50

45

40

35

30

25

20

5

iTTe}

105

100

95

90

85

Fievre 1.

Pr BLOOD ALCOHOL CONCENTRATION — LOW DOSE _
L
1 \ f f '
-30 ° 30 60 120 180
rT BLOOD ALCOHOL CONCENTRATION — HIGH DOSE
r i || —12,000 FT. WITHOUT SUPPLEMENTAL Op
| | —= 12,000 FT. WITH " "
i" if ---20,000 FT. WITH " .

r : f L L j
-30 ° 30 60 120 180
TIME (min)

Blood alcohol concentration expressed as mg % as a function of time. Low dose, n=8;

dose, n=12. Means + SE.

3



Hulpieu and Harger‘ report that alcohol may
serve as a stimulant for motility of the stomach
and intestines. Alcohol concentrations (in the
ingested drink) below 109% have little effect on
the motility of the stomach and intestines but
concentrations above 15% are definitely irritat-
ing. As presented to our subjects (average
weight near 72 kg.) the average high dose of
alcohol was approximately 15.8% and the average
low dose was approximately 7.99%. It is possible,
therefore, that increased motility caused by the
alcohol concentration combined with the in-
creased motility attributed to the lowered baro-
metric pressure were responsible for the signifi-
cant increase in blood alcohol level at 20,000 ft.
for the high dose but not for the low dose.

Additional studies which would include inter-
mediate altitudes, with and without supplemental
oxygen, and the administration of the high dose
of alcohol in a more dilute drink concentration
(less than 10%) could further clarify these find-
ings. However, none are planned at this time.

Vv. Summary.

This study established blood alcohol levels in
man at 12,000 ft. with and without supplemental
oxygen and at 20,000 ft. with supplemental
oxygen. At 2.50 ml. of 100 proof bourbon/kg.
body weight, subjects exhibited a lower blood
alcohol level at 12,000 ft. without supplemental
oxygen than at 20,000 ft. with supplemental
oxygen. A difference in blood levels was not
seen with 1.25 ml. of 100 proof bourbon/kg.
body weight.

It was established that dehydration effects
alone could not account for these findings.

The effect of breathing a normal oxygen mix-
ture could not be ascertained with the data
collected.

An increased motility of the gastrointestinal
tract caused by the high alcohol concentration
and the increased motility attributable to the
lowered barometric pressure could increase the
absorption rate of the alcohol at 20,000 ft. with
the high dose, thereby contributing to higher
blood alcohol levels.

REFERENCES

1. Armstrong, H. G. Aerospace Medicine, The Williams
and Wilkins Co., Baltimore, 1961.

2. Greenberg, L. “The Metabolism and Pharmacology of
Alcohol,” Acad. Med. N. J. Bul., 9(3) : 136-142, 1963.

8. Higgins, E. A. et al. “The Effects of Alcohol at
Three Simulated Aircraft Cabin Conditions,” OAM
Report No, AM 68-18, 1968.

»

Hulpieu, H. R. and R. N. Harger: “The Alcohols” in
Pharmacology in Medicine, Edited by Victor A. Drill,
McGraw-Hill, New York, 1958.

5. McFarland, R. A. and W. H. Forbes. “The Metabo-
lism of Alcohol in Man at High Altitudes,” Human
Biol. 8 :387-889, 1936.

6. Miller, S. U. “Increased Human Body Water Loss
at Reduced Ambient Pressure,” Aerospace Med., 33:
689-691, 1962.

7. Syed, R. A. “Enzymatic Determination of Ethyl
Alcohol by an Automated Fluorometric Technique,”
Symposium on Automation in Analytical Chemistry,
‘Technicon, Inc., New York, 1967.

8. Winer, B. J. Statistical Principles in Haperimentat
Design, McGraw-Hill, New York, 1962.


100 - HEART RATE - LOW DOSE

7OFr
L 1 L 1 1 1 J
-30 re) 30 60 120 180
95 5 HEART RATE — HIGH DOSE

BEATS PER MINUTE

12,000 FT. WITHOUT SUPPLEMENTAL O5
sor ——— 12,000 FT. WITH " "
------ 20,000 FT. WITH

1 ;

-30 ie) 30 60 120 (80
TIME (min)

Fiaure 3. Heart rate expressed in beats per minute as a function of time. Low dose, n=8; High dose n=12.
Means + SE.

5



48.57

48.0F

47.5

47.0F

46.55

46.07

45.5 F

45.0F

44.55

44.0F

ar |

e
H
H
H
H

4

HEMATOCRIT

48.55

48.0

47.55

470Pr

49.0 -

-30 ° 30 60 120 180
HEMATOCRIT — HIGH DOSE

‘

L————9@----5

12,000 FT. WITHOUT SUPPLEMENTAL O5
——— 12,000 FT. WITH " .
vosase 20,000 FT. WITH ‘ ‘

-30 ° 30 60 (20 180

Figure 2.

TIME (min)

Hematocrit expressed as a function of time. Low dose, n=8; High dose, n=12. Means + SE.

4


centration for the high alcohol dose (P<.05).
Using the Student Multiple Range test, this
study did verify the finding of the previous
study,’ that blood alcohol concentrations were
significantly higher for subjects at 20,000 ft.
than for those at 12,000 ft. without supplemental
oxygen (P<.05).

McFarland and Forbes* also have reported
that the concentration of alcohol in the blood
rose more rapidly and reached a higher level at
high altitudes than at sea level.

Results for the two 12,000 ft. altitude condi-
tions did not approach significance for difference.
Although blood alcohol concentrations at 20,000
ft. (high dose) were significantly higher than
those found at 12,000 ft. without supplemental
oxygen, the statistical comparison between the
20,000 ft. values and those for 12,000 ft. with
supplemental oxygen was not significant (P<.10).
Therefore, the effects of breathing oxygen on
blood alcohol concentrations cannot be ascertained
from the data obtained in this study.

It was considered that dehydration would in-
fluence the findings because alcohol enhances
diuresis and Miller® reported an increased hu-
man body water loss at reduced ambient pres-
sures. If the diuretic loss were much greater
with the high dose of alcohol, then an additional
water loss due to reduced ambient pressure might
prove to be of greater significance for the high
dose than for the low dose.

Although hematocrit changes with time were
very small, they were significant (P<.01).
Lowest values were for the control samples with
peak values at 2 hours. Subjects receiving the
high dose of alcohol had mean hematocrit values
increasing from 46.0 to 47.8. Mean hematocrit
values for low-dose subjects were 45.6 to 46.9.
These were increases of 1.8 and 1.3 respectively,
which might reflect the diuretic effect of the
alcohol demonstrated by the urine volumes.
Although individual variation was quite large,
those receiving the high alcohol dose produced
statistically higher urine volumes. Using
Miller’s method for estimating evaporative water
loss, the losses in our subjects would be 186.7
gm./hr. and 195.6 gm./hr. for 12,000 ft. and
20,000 ft. respectively. This small difference of
less than 10 gm./hr. would not be sufficient to
account for the difference in blood alcohol con-
centration. None of the measured corrected

a

weight losses were as high as would have been
predicted by Miller’s method. There were no
significant differences for weight loss. It does
not appear, from the data collected in this study,
that differences in dehydration levels can ac-
count for the observed phenomenon.

There are other possible explanations for the
blood alcohol concentration findings which, how-
ever, could not be tested with this experimental
design. A reduced rate of metabolism at 20,000
ft. could explain the findings for the high dose
of alcohol. If this were the case, however, one
would expect a similar finding for the low dose.
Furthermore, alcohol oxidation (in a healthy
individual) appears to be fairly constant. Many
attempts have been made to alter the rate of
metabolism of alcohol (e.g., administration of
thyroid extract, inhalation of oxygen, and exer-
cise) without significant results? Once peak
blood alcohol levels were attained, the rate of de-
cline of blood alcohol levels at 20,000 ft. was
quite similar to the rate of decline at lower alti-
tudes, Therefore, a reduced rate of alcohol
metabolism at 20,000 ft.. does not appear to be
a logical explanation.

Another explanation might be a greater ab-
sorption rate at 20,000 ft. facilitated by the high
dose of alcohol. A greater absorption rate at
20,000 ft. might be considered possible because
of a reported hypermotility of the intestinal
tract at lowered ambient pressures.t The
increase in motility appears to be related to the
expansion of gases contained in the gastroin-
testinal tract. Because these gases are saturated
with water vapor they do not expand in exact
proportion to the decrease of barmoetric pressure.
The pressure changes from ground level (just
over 1,200 ft.) to 12,000 ft. and to 20,000 ft. may
be expressed as: (A) 727-47/484-47 or 1.55, and
(B) 727-47/350-47 or 2.25. Gas expansion at
20,000 ft. is almost one and one-half times as
great as at 12,000 ft. At slow rates of ascent
(less than 300 ft./min.) the distention persists
for an hour or two when the gas volume again
becomes approximately equal to ground level.
At higher rates of ascent (1,000 ft./min. or
more), as in this study, gas tends to become more
localized in pockets in the intestinal loop instead
of being passed off. Under these conditions
hypermotility probably persists even longer.



AM 70-5

BLOOD ALCOHOL CONCENTRATIONS AS AFFECTED
BY COMBINATIONS OF ALCOHOLIC BEVERAGE
DOSAGES AND ALTITUDES

E. Arnold Higgins, Ph.D.
John A. Vaughan, B.S.
Gordon E, Funkhouser, B.A.

Approved by Released by
Le / Z Fegel at
J. R. Dux, M.D. P. V. Smern, M.D.
Cuter, Crvm AEROMEDICAL Feperat Arr Sureron
Insrirore
April 1970

Department of Transportation

FEDERAL AVIATION ADMINISTRATION
Office of Aviation Medicine





99.0 OXYGEN SATURATION - LOW DOSE A

98.0
97.0
96.0

95.0

94.0 -

b -30 °O 30 60 120 180
a 100.0 -- OXYGEN SATURATION — HIGH DOSE B

& 990+ 5
a

---t--

98.0

97.0
—— 12,000 FT. WITHOUT SUPPLEMENTAL 0.
96.0 F ——— 12,000 FT. WITH " "
20,000 FT. WITH
95.0 F
94.0 +
93.0 +
1 \ . 1 1 -_
-30 o) 30 60 120 180
TIME (min)

Faure 4. Blood oxygen saturation expressed in per cent as a function of time. Low dose, n=8; High dose,
n=12, Means + SE.

6


Tasux II.—Changes in body weight for all conditions*

Pre- Post- Change in
exposure Fluid intake Urine output exposure body weight
Conditions weight weight (corrected)
(kg.) (kg.) (g-/kg.) (kg.) (g-/kg.) (kg.) (kg.) (g./kg.)
Low Dose—
12, 000 ft. 72, 354 0. 601 8.361 0.709 | 10.010) 72.014) -0,.232] -3.159
without sup. O2 +2.160 | +0.005; +0.266} 40,092] +1.397| +2.190| +0.036| +0.468
12, 000 ft. 74, 586 0.610 8,338 0.454 5.904 | 74.485] —0.257| —3.498
with supp. Oz 44,269} +0,006| +0.422| +0.089/ +0.812| +4.200/ +0.023) +0.350
20,000 ft. 68.758 0. 602 9.075 0. 580 8.786 | 68.529 | -0.251| —3.616
with supp. O2 $4,938 | 40.002} +0.634| +0.114] 41.698] +4.910; 40,032] +0,332
High Dose—
12,000 ft. 72.371 0. 595 8.301 1.148} 16.085} 71.563 | —0.256| —3.581
without sup. O2 £2,259 | +0.008| +0.252| +0117] 41.724} +2,281] +0.018/ +0,284
12, 000 ft. 72.766 0, 596 8.342 1.095 | 15.135 | 71.985 | -0.284) —3.890
with supp. O2 £2,997 | +0,005| +0.348} +0.069/ +0.858/ +2.956| +0,048] 40.630
20,000 ft. 72,021 0. 602 8.479 0.889 | 13.083] 71.406 | -0.317| —4,323
with supp. Oz £2,594 | 40.008 | +0.320| 20.107) +1.675) +2.589| +0,061) +0.771

*Reported as means + standard errors.

100 proof bourbon.* Each dose was mixed with
a cola to a total volume of about 600 ml.

Data from repeated measures were subjected to
an analysis of variance (repeated measures tech-
nique) and the Student multiple range test.*
Other data were subjected to “t” tests.

Ill. Results.

Blood alcohol concentration at both dose levels
showed significant differences with time
(P<.01); peak values were attained between
30 and 60 minutes after ingestion (Figure 1, A &
B). Differences attributable to cabin conditions
were evident only at the high dose (P<.05).

Changes in hematocrit at the two alcohol levels
are shown in Figure 2, A & B. There was a
significant increase in hematocrit with time in
each case (P<.01); generally, a maximuwmn level
was attained in or near the second hour.
Hematocrits did not vary significantly with

*The Old Grand-Dad Distillery Co., Frankfort, Ken-
tucky.

cabin condition, nor did they demonstrate any
significant interactions.

At both alcohol levels time significantly in-
fluenced heart rate (P<.01) (Figure 3, A & B).
Maximum heart rates occurred at about 60
minutes, after which they gradually declined
during the remaining 120 minutes.

Blood oxygen saturation measurements (Figure
4, A & B) demonstrated significant effects for
both time and cabin condition as well as for the
interaction between the two (P<.01).

Subjects receiving the high alcohol dose had
greater urine volumes than those receiving the
low dose (P<.01). Mean volume with the high
dose was 1,044 ml.; mean volume with the low
dose was 581 ml. Body weight change, corrected
for fluid intake and urine loss, was not signifi-
eantly affected by altitude (Table IT).

IV. Discussion.

By Analysis of Variance the data revealed that
a significant difference existed when considering
the effect of cabin condition on blood alcohol con-


BLOOD ALCOHOL CONCENTRATIONS AS AFFECTED BY
COMBINATIONS OF ALCOHOLIC BEVERAGE DOSAGES AND ALTITUDES

I, Introduction.

In an earlier study * human subjects ingesting
2.50 ml. of 100 proof bourbon/kg. body weight
had a significantly higher blood alcohol level at
20,000 ft. than those ingesting this amount of
alcohol at 12,000 ft. or at ground level. The
altitude-related difference was not apparent with
a lower dose of alcohol (1.25 ml. of 100 proof
bourbon/kg. body weight).

This report includes the results from sub-
sequent experiments designed to: (1) Verify the
altitude-dose interaction; (2) examine the pos-
sibility that the principle mechanism involves de-
hydration; and (8) determine if breathing
oxygen was a factor.

IL. Methods.

Sixty male paid volunteer subjects, 21 to 31
years old (mean age, 22 years), were divided into
three groups. One of the two groups exposed to
12,000 ft. breathed ambient air; the other group
was given a normal oxygen mixture by a
demand-type regulator system. The third group
was exposed to 20,000 ft. and also breathed the
normal oxygen mixture.

In each experiment, two to four subjects were
tested for 3 hours during which time physiolog-
ical measurements were made at intervals (see
Table I).

Taste I.—Schedule of events

A. Subjects report to Employee Health Clinic
at 8:30 a.m. (no breakfast) :
Execution of forms.
Physical examination by flight surgeon.
Consumption of 8 oz. milk and two slices of
dry toast.

B. In Laboratory :
Pre-exposure nude body weight.

C. In Altitude Chamber:

— 30 minutes: measurement of oxygen sat-
uration and heart rate, draw
5 ml. blood sample.

— 30 minutes to time zero: consumption of

alcoholic beverage over 30

minutes (4% per 5 minutes).

ascend to altitude.

repeat above measurements,

blood sample.

repeat above measurements,

blood sample.

repeat above measurements,

blood sample.

repeat above measurements,

blood sample.

End of exposure to altitude.

D. In Laboratory:

Post-exposure urine collection followed by
nude body weight.

Blood oxygen saturation was determined by a
Waters (Model XE-350) ear oximeter and heart
rate was obtained by counting radial artery
pulses.

Nude body weights were taken before and after
the altitude exposure on a. 125 kg. balance, sensi-
tive to 10 gm.; corrections were made for fluid
intake and urine excretion (see Table II).

A 5-ml. sample of venous blood was drawn in
a heparinized syringe. Hematocrit was meas-
ured by a microcapillary centrifuge and reader.
The remainder of the blood was mixed with
desiccated sodium and ammonium oxalate, sealed
and stored in a refrigerator (0.6 to 3.3° C).
Blood alcohol levels were measured in these
stored samples by the automated method of
Syed."

Twenty-four of the subjects (eight per con-
dition) received 1.25 ml./kg. body weight (low
dose) and the remaining 36 men (12 per condi-
tion) each received 2.50 ml./kg. (high dose) of

0 minutes:
+ 30 minutes:

+ 60 minutes:
+120 minutes:

+180 minutes:



ACKNOWLEDGMENTS

The authors thank the physicians of CAMI for providing medical
coverage during the chamber flights, and to the personnel of the Physiological
Operations and Training Section for operating the altitude chamber. We
also are grateful to Mr. Floyd Passmore for his technical assistance and to
Mr. William V. Flores for the technical illustrations of this report. We also
thank Dr. P. F. Iampietro for his review of the manuscript and helpful
suggestions.

Qualified requesters may obtain Aviation Medical Reports from Defense Documentation
Center. The general public may purchase from Clearinghouse for Federal Scientific
and Technical Information, U.S. Dept. of Commerce, Springfield, Va. 22151