penalties only apply above 26 mg per 100 ml (0026%) of breath due to lawsuits about sensitivity of devices used) New drivers, drivers under 24 years of age and commercial drivers 5 mg per 100 ml of breath(0,005%) New Zealand—drivers under the age of 20 Nepal Oman Pakistan Paraguay Romania (beyond 008% drivers will not only receive a fine and have their license suspended, the offense will also be added to their criminal records) Russia (0‰ permille introduced in 2010, cancelled in September 2013) Saudi Arabia Slovakia United Arab Emirates United States—drivers under the age of 21 China Israel 24 mg per 100 ml (0024%) of breath (penalties only apply above 26 mg per 100 ml (0026%) of breath due to lawsuits about sensitivity of devices used) New drivers, drivers under 24 years of age and commercial drivers 5 mg per 100 ml of breath

(0,005%) Netherlands (for drivers in their first five years after gaining a driving license) Norway (road vehicles and sea vessels over 15 m) Poland Puerto Rico Sweden Ukraine Belarus Chile India (note: In the state of Kerala, a policy of zero tolerance has developed) Serbia Japan Uruguay (000% for truck/taxi/bus drivers) Russia (since September 2013) Lithuania (002% for drivers in their first two years after gaining a driving license) Mexico Argentina (002% for motorbikes, 000% for truck/taxi/bus drivers) Australia (000% for Australian Capital Territory learner, provisional and convicted DUI drivers (changed down from 002% on December 1, 2010), 002% for truck/bus/taxi, 000% for learner drivers, provisional/probationary drivers (regardless of age), truck and bus drivers, driving instructors and DUI drivers in all other states) Austria – no limit for pedestrians; 0

08% for cycling; 005% generally for cars less than 7,5 t (driving licence B) and motorbikes (A); but 0,01% during learning (for driver and teacher or L17-assistant), during probation period (at least the first 2 years) or up to the age of 20 (A1, AM, L17, F), trucks (C greater than 7,5 t), bus (D), drivers of taxi and public transport Belgium Bosnia and Herzegovina Bulgaria Canada: Alberta, British Columbia, Ontario, Manitoba, Newfoundland, Nova Scotia, New Brunswick—provincial offence Costa Rica Croatia—professional drivers, driving instructors and drivers of the vehicle categories C1, C1+E, C, C+E, D, D+E and H; the limit for other drivers is 050 mg/g, but they do get an additional separate fine if they cause an accident while having a blood alcohol level between 0 and 0,50 mg/g Denmark Finland France (0025% for bus drivers) Germany (00‰ for learner drivers, all drivers 18–21 and newly licensed drivers of any age for first two years of licence; also, if the BAC exceeds 03‰, driving is illegal if the driver is showing changes in behavior (“Relative Fahruntüchtigkeit”)) Greece Hong Kong Iceland Ireland (002% for learner drivers and professional drivers) Italy (000% for drivers in their first three years after gaining a driving license) Latvia (002% for drivers in their first two years after gaining a driving license) Luxembourg Macedonia (000% for drivers in their first two years after gaining a driving license) Netherlands (0

02% for drivers in their first five years after gaining a driving license) New Zealand (for drivers over 20, from 2014) Peru Philippines Portugal (002% for drivers holding a driver’s licence for less than three years, professional drivers, and drivers of taxis, heavy vehicles, emergency vehicles, public transport of children and carrying dangerous goods) Slovenia (000% for drivers in their first two years after gaining a drivers licence, drivers under 21 and common drivers, such as buses, trucks) South Africa Spain (003% for drivers in their first two years after gaining a driving license and common carriers, such as buses, trucks) Switzerland (001% for drivers in their first three years after gaining a drivers licence and for driving instructors) Thailand Taiwan (breath alcohol limit decreased from 025 to 015 from 13 June 2013) Turkey The Bahamas Canada—criminal offence England and Wales (0

02% for operators of fixed-wing aircraft; both countries share the same law regarding motoring alcohol limits) Malaysia (000 for Probationary Driving Licence holders) Malta New Zealand (000% for drivers under 20) Norway (legal limit for sea vessels under 15 m) Northern Ireland (The government of Northern Ireland intends to reduce the general limit to 005%) Puerto Rico (for drivers 21 years and older) Scotland (The Scottish Government intends to reduce the limit to 005%) Singapore United States—all states impose penalties for driving with a BAC of 008% or greater Even below those levels drivers can have civil liability and other criminal guilt (eg, in Arizona driving impairment to any degree caused by alcohol consumption can be a civil or criminal offense in addition to other offenses at higher blood alcohol content levels) Drivers under 21 (the most common US legal drinking age) are held to stricter standards under zero tolerance laws adopted in varying forms in all states: commonly 001% to 005% See Alcohol laws of the United States by state Federal Motor Carrier Safety Administration: 004% for drivers of a commercial vehicle requiring a commercial driver’s license and 001% for operators of common carriers, such as buses Cayman Islands Legally drunk in some jurisdictions Limits by country (BrAC: Breath Alcohol Content) In certain countries, alcohol limits are determined by the Breath Alcohol Content (BrAC), not to be confused with blood alcohol content (BAC) In Greece, the BrAC limit is 250 microgrammes of alcohol per litre of breath The limit in blood is 050 g/l

The BrAC limit for drivers in their first two years after gaining a driving license and common carriers is 100 microgrammes per litre of breath BrAC 250–400 = €200 fine BrAC 400–600 = €700 fine, plus suspension of driving license for 90 days (introduced in 2007) BrAC greater than 600 = 2 months imprisonment, plus suspension of driving license for 180 days, plus €1,200 fine BrAC 250–400 = €200 fine BrAC 400–600 = €700 fine, plus suspension of driving license for 90 days (introduced in 2007) BrAC greater than 600 = 2 months imprisonment, plus suspension of driving license for 180 days, plus €1,200 fine In Hong Kong, the BrAC limit is 220 microgrammes per litre of breath (as well as other defined limits) In The Netherlands and Finland, the BrAC limit is 220 microgrammes of alcohol per litre of breath (μg/l, colloquially known as “Ugl”) In New Zealand, the BrAC limit is 400 micrograms of alcohol per litre of breath for those aged 20 years or over, and zero for those aged under 20 years

In Singapore, the BrAC limit is 350 microgrammes of alcohol per litre of breath In Spain the BrAC limit is 250 microgrammes of alcohol per litre of breath and 150 microgrammes per litre of breath for drivers in their first two years after gaining a driving license and common carriers In the United Kingdom the BrAC limit is 350 microgrammes of alcohol per litre of breath (as well as the above defined blood alcohol content) Other limitation schemes For South Korea, the penalties for different blood alcohol content levels include 001–0049 = No Penalty 005–009 = 100 days license suspension greater than 010 = Cancellation of car license 001–0049 = No Penalty 005–009 = 100 days license suspension greater than 010 = Cancellation of car license

Scientific definitions “001” Blood alcohol content is the hundredth decimal part of the one thousandth part of a liter (Please note that this “001” is measured in permille and not percentage as the “01” example in introduction and numbers in 1 Effects at different levels) In digesting these numbers it must be remembered that one milliliter is the thousandth part of a liter Therefore 1% of a milliliter is 000001-Liter Expressing blood-alcohol concentration as “001” is naming the hundredth part of a thousandth part

As final example, a blood-alcohol concentration of 008, being the 008 “part” of a milliliter (ITSELF the thousandth part of a Liter) therefore names an absolute blood-alcohol volume of 000008-Liter (within every liter of blood) Each country or state may define BAC differently

For example, the state of California in the United States legally defines BAC as a ratio of grams of alcohol per 100 milliliters of blood, which is equal to grams of alcohol per deciliter of blood Since measurement must be accurate and inexpensive, several measurement techniques are used as proxies to approximate the true parts per million measure Some of the most common are listed here: (1) Mass of alcohol per volume of exhaled breath (for example, 038 mg/L; see also breath gas analysis), (2) Mass per volume of blood in the body (for example, 008 g/dL), and (3) Mass of alcohol per mass of the body (for example, 00013 g/Kg) The number of alcoholic beverages (drinks) consumed is often a poor measure of blood alcohol content because of variations in sex, body weight, and body fat An ethanol level of 010% is equal to 22 mmol/l or 100 mg/dl of blood alcohol This same 0

10% BAC also equates to 010 g/dL of blood alcohol or 010 g/210L of exhaled breath alcohol or 0476 mg/L of exhaled breath alcohol Likewise, 010 mg/L of exhaled breath alcohol converts to 002% BAC, 0022 g/dL of blood alcohol or 0022 g/210L of exhaled breath alcohol Test assumptions Blood alcohol tests assume the individual being tested is average in various ways

For example, on average the ratio of blood alcohol content to breath alcohol content (the partition ratio) is 2100 to 1 In other words, there are 2100 parts of alcohol in the blood for every part in the breath However, the actual ratio in any given individual can vary from 1300:1 to 3100:1, or even more widely This ratio varies not only from person to person, but within one person from moment to moment Thus a person with a true blood alcohol level of

08% but a partition ratio of 1700:1 at the time of testing would have a10 reading on a Breathalyzer calibrated for the average 2100:1 ratio A similar assumption is made in urinalysis When urine is analyzed for alcohol, the assumption is that there are 13 parts of alcohol in the urine for every 1 part in the blood, even though the actual ratio can vary greatly

Breath alcohol testing further assumes that the test is post-absorptive—that is, that the absorption of alcohol in the subject’s body is complete If the subject is still actively absorbing alcohol, their body has not reached a state of equilibrium where the concentration of alcohol is uniform throughout the body Most forensic alcohol experts reject test results during this period as the amounts of alcohol in the breath will not accurately reflect a true concentration in the blood Auto-brewery syndrome is a rare medical condition where the stomach produces brewers yeast that breaks down starches into ethanol; which enters the blood stream Metabolism and excretion Alcohol is absorbed throughout the gastrointestinal tract, but more slowly in the stomach than in the small or large intestine

For this reason, alcohol consumed with food is absorbed more slowly, because it spends a longer time in the stomach Furthermore, alcohol dehydrogenase is present in the stomach lining After absorption, the alcohol passes to the liver through the hepatic portal vein, where it undergoes a first pass of metabolism before entering the general bloodstream Alcohol is removed from the bloodstream by a combination of metabolism, excretion, and evaporation The relative proportion disposed of in each way varies from person to person, but typically about 95% is metabolized by the liver

The remainder of the alcohol is eliminated through excretion in breath, urine, sweat, feces, milk and saliva Excretion into urine typically begins after about 40 minutes, whereas metabolisation commences as soon as the alcohol is absorbed, and even before alcohol levels have risen in the brain Alcohol is metabolized mainly by the group of six enzymes collectively called alcohol dehydrogenase These convert the ethanol into acetaldehyde (an intermediate that is actually more toxic than ethanol) The enzyme acetaldehyde dehydrogenase then converts the acetaldehyde into non-toxic Acetic acid

Many physiologically active materials are removed from the bloodstream (whether by metabolism or excretion) at a rate proportional to the current concentration, so that they exhibit exponential decay with a characteristic halflife (see pharmacokinetics) This is not true for alcohol, however Typical doses of alcohol actually saturate the enzymes’ capacity, so that alcohol is removed from the bloodstream at an approximately constant rate This rate varies considerably between individuals; Another sex based difference is in the elimination of alcohol Persons below the age of 25, women persons of certain ethnicities, and persons with liver disease may process alcohol more slowly, also false positive of High (BAC) reading are related to patients with proteinuria and hematuria, due to kidney-liver metabolism and failure

(for example, Hematuria 1+ protenuria 1+ ) Also have impaired acetaldehyde dehydrogenase; this causes acetaldehyde levels to peak higher, producing more severe hangovers and other effects such as flushing and tachycardia Conversely, members of certain ethnicities that traditionally did not use alcoholic beverages have lower levels of alcohol dehydrogenases and thus “sober up” very slowly, but reach lower aldehyde concentrations and have milder hangovers Rate of detoxification of alcohol can also be slowed by certain drugs which interfere with the action of alcohol dehydrogenases, notably aspirin, furfural (which may be found in fusel alcohol), fumes of certain solvents, many heavy metals, and some pyrazole compounds Also suspected of having this effect are cimetidine (Tagamet), ranitidine (Zantac), and acetaminophen (Tylenol) (paracetamol) Currently, the only known substance that can increase the rate of metabolism of alcohol is fructose

The effect can vary significantly from person to person, but a 100g dose of fructose has been shown to increase alcohol metabolism by an average of 80% Fructose also increases false positives of high BAC ratio readings in anyone with proteinuria and hematuria, due to kidney-liver metabolism Alcohol absorption can be slowed by ingesting alcohol on a full stomach Spreading the total absorption of alcohol over a greater period of time decreases the maximum alcohol level, decreasing the hangover effect Thus, drinking on a full stomach or drinking while ingesting drugs which slow the breakdown of ethanol into acetaldehyde will reduce the maximum blood levels of this substance and thus decrease the hangover

Alcohol in non-carbonated beverages is absorbed more slowly than alcohol in carbonated drinks Retrograde extrapolation Retrograde extrapolation is the mathematical process by which someone’s blood alcohol concentration at the time of driving is estimated by projecting backwards from a later chemical test This involves estimating the absorption and elimination of alcohol in the interim between driving and testing The rate of elimination in the average person is commonly estimated at015 to

020 grams per deciliter per hour (g/dl/h), although again this can vary from person to person and in a given person from one moment to another Metabolism can be affected by numerous factors, including such things as body temperature, the type of alcoholic beverage consumed, and the amount and type of food consumed In an increasing number of states, laws have been enacted to facilitate this speculative task: the blood alcohol content at the time of driving is legally presumed to be the same as when later tested There are usually time limits put on this presumption, commonly two or three hours, and the defendant is permitted to offer evidence to rebut this presumption Forward extrapolation can also be attempted

If the amount of alcohol consumed is known, along with such variables as the weight and sex of the subject and period and rate of consumption, the blood alcohol level can be estimated by extrapolating forward Although subject to the same infirmities as retrograde extrapolation—guessing based upon averages and unknown variables—this can be relevant in estimating BAC when driving and/or corroborating or contradicting the results of a later chemical test Cases of high blood alcohol levels On Monday March 26, 2012, a man was found in a ditch in the US state of Indiana with a BAC of 0

552% In November 2007, a driver was found passed out in her car in Oregon in the United States A blood test showed her blood alcohol level was 0550% She was charged with several offenses, including two counts of driving under the influence of an intoxicant, reckless endangerment of a person, criminal mischief and driving with a suspended license

Her bail was later set at US$50,000, since she had several previous convictions for similar offenses In December 2007, a driver was arrested in Klamath County, Oregon, after she was found unconscious in her car which was stuck in a snow bank with its engine running Police were forced to break a car window to remove her After realizing she was in an alcohol-induced coma, they rushed her to the hospital where a blood test showed her blood alcohol level was 0720%

She reportedly was released from the hospital the next day She was subsequently charged with drunk driving In July 2008, a driver was arrested after he ran into a highway message board on Interstate 95 in Providence, Rhode Island A breath test showed his blood alcohol level was at 0491% and he was raced to the hospital where he was sedated and placed in a detoxification unit

He was subsequently charged with driving while intoxicated and resisting arrest He was later sentenced to one year probation, a $500 fine, 40 hours of community service and a one-year loss of his driver’s license The police later stated that his blood alcohol level was the highest they had ever seen for someone who hadn’t died of alcohol poisoning It was later estimated that the driver had consumed 10–14 drinks over the course of 1–2 hours, based on the standard levels of elimination which as documented previously can vary by up to 300% In December 2009, a South Dakota woman was found behind the wheel of a stolen car with a measured blood alcohol content of

708%, almost nine times the state’s limit of08%, thus becoming the highest recorded level of alcohol toxicity for the state After she was hospitalized, she was released on bond and subsequently found in another stolen automobile while under the influence In August 2012, an Iowa man was arrested for driving under the influence Breathalyzers and subsequent lab tests confirmed a BAC of

627%, about 8 times the legal limit for driving At that blood alcohol level, he was conscious, yet incoherent and unable to answer simple questions Highest recorded blood alcohol level/content There have been reported cases of blood alcohol content higher than 100% In March 2009, a 45-year-old man was admitted to the hospital in Skierniewice, Poland, after being struck by a car

The blood test showed blood alcohol content at 123 The man survived but did not remember either the accident or the circumstances of his alcohol consumption One such case was reported by O’Neil, and others in 1984 They report on a 30-year-old man who survived a blood alcohol concentration of 1,500 mg/100 ml blood after vigorous medical intervention

In South Africa, a man driving a Mercedes-Benz Vito light van containing 15 sheep, allegedly stolen from nearby farms, was arrested on December 22, 2010, near Queenstown in Eastern Cape His blood had an alcohol content of 16 g/100 ml Also in the vehicle were five boys and a woman who were also arrested In 2004, an unidentified Taiwanese woman died of alcohol intoxication after immersion for twelve hours in a bathtub filled with 40% ethanol

Her blood alcohol content was 135% It was believed that she had immersed herself as a response to the SARS epidemic In Poland, a homeless man was found sleeping half-naked on January 28, 2011, in Cieszyn His blood had an alcohol level of 1

024% Despite the temperature of −10 °C and extremely high blood alcohol content, the man survived In December 2004, a man was admitted to the hospital in Plovdiv, Bulgaria, after being struck by a car After detecting a strong alcohol odor, doctors at a hospital conducted a breath test which displayed the man’s blood alcohol content at 0914

The man was treated for serious injuries sustained in the crash and survived In February 2005, French gendarmes from Bourg-en-Bresse, France, conducted a breath test on a man who had lost control of his car He had an alcohol content of 0976 He was not injured in the accident but was charged with a €150 fine and his driving license was canceled

In 1982, a 24-year-old woman was admitted to the UCLA emergency room with a serum alcohol concentration of 15 (1,510 mg/dL), corresponding to a BAC of 133 She was alert and oriented to person and place Serum alcohol concentration is not equal to nor calculated in the same way as blood alcohol content

In 2012, on Oct 26th a man from Olszewo-Borki community, Poland, who died in a car accident, had 223%; however, the blood sample was collected from a wound and thus possibly contaminated In 2013, on July 26 a 30-year-old man from Alfredówka, Poland, was found by Municipal Police Patrol from Nowa Dęba lying in the ditch along the road in Tarnowska Wola At the hospital there was recorded that the man had 1374 permille of alcohol in the blood (1374%) The man survived

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