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

• Published in: Alcohol and alcoholism (Oxford) Vol. 34; no. 1; pp. 71 - 77
• Main Authors: WURST, F. M, KEMPTER, C, SEIDL, S, ALT, A
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Oxford Oxford University Press 1999; Oxford Publishing Limited (England)
• Subjects: Adult; Alcohol consumption; Alcohol Drinking - urine; Alcoholism - diagnosis; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Biological markers; Biomarkers; Chlormethiazole - therapeutic use; Chromatography, Liquid - methods; Ethanol - blood; Ethanol - pharmacokinetics; Female; Forensic Medicine; Glucuronates - metabolism; Humans; Male; Medical sciences; Middle Aged; Recurrence; Substance Withdrawal Syndrome - drug therapy; Time Factors; Toxicology; Consumption; Human; Urine; Biological fluid; Relapse; Ethanol; Metabolite; Toxicity; Alcoholism; Biological marker; Medical screening; Glucuroconjugate; Dependence; Serum
• ISSN: 0735-0414; 1464-3502; 1464-3502
• DOI: 10.1093/alcalc/34.1.71

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.