title: [Diuretics and their potential effect on breath-alcohol concentration--a case report].
abstract: Many objections were raised to breath-alcohol analysis upon its introduction in the field of traffic law enforcement in Germany, but in the meantime this issue has become less relevant in forensic routine work. In the present case, the defending lawyer claimed that the ethanol concentration in the blood and hence in the breath of his client, which was 0.35 mg/l according to the Dräger Alcotest 7110® Evidential and thus above the legal limit of 0.25 mg/l, had been changed by diuretics taken 4 hours before the breath alcohol test, viz. 10 mg of torasemide, a loop diuretic, and 50 mg of spironolactone, a competitive aldosterone antagonist. According to the literature, the maximum urinary output in healthy subjects within the first 4 hours after 10 mg torasemide was 1450 ml. In patients suffering from heart failure, the urinary volume was reduced by a factor of 2.5-3; after chronic intake of torasemide, water loss did not differ from placebo. Spironolactone, which acts on the distal tubule, has little effect on urinary output. In a publication, the loss of water in excess within 24 hours was 90 ml. Co-administration of 100 mg spironolactone and 20 mg furosemide, which roughly compares to 10 mg torasemide, resulted in a mean urinary volume of 1566 ml within the first 4 hours. In terms of the reported case and provided that no compensatory fluid had been taken, a purely theoretical maximum shift of 0.007 mg/ may occur in the breath-alcohol concentration due to the smaller distribution volume even considering maximum urinary excretion values. On the other hand, already mild levels of dehydration may be associated with negative symptoms affecting driving ability.
authors.forename: Georg
authors.initials: G
authors.lastname: Schmitt
authors.forename: Gisela
authors.initials: G
authors.lastname: Skopp
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000097:blood* / Q000175:diagnosis*; D001944:Breath Tests; D004232:Diuretics / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D000431:Ethanol / Q000032:analysis* / Q000493:pharmacokinetics*; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005665:Furosemide / Q000493:pharmacokinetics / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D011237:Predictive Value of Tests; D013148:Spironolactone / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D013449:Sulfonamides / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D000077786:Torsemide; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D004232:Diuretics; D013449:Sulfonamides; D013148:Spironolactone; D000431:Ethanol; D005665:Furosemide; D000077786:Torsemide