PeaceHealth Laboratories
February 2012
Physician Update
New Urine Ethanol (Alcohol) Markers Available –
Ethyl Glucuronide and Ethyl Sulfate
what’s new?
Effective Wednesday, March 7, 2012, two new
urine ethanol markers will be available from
PeaceHealth Laboratories as quantitative tests by
HPLC/MS/MS to directly identify and measure
the concentration of ethyl glucuronide (EtG) and
ethyl sulfate (EtS).
BENEFITs
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Identifying alcohol use is especially
important when treating patients
requiring chronic opioid or sedative
therapy. Alcohol use can increase the
risk of serious adverse drug reactions in
these patients.
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While using traditional urine tests to
detect alcohol is limited to less than 12
hours after use, urine ethyl glucuronide
(EtG) and ethyl sulfate (EtS) can be
detected up to several days following
moderate to excessive consumption of
alcoholic beverages.
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The test’s interpretation will indicate the
potential source of EtG and EtS,
including potential interferences.
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Available as an add-on test to any
These markers have an extended detection time
of up to 80 hours following moderate to excessive
alcohol beverage consumption compared to the
common urine ethanol test that detects ethanol
for less than 12 hours.
Urine EtG and EtS are direct alcohol markers that
are more effective to document abstinence, detect
relapse and deter drinking in your patients.
A very small fraction (< 0.1%) of ingested ethanol
is conjugated in the liver to produce EtG and EtS,
catalyzed by uridine diphosphate-glucuronosyltransferase and sulfotransferase, respectively. EtG
and EtS are excreted mainly in the urine.
This testing is not intended for use in forensic
investigations and is not recommended for
employment testing.
Reference Range
Ethyl glucuronide
< 500 ng/mL
Ethyl sulfate
< 200 ng/mL
The cutoff levels for EtG and EtS were carefully
selected to reduce the likelihood of false positives
due to incidental exposure, as can happen with a
very low detection limit. Interpretive comments
on reports will indicate if the result is consistent
with ethanol ingestion or if the result indicates
potential interferences.
PtProtect Pain Management Panel.
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Consultation on test results is available
from board-certified toxicologists.
continued on next page
800-826-3616 www.peacehealthlabs.org
PeaceHealth Laboratories
Incidental Exposure
Incidental exposure to ethanol can occur from
many sources since ethanol is common in many
available products. Ethanol is used in cooking,
hygiene products, antibacterial hand gels,
perfumes, bug spray, gasohol, communion wine,
wine vinegar, soy sauce, as a solvent in over-thecounter medications and in many other sources.
Effect of Urinary Tract Infections on
EtG and EtS
The effect of E. coli urinary tract infections
on EtG and EtS is shown in Table 3.
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E. coli urinary tract infection (UTI) may
cause degradation of EtG (false-negative result) but does not affect EtS.
Individuals being monitored using EtG/EtS
should be warned to avoid all sources of ethanol
including foods containing ethanol, ethanol
based mouthwash, over-the-counter medications
containing ethanol, and vapors from any products
for topical use that contain ethanol. There is currently no known reference range that can reliably
distinguish between all possible
incidental exposure to ethanol and beverage
ethanol consumption.
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Effect of Ethanol Containing “NonAlcoholic” Beverages on EtG and EtS
The effect on test results for EtG and EtS
when patients consume “non-alcoholic”*
beverages in large quantities is shown in
Table 1.
Grant Beardsley, MS, MT(ASCP), NRCC/TC
Manager, Drug Testing Services,
Clinical Toxicologist
Y 541-687-2134 ext. 8137
Y 800-826-3616 ext. 8137
[email protected]
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E. coli UTI with ethanol, or E. coli UTI with
yeast and glucose may cause positive EtG but not a positive EtS.
QUESTIONS?
Stephen Erfurth, PhD, DABCC, DABCC/TC
Director of Science and Technology
Y 541-341-8092
Y 800-826-3616 ext. 8092
[email protected]
“Non-alcoholic” beer (2.5 L) may cause a
positive EtG and a positive EtS.
“Non-alcoholic” wine (750 mL) may cause a
positive EtS but not a positive EtG.
Effect of Exposure to Ethanol Containing
Products on EtG and EtS
Table 2 lists the effects of the following
products on EtG and EtS.
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Mouthwash
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Hand sanitizers
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Baker’s yeast and sucrose
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Brewer’s yeast and sucrose
*“non-alcoholic” beer and “non-alcoholic” wine may contain ethanol at
approximately 0.40% and 0.20%, respectively, which may cause a positive
EtG and/or EtS test result.
Table 1 – Effect of Ethanol Containing Beverages on EtG and EtS
EtG (Ethyl Glucuronide)
Reference Range < 500 ng/mL
EtS (Ethyl Sulfate)
Reference Range < 200 ng/mL
Average duration of EtG/EtS above
reference range following one alcoholic
beverage
20.6 hrs.
21.2 hrs.
Will ingestion of large amounts of “nonalcoholic” beer (2.5 L) produce a result
above the reference range?
Yes
Yes
Will ingestion of large amounts of “nonalcoholic” wine (750 mL) produce results
above the reference range?
No
Yes
Condition / Characteristic
Table 2 – Effect of Exposure to Ethanol Containing Products on EtG and EtS
Condition / Characteristic
EtG (Ethyl Glucuronide)
Reference Range < 500 ng/mL
EtS (Ethyl Sulfate)
Reference Range < 200 ng/mL
Will intense exposure to mouthwash with
high ethanol content produce a result
above the reference range?
No
No
Will the intense use of hand sanitizer
containing ethanol produce a result
above the reference range?
Yes
No
Will ingesting Baker’s yeast and sucrose
together produce a result above the
reference range?
No
Yes
Will ingesting Brewer’s yeast and
sucrose produce a result above the
reference range?
No
No
Table 3 – Effect of Urinary Tract Infections* on EtG and EtS
EtG (Ethyl Glucuronide)
Reference Range < 500 ng/mL
EtS (Ethyl Sulfate)
Reference Range < 200 ng/mL
Yes
(could cause a false-negative result)
No
Will in-vitro synthesis of EtG/EtS in
presence of E. coli and ethanol cause the
result to be above the reference range?
Yes
No
Will in-vitro synthesis of EtG/EtS in
presence of E. coli, fermenting yeast and
glucose cause the result to be above the
reference range?
Yes
No
Condition / Characteristic
In the presence of E. coli from a UTI,
could the result be lower due to
degradation of EtG or EtS?
*UTI = urinary tract infection or E. coli contamination of urine.
continued on back
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PeaceHealth Laboratories
ORDERING INFORMATION
36980Urine Ethanol
Ethyl Glucuronide/Ethyl
Sulfate, UR Available –
New
(Alcohol) Markers
Methodology:
High-Performance Liquid Chromatography/Tandem Mass Spectrometry Ethyl
Glucuronide
and Ethyl Sulfate (Continued)
(HPLC/MS/MS)
Performed:
Monday, Wednesday, Friday
Released:
Less than 72 hours
CPT Code:
82055 x 2
SPECIMEN REQUIREMENTS
Collect:
Random urine in a clean, dry plastic container
Handling:
Specimen stable ambient; refrigerate if specimen will not reach testing
laboratory within 7 days of collection.
Stability:
Ambient:
Refrigerated:
Frozen:
Transport:
Ambient or refrigerated
Standard Volume:
30 mL urine
Minimum Volume:
10 mL urine
Rejection Criteria:
Insufficient quantity, unlabeled or mislabeled specimen, or delayed transport
Retention:
12 months
Comments:
500 ng/mL Ethyl Glucuronide (EtG) threshold/cutoff; 200 ng/mL Ethyl Sulfate (EtS) threshold/cutoff. Interpretation provided with each specimen result.
7 days
4 weeks
6 months
References
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Thierauf, Annette et al: Urine tested positive for ethyl glucuronide and ethyl sulfate after the consumption of “nonalcoholic” beer, Forensic Science International, 202, 2010, 82-85.
Hoiseth, Gudrun et al: Levels of Ethyl Glucuronide and Ethyl Sulfate in Oral Fluid, Blood, and Urine After Use of Mouthwash
and Ingestion of Nonalcoholic Wine, J of Analytical Toxicology, Vol. 34, March 2010, 84-88.
Reisfield, Gary M et al: Ethyl Glucuronide, Ethyl Sulfate, and Ethanol in Urine after Intensive Exposure to High Ethanol
Content Mouthwash, J of Analytical Toxicology, Vol. 35, June 2011, 264-268.
Reisfield, Gary M et al: Ethyl Glucuronide, Ethyl Sulfate, and Ethanol in Urine after Sustained Exposure to an Ethanol-Based
Hand Sanitizer, J of Analytical Toxicology, Vol. 35, March 2011, 85-91.
Thierauf, Annette et al: Urine tested positive for Ethyl Glucuronide and ethyl sulfate after the consumption of yeast and
sugar, Forensic Science International, 202,2010, e45-e47.
Helander, Anders et al: Postcollection Synthesis of Ethyl Glucuronide by Bacteria in Urine May Cause False Identification of
Alcohol Consumption, Clinical Chemistry, 53, No. 10, 2007, 1855-1857.
Helander, Anders and Dahl, Helen: Urinary Tract Infection: A Risk Factor for False-Negative Urinary Ethyl Glucuronide but
Not Ethyl Sulfate in the Detection of Recent Alcohol Consumption, Clinical Chemistry, 51, No. 9, 2005, 1728-1730.
Helander, Anders and Beck, Olof, Clinical Chemistry, 50, No. 5, 2004, 936-937.
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800-826-3616 www.peacehealthlabs.org
022712 |
© 2012 PeaceHealth Laboratories