Elevated blood alcohol level in decompensated alcoholic liver disease

Dear Ask The Doctor: --MY QUESTION IS ABOUT ALCOHOLIC LIVER DISEASE--There was no option for this so I picked liver cancer. My sister in law has been diagnosed with Wilsons Disease, Graves Disease and she has been an alcoholic for many many years. She has recently been diagnosed through a liver biopsy to have alcoholic liver disease among many other medical issues at this time. She has had her stomach drained due to swelling and liquids filling up in her abdomen and stomach so she is not in good condition and was told to stop drinking. Just last week she was apparently 32 days sober since her stomach had been drained. She was on her way to pick up her children when she was lighting a cigarette and crashed her vehicle. Upon getting her blood results in the ER she was told her blood levels were 4 times the legal limit. She swears she is 32 days sober at this time. She demands to be tested again but this time her blood indicated she was twice the legal limit.Family and paramedics did not smell alcohol on her and she had no means to get her hands on anything to drink. She is being monitored. Is it possible that something in her liver in holding on to toxins or that traces of alcohol could still be present after that many days because of her alcoholic liver disease? How is it that her blood showed high levels if alcohol when has drank nothing for 32 days? She swears she was not impaired and did not have a drink because it could threaten her life. The family is not sure what to think cause we want to beleive her. Please help and your time and answers are appreciated. Stephanie

Dear Stephanie: In patients with alcoholic liver disease, the metabolism of alcohol may be slowed due to reduced overall liver function. The initial blood alcohol sample taken indicated a level 4 times over the legal limit and the subsequent sample indicated a level 2 times over the legal limit, therefore this would suggest that the alcohol was metabolized at an average rate. There are reports of some medications that may interfere with blood alcohol levels for example; H2 receptor antagonists (commonly ranitidine and cimetidine), however the reports are that these drugs interfere with blood alcohol levels while coingested with alcohol. On balance the finding of two blood samples with above the legal limit of alcohol, in a patient with a history of alcohol abuse, would suggest to me that this is not a laboratory error and that your sister-in-law must have consumed alcohol prior to her accident.