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False positive on breathalyzerThe short answer is yes. Ketoacidosis (elevated ketone levels) have been identified with false positive tests with blood alcohol measurements:

One reference to J Forensic Sci. 1995 Jul;40(4):686-7.

states:

We report the identification of acetone (0.45mg/mL) and isopropanol (0.17 mg/mL) but without the presence of ethanolin a blood sample from a man suspected of driving under the influenceof alcohol. A preliminary breath screening test with an electrochemicalinstrument (Alcolmeter S-L2) was positive and an evidential breath-testwith a dual wavelength infrared analyzer (Intoxilyzer 5000), recognizedthe presence of an interferant in the subject's breath. The manadmitted drinking moderate amounts of alcohol (vodka) the previousevening and was being treated by his doctor for hyperglycemia byspecial dietary control. This case scenario provides a good example ofsevere metabolic ketoacidosis in an ostensibly healthy man driving on the highway. Biotransformation of the abnormally high concentration ofblood-acetone to isopropanol occurs through the alcohol dehydrogenasepathway.

PMID: 7595310 [PubMed - indexed for MEDLINE]

Another reference (more recent) is even more interesting as it relates to to a person on a low carb high fat diet (like Atkins).

Int J Obes (Lond). 2007 Mar;31(3):559-61. Epub 2006 Aug 8

A 59-year-old man undergoing weight loss with verylow calorie diets (VLCD) attempted to drive a car, which was fittedwith an alcohol ignition interlock device, but the vehicle failed tostart. Because the man was a teetotaller, he was surprised and upset bythis result. VLCD treatment leads to ketonemia with high concentrationsof acetone, acetoacetate and beta-hydroxybutyrate in the blood. Theinterlock device determines alcohol (ethanol) in breath byelectrochemical oxidation, but acetone does not undergo oxidation withthis detector. However, under certain circumstances acetone is reducedin the body to isopropanol by hepatic alcohol dehydrogenase (ADH). Theignition interlock device responds to other alcohols (e.g. methanol,n-propanol and isopropanol), which therefore explains thefalse-positive result. This 'side effect' of ketogenic diets needsfurther discussion by authorities when people engaged insafety-sensitive work (e.g. bus drivers and airline pilots) submit torandom breath-alcohol tests.

PMID: 16894360 [PubMed - indexed for MEDLINE]

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Not likely. Ethanol in blood tests is usually determined enzymatically, with alcohol dehydrogenase. Interference from other alcohol type or ketones is usually considered to be less than 1%.

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Q: Could elevated ketone levels produce inaccurate Breathalyzer results?
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