How Long Can An Etg Test Detect Alcohol? - [2023] Información de la cerveza

Highlights –

Multiple cutoffs for ethyl glucuronide immunoassay (EtG-I) were compared with drinking self-report. The 100 ng/mL cutoff is most likely to detect heavy drinking up to five days. The 500 ng/mL cutoff is likely to only detect heavy drinking during the previous day.

Contents

- 0.0.1 How long can EtG be detected?

1 Can you pass an EtG after 48 hours?
- - 1.0.1 What is the longest EtG has been detected?
- 1.1 How is EtG eliminated from the body?
2 What can cause a false positive EtG test?
3 What is the difference between EtS and EtG?
4 Can an EtG test be wrong?
- - 4.0.1 How accurate are hair EtG tests?
  - 4.0.2 Can isopropyl alcohol cause positive EtG?
- 4.1 What can cause a positive EtG test?

How long can EtG be detected?

EtG Testing – An EtG test is a urine test that checks for something called ethyl glucuronide or EtG, EtG is a byproduct of ethanol and a compound (chemical) made in the liver called glucuronide. This compound attaches itself to toxins — in this case, ethanol — within the body and allows those toxins to be pushed out through the urine.

Even when drinking a small amount, EtG can be detected (found) within the urine. An EtG test is the most accurate test as EtG can be detected within someone’s urine for about two days or 48 hours, If the drinking is heavier, it can be detected for up to three days or 72 hours, While this is the most accurate form of testing, there are still certain drawbacks to it.

EtG isn’t able to find out how much alcohol someone has been drinking, but higher levels tend to indicate higher alcohol consumption, However, there are different factors that can influence this. For example, if there has been a significant lapse in time since using alcohol last, the EtG levels are going to be much lower.

Can you pass an EtG after 48 hours?

Common Misperceptions about Alcohol Metabolites: Ethyl Glucuronide and Ethyl Sulfate – Ethyl glucuronide and ethyl sulfate (EtG and EtS) are minor metabolites of ethanol (alcohol) that can be used to help identify recent ethanol exposure, even after ethanol is no longer measurable. Discussions on the interpretation of EtG and EtS urine test results frequently arise in programs utilizing these tests.

Concerns have mostly centered around windows of detection and the sources of the ethanol metabolites when monitoring abstinence (i.e. non-beverage versus beverage). Although EtG and EtS testing has been widely marketed as an “80 hour test”, current studies suggest that this may not apply to all amounts of alcohol exposure.

See below for some points that may be of assistance:

Light drinking (defined as approximately 2 standard drinks), will likely be detected the following morning after consumption and possibly 24 hours after drinking. Moderate drinking (defined as approximately 4-5 standard drinks) may be detected up to 48 hours after drinking.

Neither metabolite is easily detected much after 48 hours, regardless of the dose of alcohol, with the exception of a “heavy” amount of ethanol consumed.

Heavy drinking (defined as in excess of 6-7 drinks) may be detected up to 80 hours. As with all testing, the concentration of the urine specimen, as defined by the creatinine, will influence the amount of drug that is detected in urine.

*References available upon request.

What is the longest EtG has been detected?

Ethyl Glucuronide (EtG) Ethyl Glucuronide (EtG) is a direct biological marker that is formed in the body after the consumption of ethanol from drinking alcoholic beverages. When someone consumes even relatively small amounts of alcohol, EtG is formed and can be detected.

Unique biological markers of alcohol use (only alcohol consumed can create EtG) Detects recent use Longer detection window than the previously recognized urine alcohol test called, ethanol or ETOH Longer detection window than breath alcohol Highly specific and sensitive to alcohol consumption

According to the National Council on Alcoholism and Drug Dependence, Inc., alcohol is the most commonly used addictive substance in the U.S., with 1 in every 12 adults suffering from alcohol abuse or dependence. EtG testing is not used to check for current impairment, rather screens for ethanol use.

EtG and EtS are the only biomarkers recognized as appropriate for abstinence monitoring, based primarily on the time to return to normal levels following abstinence from alcohol. EtG testing allows for detection of drinking when individuals look to keep their use a secret. When persons with drinking problems know they will be tested, they usually will stop drinking to avoid penalty.

Reduced rates of substance abuse has been reported from organized treatment programs utilizing routine EtG testing programs. Drug courts that use EtG testing also report greatly reduced alcohol abuse rates. EtG testing confirms alcohol abstinence. When alcohol abusers stop drinking, it is often difficult for others to trust that they are not.

Individuals younger than the legal drinking age and members of the Armed Forces in combat zones where, regardless of age, drinking is prohibited. Individuals on probation, including adolescents, who have committed alcohol-related crimes. Individuals who have previous alcohol-related problems but have been allowed visitation with or custody of children with the stipulation that these individuals remain abstinent. Motorists who have had alcohol-related traffic convictions and who are now required to abstain as a condition of maintaining driving privileges. Medical personnel, professionals, attorneys and others who, because of previous alcohol or drug-related problems, have agreed to maintain total abstinence and accept ongoing monitoring as conditions for continuing their license or employment.

– Meghan, State Probation/Parole Officer Relapse assessment is commonly used as a way to measure alcohol dependence. However, the methods of assessing relapses range from questionnaires to biological markers of alcohol for different time spans. The aim of this was to compare the relapse rates of weekend home stays during long-term alcohol dependence treatment, assessed by EtG, breath alcohol tests and self-reports.

RESULTS: Of the total, 37.7% of the patients participating in the study were positive for EtG at least once. Breath alcohol tests had been positive in as little as 4.4% and when interviewed only 5.7% of the patients admitted to their relapse.15.6% of EtG tests were positive, but breath alcohol tests were negative.93% of the relapses were only detected by EtG.

CONCLUSION: In addition to breath alcohol tests and interviews, urinary EtG can clearly improve the verification of relapse in inpatient treatment programs. Without EtG testing, a high amount of relapses will stay undetected. (Source: ) Instant/Rapid Tests for EtG

Longer window of detection time – up to 80 hours No calibration required Used to detect recent alcohol consumption, even after the ethanol alcohol is no longer measurable

Breathalyzer

Short detection window – less than 10 hours Purchase of mouth pieces Calibration required on a regular basis Measures Impairment Sensor can be unstable Sensitive to changes in temperature, humidity and breath flow patterns Preliminary screen

Similar to standard drugs of abuse screening (marijuana, cocaine, etc.) EtG screening poses the same advantages for INSTANT results vs the laboratory screening result: IMMEDIATE POSITIVE RESULT = ADMIT TO DRINKING Why does this happen?

Scenario Onsite Screen: The offender knows that he/she drank alcohol. Within minutes of giving their specimen they are confronted by their officer, case manager, or their counselor that they are positive for EtG. How likely is the offender to admit to drinking when the positive result is right in front of them and they are given the opportunity to explain themselves? Very likely! Why? Because when an offender is confronted with evidence immediately, he or she is likely to admit use.

In addition, the offender may plea to the offense in order to receive a lesser sentence. This outcome can save the agency money as it removes the need for a confirmation test. Scenario Lab Screen: The offender knows that he/she drank and they are just hoping that you are not going to catch him, right? When a specimen is collected, NOT tested on an instant/rapid screen but then sent to a lab for the EtG screen, how likely is that offender to admit to drinking? Not likely! Why? Because they are hoping to delay the punishment, resulting in a slim chance of changing any behavior for the good.500ng/mL – considered the “Goldilocks”, or “just right”, cut-off level for EtG in criminal justice testing.

Positive results at this cut-off are consistent with recent ingestion of alcohol (approximately 48 hours prior to specimen collection). At a cut-off of 500 ng/mL, studies indicate that positive results are NOT associated with incidental exposure (e.g.

mouthwash, hand sanitizer). The Court System and the Scientific Community agrees that 500 ng/mL is the not too low and not too high for court mandated drug and alcohol testing programs. When EtG was first made available to the courts in the laboratory setting, the laboratories had the ability to test for EtG at various different cut-off levels, 100 ng/mL, 250 ng/mL, 500 ng/mL, and even 1,000 ng/mL.

The scientific community had the ability to test lower, but that created positives that were caused by incidental exposure; making prosecuting violations difficult. In contrast, the higher cut offs were not sensitive enough and false negatives were widely reported.

Although various screening cut-offs are still available to agencies using EtG biomarker, the courts and scientific community most often defer to 500 ng/mL.
While EtG can be detectable as soon as 2 hours after use and up to 80 hours past consumption, there are many variables that may affect this detection window.1.

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Individuals metabolism 2. % alcohol content in drinks consumed 3. How quickly was the alcohol consumed 4. Hydration levels 5. Frequency of drinking.i.e. did drinking occur only on one occasion or is it more regular and ongoing Every 15 minutes for 8 hours used hand sanitizer, no subject had more than 62 ng/mL EtG. The screening cut off level for EtG 500 ng/mL – way under the threshold. Three daily dose of 1oz. of Vicks Nyquil with 25% alcohol, the subject with the highest had only 246 ng/mL of EtG. That daily dose is well above the recommended dosage and it is still under the 500 ng/mL cut-off. 55 people used mouthwash 3 times a day for 5 straight days. Each time holding the mouthwash in their mouths for 30 seconds (a long time). The highest EtG concentration, 120ng/mL. Rapid EtG is the best tool we have for abstinence monitoring and gives us the ability for immediate detection as opposed to waiting a few days after sending out to the lab. : Ethyl Glucuronide (EtG)

How is EtG eliminated from the body?

EtG is excreted in urine in a process influenced by water-induced diuresis, making it possible to include correction of urine levels to creatinine concentrations for some applications.

What can cause a false positive EtG test?

Monday, September 23, 2019 According to the National Survey on Drug Use and Health conducted in 2015, 86.4% of people over the age of 18 reported drinking alcohol at some point in their lifetime, with 33.9% of these individuals reporting either binge drinking or heavy alcohol use in the past month.1 Of those that drink alcohol, approximately 15.1 million adults have been diagnosed as having alcohol use disorder (AUD), with only 6.7% of adults with AUD receiving treatment.1 With alcohol use and abuse both incredibly high in the US, it is important for providers to be aware of their patients’ use patterns and the potential drug interactions with their prescribed medications.

However, as with all testing, there are things providers should be aware of when considering the interpretation of their patients’ test results regarding alcohol findings. Ethanol can be directly detected in all matrices offered by Aegis – blood, oral fluid, and urine – at a threshold of 10 mg/dL. Ethanol is only detectable for up to 8 hours post ingestion, which is indicative of recent ingestion.

Aegis can also analyze samples for two ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), with detection periods up to 72 hours post-ingestion at positive thresholds of 500 ng/mL and 200 ng/mL respectively. Period of detection is influenced by patient-specific factors, amount ingested, and chronicity of ingestion.2,3 Due to the variability of ethanol metabolism, it is possible to observe differing amounts of the metabolites or the presence of one metabolite in absence of another.

There are several scenarios that providers should be aware of that may result in unexpected positives. Post-collection fermentation is a common cause of positive results for ethanol and/or EtG only and has been shown to be responsible for up to one-third of unexpected positive results.4 Post-collection fermentation is of particular concern when the sample has been left at room temperature for a day or longer, which can allow yeast naturally present in the body to ferment excreted glucose and form ethanol, which in turn can be converted to EtG in the presence of bacteria.5,6 This phenomenon is often seen in samples from diabetic patients as they can excrete a greater than normal amount of glucose in their urine.

EtG and EtS testing may have unexpectedly positive results stemming from “incidental exposures” such as electronic cigarette use, heavy use of hand sanitizer, or consuming certain foods/beverages.7-9 Though generally an uncommon practice, the consumption of raw, live Baker’s yeast, when taken in combination with a source of sugar, can result in in vivo fermentation.10 Some patients consuming large amounts of grape juice may have detectable EtS levels due to the natural fermentation of fruit’s sugar.11 When considering positive results, it is important to discuss the use of “nonalcoholic” beers and wines with patients as these beverages may contain up to 0.5 vol.

% ethanol.12 Heavy consumption of these “nonalcoholic” beers and wines can lead to EtG and EtS levels at or above the Aegis reporting threshold.11,13,14 Other fermented beverages such as kombucha, a drink consisting of tea, sugar, bacteria, and yeast, may have up to a 3% alcohol content despite being listed as a non-alcoholic beverage and may cause an unexpected positive result.15-17 Providers should also keep alcohol-containing medications in mind (prescription and over the counter ), which patients may not report using prior to their test.

Certain formulations of particular concern are: cough and cold syrups, tinctures, allergy medications, anti-diarrheals, laxatives, and toothache, cold sore, and canker sore medications. Advise patients to consult product labels or their pharmacist for alcohol content in OTC or prescription medications.

While OTC medications are restricted to a maximum of 10% alcohol content, some prescription drugs may exceed this level. If heavy medication use is suspected or known, or if the presence of alcohol metabolites conflicts with a patient’s treatment agreement, advise patients to use non-alcoholic formulations when possible.

Clinicians should be aware of the rare possibility that a patient may have auto-brewery syndrome. This syndrome causes patients to naturally make large amounts of ethanol in vivo, Individuals affected by this disease will likely have severe bowel dysfunction, an overabundance of yeast, and a carbohydrate rich diet which worsens their symptoms.18,19 A common misconception regarding alcohol testing is that mouthwash or perfume/cologne use may lead to a positive test.

Aegis has not found any data that indicates that proper use of mouthwash or personal scent products will result in a positive test, however, improper use, such as purposefully consuming these products for their alcohol content, can produce positive results.14,20 Additionally, when conducting definitive testing for alcohol, it must be noted that there is no correlation between the amount ingested and the concentration detected in urine.

Furthermore, there is not a correlation between the amount detected and the patients’ impairment or intoxication when the sample was collected.21 Though definitive testing reports concentrations of ethanol, EtG, and EtS, these concentrations cannot be used to infer the exact time or amount of alcohol last ingested.

NOTICE: The information above is intended as a resource for health care providers.
Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct.

DOWNLOAD CLINICAL UPDATE References: 1. National Institute on Alcohol Abuse and Alcoholism – Alcohol Facts and Statistics: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics 2. Kissack JC, Bishop J, Leatherwood Roper A.

Ethyl glucuronide as a biomarker for ethanol detection.
Pharmacotherapy.2008;(6):769-81.3.
Helander A, Beck O.
Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake.
J Anal Toxicol,2005;29(5):270-4.4.
Crews B, West R, Gutierrez R, et al.
An improved method of determining ethanol use in chronic pain population.

J Opioid Manage.2011;7(1):27-34.5. Sulkowski HA, Wu AHB, McCarter YS. In-vitro production of ethanol in urine by fermentation. J Forensic Sci.1995;40:990-3.6. Helander A, Olsson I, Dahl H. Postcollection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption.

Clin Chem.2007;53(10):1885-7 7.
Valentine GW, Jatlow PI, Coffman M, Nadim H, Hueorguleva R, Sofuoglu M.
The effects of alcohol-containing e-cigarettes on young adult smokers.
Drug Alcohol Depend.2016;159:272-6.8.
Reisfield GM, Goldberger BA, Crews BO, et al.
Ethyl glucuronide, ethyl sulfate, and ethanol in urine after sustained exposure to an ethanol-based hand sanitizer.

J Anal Toxicol.2011;35(2):85-91.9. Arndt T, Schröfel S, Güssregen B, Stemmerich K. Inhalation but not transdermal resorption of hand sanitizer ethanol causes positive ethyl glucuronide findings in urine. Forensic Sci Int.2014;237:126-30.10. Thierauf A, Wohlfarth A, Auwärter V, Perdekamp MG, Wurst FM, Weinmann W.

Urine tested positive for ethyl glucuronide and ethyl sulfate after the consumption of yeast and sugar.
Forensic Sci Int.2010;202(1-3):e45-7.11.
Musshoff F, Albermann E, Madea B.
Ethyl glucuronide and ethyl sulfate in urine after consumption of various beverages and foods-misleading results? Int J Legal Med.2010;124:623-30 12.U.S.

Food and Drug Administration. CPG Sec.510.400 Dealcoholized wine and malt beverages-labeling.U.S. Food and Drug Administration website. https://www.fda.gov/iceci/compliancemanuals/compliancepolicyguidancemanual/ucm074430.htm Published Oct 1, 1980. Updated November 29, 2005.

Accessed August 27, 2019.13.
Thierauf A, Gnann H, Wohlfarth A. et al.
Urine tested positive for ethyl glucuronide and ethyl sulphate after the consumption of “non-alcoholic” beer.
Forensic Sci Int.2010;202(1-3):82-5.14.
Hoiseth G, Yttredal B, Karinen R, Gjerde H, Christophersen A.
Levels of ethyl glucuronide and ethyl sulfate in oral fluid, blood, and urine after use of mouthwash and ingestion of nonalcoholic wine.

J Anal Toxicol.2010;34(2):84-8.15. Nummer BA. Kombucha brewing under the Food and Drug Administration model food code: Risk analysis and processing guidance. J Environ Health.2013;76(4):8-11.16. Ebersole B, Liu Y, Schmidt R, Eckert M, Brown PN. Determination of ethanol in kombucha products: Single-laboratory validation, First Action 2016.12.

J AOAC Int.2017;100(3):732-6.17.
Ombucha Information and Resources.
Alcohol and Tobacco Tax and Trade Bureau website https://www.ttb.gov/kombucha/kombucha-general.shtml.
Updated March 29, 2019.
Accessed August 27, 2019.18.
Welch BT, Coelho Prabhu N, Walkoff L, Trenkner SW.
Auto-brewery syndrome in the setting of long-standing Crohn’s disease: A case report and review of literature.

J Crohns Colitis.2016;10(12):1448-50.19. Logan BK, Jones AW. Endogenous ethanol “Auto-Brewery Syndrome” as a drunk-driving defence challenge. Med Sci Law.2000;40(3):206-15.20. Reisfield GM, Goldberger BA, Pesce AJ, et al. Ethyl glucuronide, ethyl sulfate, and ethanol in urine after intensive exposure to high ethanol content mouthwash.

J Anal Toxicol.2011;35(5):264-8.21.
Ingall GB.
Alcohol Biomarkers.
Clin Lab Med.2012;32(3):391-406 Additional Resources 1.
Clinical Reference Guide: Drug Testing in Healthcare,
Aegis Sciences Corporation, 2019.2.
National Institute of Drug Abuse: https://www.drugabuse.gov/drugs-abuse/alcohol 3.
Auto-brewery Syndrome Stat Pearls: https://www.ncbi.nlm.nih.gov/books/NBK513346/ 4.

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Aegis Labs Clinical Update Site: https://www.aegislabs.com/resources/clinical-update/ 5. Athena Clinical Page: https://athena.aegislabs.com/departments/clinicalscience/Pages/Home.aspx

What is the difference between EtS and EtG?

Ethyl glucuronide (EtG) and Ethyl Sulfate (EtS) are direct metabolites of ethanol. EtG and EtS can be used as indicators for alcohol use. The main difference between EtG and alcohol is that EtG can be found in urine samples much longer than alcohol in the blood or breath.

In addition, after consuming a few alcoholic drinks, EtG is detected in the urine for 48 hours to 72 hours. Sometimes, if the person consumes alcohol regularly and excessively, EtG and EtS can be detected by testing for a more extended period. There is also little difference between the two; EtS is tested in conjunction with EtG to confirm alcohol consumption.

Moreover, testing for metabolites offers greater sensitivity and accuracy for determining alcohol consumption. Another difference is the cutoff levels for EtG and EtS confirmation; EtG may be 500 ng/mL or higher, while EtS is at 75- 100 ng/mL.

Can a UTI cause a positive EtG?

9 Conclusions – EtG was first described as a metabolite of ethanol in 1967 ; however, the increased use of mass spectrometry over the past decade has resulted in the development of accurate and reliable methods for EtG and EtS in biologic samples. Although most methods were initially developed for urine, there has been renewed interest in testing hair to increase the timeframe for detecting alcohol misuse.

Published data suggest that EtG has potential as a marker of high sensitivity and specificity for the detection of alcohol misuse in a variety of settings in both clinical and forensic medicine. As a noninvasive marker, EtG in urine or hair could have a role in screening, diagnosis, and monitoring treatment in selected groups of subjects or in general population studies.

Urine EtG remains positive for periods of up to 48–72 h following heavy alcohol consumption. As such, EtG has potential use in the intermediate timeframes, i.e., between those times in which ethanol and GGT/CDT measurements are performed. This approach has been successfully applied to establish abstinence in patients on liver transplant waiting lists and in alcohol detoxification programs.

Whether EtG will be adopted in workplace monitoring or regranting driving licenses requires further work.
The availability of an immunoassay for EtG that can be performed on general clinical chemistry analyzers will make it easier to conduct larger studies.
Because bacterial UTIs cause both false-positive and false-negative EtG results, mass spectrometry-based methods that measure both EtG and EtS may be preferable.

Nearly all methods for hair measurement of EtG and EtS use mass spectrometry which allows for identification of other alcohols that could interfere with immunoassay-based methods. Further work is clearly required before the full potential of these direct ethanol biomarkers can be realized and incorporated into the armamentarium of alcohol biomarkers in general.

How is most alcohol eliminated from the body?

Metabolism of alcohol – More than 90% of alcohol is eliminated by the liver; 2-5% is excreted unchanged in urine, sweat, or breath. The first step in metabolism is oxidation by alcohol dehydrogenases, of which at least four isoenzymes exist, to acetaldehyde in the presence of cofactors.

Acetaldehyde is a highly reactive and toxic substance, and in healthy people it is oxidised rapidly by aldehyde dehydrogenases to harmless acetate.
This article is adapted from the 4th edition of the ABC of Alcohol, which will be available in February Several isoenzymes of aldehyde dehyrdrogenase exist, one of which is missing in about 50% of Japanese people and possibly other south Asian people (but rarely in white people).

Unpleasant symptoms of headache, nausea, flushing, and tachycardia are experienced by people who lack aldehyde dehydrogenases and who drink; this is believed to be because of accumulation of acetaldehyde. Under normal circumstances, acetate is oxidised in the liver and peripheral tissues to carbon dioxide and water. Concentrations of alcohol in the blood after six units of alcohol (equivalent to 48 g alcohol) At a blood alcohol concentration of 4.4 mmol (20 mg/100 ml), the curve flattens out, but detectable concentrations are present for several hours after three pints of beer or three double whiskies in healthy people; enough alcohol to impair normal functioning could be present the morning after an evening session of drinking.

Does rubbing alcohol have EtG?

No. The use of any product that contains isopropanol, such as isopropyl rubbing alcohol will not explain the present of a direct ethyl alcohol biomarker such as EtG or FAEE. Isopropanol forms its own glucoronide, isopropyl glucoronide and does not interfere with the detection of EtG or FAEE. Back to view all FAQs

How much EtG is in a bottle of wine?

Abstract – Aims This study examines the biomarker ethyl glucuronide (EtG) in various alcoholic beverages. Short summary The biomarker EtG was consistently found to be a natural compound of wine, whereas it was not detected in any of the other tested alcoholic beverages, which included various distilled spirits, liqueurs and beer of different types and geographical origins.

Methods Alcoholic beverages ( n = 114) were analyzed by a validated liquid chromatography/tandem mass spectrometry assay. Beverages included samples from beer, wine, liqueurs and spirits from different manufacturers and geographical origins. Results EtG was not detected in any kind of distilled alcoholic beverages, regardless of the type of spirit (rum, gin, vodka, whiskey, fruit brandy, corn brandy, cordial) or liqueur ( n = 52).

EtG was also not detected in any of the analyzed samples of beer, which included pilsener, weissbier, lager beer and ale from different origins ( n = 20). In contrast, EtG was detected in every of the analyzed samples of wine ( n = 42) without exception.

Highest amounts were found in red wine and ranged from 1425 to 3720 μg/l ( n = 16). Significantly, lower concentrations of EtG were observed for white wine (347–1685 μg/l, n = 14) and sparkling wine (281–1447 μg/l, n = 10). Conclusions Wine is an external source of EtG. It has been shown that milligram amounts of the biomarker can be contained in a bottle of wine.

This should be considered in biomarker testing, especially in EtG hair analysis, which is susceptible to external contamination.

What is the lowest EtG cutoff?

Highlights –

Can an EtG test be wrong?

Ethyl Glucuronide and Ethyl Sulfate – EtG/EtS is a marker that can be detected for a period of a few days following alcohol ingestion, EtG is a minor metabolite of ethanol resulting from ethanol conjugation with glucuronic acid, Both EtG and EtS are minor products of phase II ethanol metabolism representing <0.1% of total ethanol disposition. EtG is formed by conjugation with glucuronic acid catalyzed by the enzyme UDP-glucuronosyltransferase, while EtS formation is catalyzed by sulfotransferase. Both of these markers can be detected in the blood for ~36 hours and for several days in urine and tissues for several days following cessation of alcohol intake, Blood spot analysis has also been shown to be a viable matrix, Consumption of a relatively small quantity of alcohol such as 7 g may result in detectable EtG level in urine up to 6 hours. Detection time is longer after consumption of higher amounts of alcohol. EtG/EtS species are also present in hair and represent a promising marker for postmortem investigations of alcohol use, In general, the EtG level in hair in 95% of abstainers studied was <1.0 pg/mg of hair, while 30% of abstainers exhibited EtG levels below the detection limit of the highly sensitive liquid chromatography combined with tandem mass spectrometry assay (LC/MS/MS: detection limit: 0.5 pg/mg of hair). Hair color, gender, age, body mass index, smoking, and cosmetic treatment of hair did not appear to influence hair analysis for EtG. Various cutoff concentrations have been proposed for analysis of EtG in hair where value is expressed as pg/mg of hair. Morini et al. stated that 27 pg/mg exhibits a strong sensitivity (92%) and specificity (96%), A metaanalysis indicated that a cutoff of 30 pg/mg limits the false negatives in differentiating heavy from social drinking and abstinence, EtG in meconium is also measured to investigate possible exposure of a fetus to maternal alcohol use. Bana et al. used a cutoff of 50 ng/gm of meconium for EtG and 1000 ng/gm of meconium for FAEEs for their study and reported that 34.6% women consumed alcohol during pregnancy while 17% women showed positive results with both markers, For hair, EtG sensitivity of 96% and specificity of 99% has been reported at a cutoff concentration of 30 pg/mg of hair to identify individuals who are drinking alcohol chronically at amounts exceeding 60 g/day, Urinary glucuronide at a cutoff of 100 ng/mL, exhibited a sensitivity and specificity was 76% and 93%, respectively. The sensitivity and specificity of urinary EtS at 25 ng/mL cutoff was 82% and 86% respectively when utilized to detect drinking 3–7 days prior to clinic visits, False positive and false negative results have been reported with both EtG and EtS. False positive test results may be due to incidental exposure to alcohol-containing products such as mouthwash and hand sanitizers, especially if a lower cutoff concentration is used. Consuming nonalcoholic beer and wine in larger amounts may also produce false positive results because such products may contain a small amount of alcohol. Eating baker's yeast with sugar, drinking large amounts of apple juice, or even eating ripe bananas may cause detectable amounts of EtG and EtS in urine. Urinary tract infections may also produce false negative test results due to degradation of EtG in urine by the beta-glucuronidase enzyme present in Escherichia coli, In contrast, EtS is not affected by this process. In 2006, an advisory was issued due to potentially false positive test results with EtG testing and warned against use of EtG as the sole evidence in determining abstinence in criminal justice, regulatory, or legal settings, Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780128156070000034

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How accurate are hair EtG tests?

How reliable are hair alcohol tests? – Testing hair for alcohol abuse is one of the most accurate and reliable tests available. However, the results of a hair test can be affected by different hair treatments, and for this reason, we recommend combining the test with a secondary method, such as blood alcohol testing, in order to get the most accurate results.

Can isopropyl alcohol cause positive EtG?

What can cause a positive EtG test?

However, as with all testing, there are things providers should be aware of when considering the interpretation of their patients’ test results regarding alcohol findings.
Ethanol can be directly detected in all matrices offered by Aegis – blood, oral fluid, and urine – at a threshold of 10 mg/dL.
Ethanol is only detectable for up to 8 hours post ingestion, which is indicative of recent ingestion.

Ethanol.12 Heavy consumption of these “nonalcoholic” beers and wines can lead to EtG and EtS levels at or above the Aegis reporting threshold.11,13,14 Other fermented beverages such as kombucha, a drink consisting of tea, sugar, bacteria, and yeast, may have up to a 3% alcohol content despite being listed as a non-alcoholic beverage and may cause an unexpected positive result.15-17 Providers should also keep alcohol-containing medications in mind (prescription and over the counter ), which patients may not report using prior to their test.

While OTC medications are restricted to a maximum of 10% alcohol content, some prescription drugs may exceed this level.
If heavy medication use is suspected or known, or if the presence of alcohol metabolites conflicts with a patient’s treatment agreement, advise patients to use non-alcoholic formulations when possible.

NOTICE: The information above is intended as a resource for health care providers.
Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct.

Ethyl glucuronide as a biomarker for ethanol detection. Pharmacotherapy.2008;(6):769-81.3. Helander A, Beck O. Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake. J Anal Toxicol,2005;29(5):270-4.4. Crews B, West R, Gutierrez R, et al. An improved method of determining ethanol use in chronic pain population.

Clin Chem.2007;53(10):1885-7 7.
Valentine GW, Jatlow PI, Coffman M, Nadim H, Hueorguleva R, Sofuoglu M.
The effects of alcohol-containing e-cigarettes on young adult smokers.
Drug Alcohol Depend.2016;159:272-6.8.
Reisfield GM, Goldberger BA, Crews BO, et al.
Ethyl glucuronide, ethyl sulfate, and ethanol in urine after sustained exposure to an ethanol-based hand sanitizer.

Urine tested positive for ethyl glucuronide and ethyl sulfate after the consumption of yeast and sugar. Forensic Sci Int.2010;202(1-3):e45-7.11. Musshoff F, Albermann E, Madea B. Ethyl glucuronide and ethyl sulfate in urine after consumption of various beverages and foods-misleading results? Int J Legal Med.2010;124:623-30 12.U.S.

Accessed August 27, 2019.13.
Thierauf A, Gnann H, Wohlfarth A. et al.
Urine tested positive for ethyl glucuronide and ethyl sulphate after the consumption of “non-alcoholic” beer.
Forensic Sci Int.2010;202(1-3):82-5.14.
Hoiseth G, Yttredal B, Karinen R, Gjerde H, Christophersen A.
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