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. 2010 Apr 1;6(4):438–442. doi: 10.1007/s13181-010-0048-z

Alcohol Levels Do Not Accurately Predict Physical or Mental Impairment in Ethanol-Tolerant Subjects: Relevance to Emergency Medicine and Dram Shop Laws

James R Roberts 1,✉, Denis Dollard 2
PMCID: PMC3550465  PMID: 20358415

Abstract

The human body and the central nervous system can develop tremendous tolerance to ethanol. Mental and physical dysfunctions from ethanol, in an alcohol-tolerant individual, do not consistently correlate with ethanol levels traditionally used to define intoxication, or even lethality, in a nontolerant subject. Attempting to relate observed signs of alcohol intoxication or impairment, or to evaluate sobriety, by quantifying blood alcohol levels can be misleading, if not impossible. We report a case demonstrating the disconnect between alcohol levels and generally assigned parameters of intoxication and impairment. In this case, an alcohol-tolerant man, with a serum ethanol level of 515 mg/dl, appeared neurologically intact and cognitively normal. This individual was without objective signs of impairment or intoxication by repeated evaluations by experienced emergency physicians. In alcohol-tolerant individuals, blood alcohol levels cannot always be predicted by and do not necessarily correlate with outward appearance, overt signs of intoxication, or physical examination. This phenomenon must be acknowledged when analyzing medical decision making in the emergency department or when evaluating the ability of bartenders and party hosts to identify intoxication in dram shop cases.

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Footnotes

Dr. Roberts participates in alcohol-related litigation and Dr. Dollard does not participate in alcohol-related litigation.

There was no funding for this submission.

The information has not been previously presented.

The information has not been previously presented.

Contributor Information

James R. Roberts, Phone: +1-215-7489740, FAX: +1-215-748 9207, Email: JRoberts@mercyhealth.org

Denis Dollard, Email: DDollard@mercyhealth.org.

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