This man came in this morning with one of the highest blood alcohol levels I’ve ever seen in an awake patient. This was after he threatened suicide, yelled at his wife and kid who were scared enough to go to grandma’s house. He was brought in for a petition for involuntary committment due to risk of self harm. The trouble is that we are not able to assess his psychiatric status until his alcohol level is below the legal driving limit. His blood alcohol was OVER FOUR TIMES the legal limit (Now 80). Beer is metabolized by the liver on what is called a zero-order metabolism. THat means that a fixed amount of alcohol is elimitated per hour regardless of how much you start with (some drugs have half-lives, that is half the drug is eliminated per unit of time). SO with a level of 340 at 7 AM, his level is projected to be at the legal limit at 7PM. That means this drunk obnoxious man spent the ENTIRE DAY in the ER, occasionally observed by police or security, and the WHOLE DAY goes by with no psychiatrist able to see him. I had to sign him out to a very kind and understanding colleague who will have to start from scratch tonight at 7.