Ethyl glucuronide--a marker of alcohol consumption and a relapse marker with clinical and forensic implications

Alcohol Alcohol. 1999 Jan-Feb;34(1):71-7. doi: 10.1093/alcalc/34.1.71.

Abstract

Ethyl glucuronide (EtG) is a non-volatile, water-soluble, direct metabolite of ethanol that can be detected in body fluids and hair. We investigated urine and serum samples from three patient groups: (1) 33 in-patients in acute alcohol withdrawal; (2) 30 detoxified in-patients (treated for at least 4 weeks) from a 'motivation station'; and (3) 43 neuro-rehabilitation patients (non-alcoholics; most of them suffering from stroke, traumatic brain injury, Parkinson's disease etc.) using gas chromatography/mass spectrometry (GC/MS) with deuterium-labelled EtG as the internal standard and additionally in the second group of patients using liquid chromatography (LC/MS-MS). We found no correlation between the concentration of EtG in urine at hospitalization and the blood-ethanol concentration (r = 0.17), the time frame of detection (r = 0.5) or the total amount of clomethiazole required for the treatment of withdrawal symptoms (r = 0.28). In four out of 30 in-patients from the 'motivation station'--where neither clinical impression nor routine laboratory findings gave indications of relapse--concentrations of EtG in urine ranged between 4.2 and 196.6 mg/l. EtG concentrations in urine of between 2.89 and 23.49 mg/l were found in seven out of 43 neuro-rehabilitation patients using GC/MS. The GC/MS and the LC/MS-MS results showed a correlation of 0.98 with Pearson's correlation test and 1.0 with Spearman's correlation test. We suggest that EtG is a marker of alcohol consumption that can be detected for an extended time period after the complete elimination of alcohol from the body. When used as a relapse marker with a specific time frame of detection intermediate between short- and long-term markers, EtG fills a clinically as well as forensically important gap. Its specificity and sensitivity exceed those of all other known ethanol markers.

MeSH terms

  • Adult
  • Alcohol Drinking / urine*
  • Alcoholism / diagnosis*
  • Biomarkers
  • Chlormethiazole / therapeutic use
  • Chromatography, Liquid / methods
  • Ethanol / blood
  • Ethanol / pharmacokinetics*
  • Female
  • Forensic Medicine
  • Glucuronates / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Substance Withdrawal Syndrome / drug therapy
  • Time Factors

Substances

  • Biomarkers
  • Glucuronates
  • Chlormethiazole
  • ethyl glucuronide
  • Ethanol