Article

In this document, toxicologist Dr. Michael Whitekus provides a comprehensive reference table outlining a spectrum of Blood Alcohol Concentration (BAC) levels. His analysis includes the number of drinks consumed to attain specific BACs and prominent clinical signs corresponding with specific BAC ranges. Dr. Whitekus’ reference also demonstrates how the relative risk of being involved in a motor vehicle crash increases exponentially with heightened BAC levels.

Clinical Signs Associated with Blood Alcohol Concentration (BAC)

Blood alcohol concentration (BAC) and alcohol consumption can be estimated based on scientifically valid standard methodology used by toxicologists [1] and this information can be used to answer key questions in alcohol related cases like the following;

  1. How many drinks did the individual consume?
  2. What was their BAC at the time of the incident?

This methodology relies on i) the principles of alcohol pharmacokinetics, ii) the gender, age, height and weight of the drinking individual, iii) the time period that they were reportedly consuming alcoholic beverages, and iv) the measured BAC and time of blood draw (if data are available).

In Table 1 below the number of drinks a typical male or female would need to consume to generate the identified BAC, and the list of clinical signs that would be expected from the BAC range are listed along with the relative risk of being in a fatal car crash while driving at the identified BAC.

Interesting facts related to the blood alcohol table (Table 1).

  • The number of dinks that a typical femaleb needs to consume to generate a given BAC is less than a typical mana for two reasons, i) women typically weigh less than men and ii) a woman’s body (of equal height and weight) contains more fat than a man’s body which reduces her ability to absorb alcohol (volume of distribution is reduced).
  • Driving Impairment begins at a BAC of ~ 0.02 % (~2 standard drinks for a malea and ~ 1 standard drink for a femaleb).
  • A drinker’s ability to drive safely is negatively impacted prior to their ability to detect any outward changes in their behavior or driving ability.
  • An individual who chooses to drive at a BAC of 0.08 % (the legal limit, ~4 standard drinks for a malea and ~ 3 standard drinks for a femaleb) is ~10 times more likely to be involved in a car crash than a sober driver.
  • An individual who is visibly intoxicated (BAC of ~0.15 % or greater) and allowed to drive is 78 times more likely to be involved in a car crash.
  • The pleasurable and most socially desirable effects of alcohol are typically attained at BACs of 0.03-0.12 % or approximately 2-6 drinks for a malea and 1-4 drinks for a femaleb.
  • Once an individual is visibly intoxicated (BAC of ~0.15%, ~ 7-9 drinks for a malea and ~ 4.5-6 drinks for a femaleb) there are no socially desirable clinical signs associated with further drinking.


Table 1. Blood Alcohol Concentration Table [1-7] Download PDF Version

Blood-Alcohol Concentration (percent) # drinks for Male to achieve BAC a,c # drinks for Female to achieve BAC b, c Prominent Clinical Signs Risk for Car Crash d
0.01-0.05 1.5-3.1 1.0-2.0 Behavior nearly normal by ordinary observation. Impairment detectable by special tests. ND-4.3
0.02 1.9 1.2 Driving impairment starts around 0.02% BAC. 1.8
0.03-0.12 2.3-6.0 1.5-3.8 Mild euphoria, sociability, talkativeness. ↑ self-confidence; ↓ inhibitions, attention, judgment and control; loss of efficiency in critical performance tests. 2.4-33
≥0.04 2.7 1.7 Driving under the influence for professional driver with CDL license. 3.2
≥0.08 4.3 2.8 Driving under the influence for normal driver. 10
0.09-0.25 4.7-11.2 3.0-7.2 Emotional instability; ↓ in perception; memory and comprehension; sensory-motor in-coordination; impaired balance; slurred speech; vomiting; drowsiness. 14- >330
0.15 7.2-9.2 4.6-5.9 >50% of social drinkers are visibly intoxicated at 0.15 % and 84% of all drinkers (including heavy drinkers who develop tolerance) are visibly intoxicated at 0.20 %. 78
0.18-0.30 8.4-13.3 5.4-8.5 Disorientation; mental confusion; vertigo; exaggerated emotional states (fear, rage, grief); ↑ pain threshold; staggering gait; ataxia; memory loss; apathy. 185- >330
0.25-0.40 11.2-17.3 7.2-11.1 Approaching loss of motor function; Marked ↓ response to stimuli; inability to stand or walk; incontinence; impaired consciousness. >330
0.35-0.50 15.3-21.4 9.8-13.6 Complete unconsciousness; coma; depressed reflexes; ↓ temperature; circulation and respiration impairment. Possible death from respiratory or cardiac arrest. >330

a. Based on a 5’10’’, 25 year old, 175 lb male.
b. Based on 5’4’’, 25 year old, 125 lb female.
c. Empty stomach, drinking alcohol for 60 minutes followed by 30 minutes of non-drinking activity. One standard drink equals 14 g of alcohol or 5 oz wine (12%), 12 oz beer (5%), 1.5 oz liquor (40%). Assuming an elimination rate of 18 mg/dL/h.
d. The relative risk (x times greater) of being in a fatal single motor vehicle crash compared to driving sober. Data are for male/female, age 21-34.
ND= No data

References:

  1. Brick,J., Standardization of alcohol calculations in research. Alcohol Clin Exp Res, 2006. 30(8): p. 1276-87.
  2. Administration, N.H.T.a.S., Effects of Low Doses of Alcohol on Driving-related Skills: A Review of the Evidence. 1998.
  3. Brick, J. and C.K. Erickson, Intoxication is not always visible: an unrecognized prevention challenge. Alcohol Clin Exp Res, 2009. 33(9): p. 1489-507.
  4. Caplan, Y.H., B.A. Goldberger, Garriott’s Medicolegal Aspects of Alcohol. 6th ed. 2015, Tucson, Arizona: Lawyers and Judges Publishing Company, Inc. .
  5. Moskowitz, H., Burns, M., Fiorentino, D., Smiley, A., and Zador, P., Driver Characteristics and Impairment at Various BACs, N.H.T.S. Administration, Editor. 2000.
  6. Moskowitz, H. and M. Burns, Effects of rate of drinking on human performance. J Stud Alcohol, 1976. 37(5): p. 598-605.
  7. Moskowitz, H., M.M. Burns, and A.F. Williams, Skills performance at low blood alcohol levels. J Stud Alcohol, 1985. 46(6): p. 482-5.

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Michael J. Whitekus, Ph.D., DABT

Toxicologist & Drug Safety Expert

Dr. Michael Whitekus is a toxicologist with expertise and experience in several areas including drug safety, pharmacology, inhalation toxicology, environmental contaminants , alcohol and prescription and non-prescription drugs. He has spent much of his career evaluating the safety profiles of pharmaceutical drugs as well as elucidating their efficacies, side effects, and mechanisms of action. Dr. Whitekus applies his expertise in drug safety and toxicology towards resolving disputes relating to adverse drug and alcohol events and exposure to chemical and environmental toxins.

Dr. Whitekus is frequently tasked with analyzing the degree to which various drugs and alcohol affect impairment, reconstructing dose and concentration levels leading up to an event based on known factors, and evaluating potential interactions between alcohol, medications, and other substances. In addition to his extensive toxicological experience, Dr. Whitekus is a graduate of the Borkenstein course on Alcohol and Highway Safety.