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Ethyl Glucuronide and Ethyl Sulfate

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are biomarkers of alcohol consumption and are used to monitor alcohol abstinence. Each metabolite represents less than 0.1% of the total metabolites of ethanol. They are detectable in urine within minutes of alcohol consumption and remain detectable for approximately three days.

Use of hand sanitizers or the ingestion of mouthwash or cough syrup containing alcohol can result in detectable levels of EtG and EtS. Hand sanitizers usually produce EtG levels less than 100 ng/mL. Mouthwash usually produces EtG levels between 100 and 300 ng/mL.

EtG can be either produced or degraded by bacteria. Bacterial beta-glucuronidase can degrade 50% of EtG within 24 hours after collection. EtS is neither produced nor degraded by bacteria. The presence of EtS increases the likelihood that the source of EtG was ethanol ingestion and not in vitro production.

Screening for EtG is performed by immunoassay. If the screening test is positive, confirmation of EtG and EtS is performed by liquid chromatograpy and tandem mass spectrometry. The screening threshold for EtG is 500 ng/mL. The confirmation cutoff for is 500 ng/mL for EtG and 250 ng/mL for EtS.

Specimen requirement is 20 mL of urine collected without preservatives. Specimen can be stored up to 7 days refrigerated.

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