GLP-1 dose escalation and disputed ignition interlock alcohol results: Case report.

Abstract

Ignition interlock breath alcohol devices use electrochemical fuel-cell technology to detect alcohol in breath. Although these devices are intended to detect ethanol, fuel-cell sensors also detect other alcohols, including isopropanol. Prior reports have described false-positive breath alcohol results in individuals with increased ketone body production, including a case involving a very-low-calorie ketogenic diet and another involving diabetic ketoacidosis. This report involves a 45-year-old woman prescribed Wegovy, a GLP-1 receptor agonist, who had two positive ignition interlock results within days of a dose increase from 1.0 mg to 1.7 mg. The individual denied alcohol consumption, testified regarding several years of sobriety, and otherwise maintained employment and compliance with ignition interlock requirements. One plausible explanation for the positive results is that reduced caloric intake following the GLP-1 dose escalation increased reliance on fat metabolism. This may have triggered an increased endogenous acetone production and subsequent reduction of acetone to isopropanol. Isopropanol undergoes electrochemical oxidation on fuel-cell-based breath alcohol sensors and can produce an apparent alcohol-positive result despite not drinking alcohol. This mechanism should be considered when evaluating disputed ignition interlock violations in individuals using GLP-1 receptor agonists.

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