Fm. Wurst et al., Ethyl glucuronide - A marker of alcohol consumption and a relapse marker with clinical and forensic implications, ALC ALCOHOL, 34(1), 1999, pp. 71-77
Ethyl glucuronide (EtG) is a non-volatile, water-soluble, direct metabolite
of ethanol that can be detected in body fluids and hair. We investigated u
rine and serum samples from three patient groups: (1) 33 in-patients in acu
te alcohol withdrawal; (2) 30 detoxified in-patients (treated for at least
4 weeks) from a 'motivation station' and (3) 43 neuro-rehabilitation patien
ts (non-alcoholics; most of them suffering from stroke, traumatic brain inj
ury, Parkinson's disease etc.) using gas chromatography/ mass spectrometry
(GC/MS) with deuterium-labelled EtG as the internal standard and additional
ly in the second group of patients using liquid chromatography (LC/MS-MS).
We found no correlation between the concentration of EtG in urine at hospit
alization 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 routi
ne 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-rehabilitat
ion patients using GC/MS. The GC/MS and the LC/MS-MS results showed a corre
lation of 0.98 with Pearson's correlation test and 1.0 with Spearman's corr
elation test. We suggest that EtG is a marker of alcohol consumption that c
an be detected for an extended time period after the complete elimination o
f 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 a
nd sensitivity exceed those of all other known ethanol markers.