Dr. Bill:

I drank a 7 glasses of red wine between 8:00 and 11:30 on Saturday evening. The alcohol content was 14.5% . I have to test Tuesday no later than 6:30, so that gives me 67 hours from last drink. I am 33 yrs old, 5'2, and weigh 115 lbs. I believe they use a cutoff of 100ng or 250ng. I have been in the program for seven months and have had one slip up and tested dilute. I consumed quiet a bit of water the morning that I tested and couldn't flush it out fast enough. I have consumed about 3 gallons of water over the past two days and ran 10 miles today. I am going to stop the waterloading tonight and stay hydrated, but not dilute. I have also been taking over the counter diuretic. I believe the name is Panadorm, I need to look on the box. I couldn't find it on the list of over the counter meds that are not allowed. I also plan on running another 10 miles tomorrow. I have also been taking milk thistle and green tea tablets. I have an aquaintence that stopped drinking because of liver enzymes and started taking milk thistle and their enzymes supposedly returned to normal and they drink socially again. I am in the program because of a physical addiction to xxanx, which I started under a doctors care and I was never winged off appropriately. I haven't had a problem once the physical symptoms went away with returning to that or having the desire. I made a really poor decision and the consequences are pretty significant. Do I have a chance of passing?

A glass of wine is 5 oz and a bottle of wine contains 25 oz. It's important to get the amount consumed entirely clear in order to have a starting quantity.

Also, you mentioned drinking once before and the sample being dilute... did it also report detecting EtG?

Stop the diuretic!

The sample that tested dilute in the past didn't test positive for ETG. If it did, it wasn't brought to my attention. I had drank once again red wine 48 hours prior (not as much) and got a surprise ETG. I have also had one sample come back positive when I didn't have anything to drink. It was sent off for confirmation and came back unconfirmed. This time I drank one bottle of wine containing 14.5% (5 drinks) more because of the alcohol content. Two glasses or less of red wine containing 14%. Will the diuretic cause problems with dilution or show up in the urine sample? Or is it just dangerous because of the physical ramifications?

Restatement. You drank 1 bottle + 2 glasses?

At 14.5% that would be 8.5 standard drinks (US) across 3.5 hours; 119 g of absolute alcohol and at your size 2.28 g/kg of body weight.

Despite that you will probably be clear at 67 hours although there is a chance of detection at that time span. The water accelerated clearance. Not sure about milk thistle but it didn't hurt anything.

I was wondering about the dilute sample because if EtG is detected in a dilute sample (5-19 mL creatinine) it can easily be calculated in ratio to creatinine (U100EtG). Usually if the analyte is present it will be noted dilute-positive.

Finally, alcohol is a diuretic and heavy drinking brings about dehydration. What you need is re-hydration.

Thank you so much for your reply. I was told that I didn't test positive for alcohol, but it was dilute. I panicked and made the mistake of drinking way too much water that morning. The sample that I left was completely clear. I had a headache and upset stomach from the water consumption. I didn't want to make the same mistake this time and test dilute hence the diuretic and plus I have read that it could possibly help in other post. I have consumed massive amounts of water, so I doubt that I am dehydrated. Is it safe to say, if the urine has slight yellow tint that I will not test dilute? I just want to make sure that I don't run that risk this time, but I am still hydrated. I greatly appreciate your help.

I will know if I passed this Friday and I will post the results.

Thank you so much for your reply. I was told that I didn't test positive for alcohol, but it was dilute. I panicked and made the mistake of drinking way too much water that morning. The sample that I left was completely clear. I had a headache and upset stomach from the water consumption. I didn't want to make the same mistake this time and test dilute hence the diuretic and plus I have read that it could possibly help in other post. I have consumed massive amounts of water, so I doubt that I am dehydrated. Is it safe to say, if the urine has slight yellow tint that I will not test dilute? I just want to make sure that I don't run that risk this time, but I am still hydrated. I greatly appreciate your help.

EtG is water soluble and fluid creates all of the impetus required for elimination. I recommend drinking plenty of water the day prior to and day of the test even to totally abstinent individuals in order to avoid false positives from incidental exposure. Just allow 3 hours and there is no chance of dilution nor of an overly concentrated urine (that magnifies EtG).

Please let us know how this turns out. But given your description would imagine you will be clear at that time span.

I am curious about one thing concerning concentrations of creatine and EtG. If the sample is in the range where it is not considered a dilute by the lab, but barely makes the cutoff for creatine levels and the EtG levels just barely register under the cutoff, does that mean you pass? In other words if your creatine levels were on the high side and you gave a highly concentrated sample and the EtG just registered over the cutoff, the lab would not adjust for the concentration and you would fail. Am I correct in my assumption that the labs do not take that into consideration for the most part?

Also, can the range in creatine levels that are allowed make a huge difference in EtG concentration.

Dr Bill,

One last question about EtG and the fact that it is water soluble. I ingested close to 30 lbs of water over the course of two and half days. That is close to 25% of my body weight. It would stand to reason that if no more EtG is being created after BAC is 0 and that you have a set amount that is being stored in your body that it would be subject to dilution through large amounts of water consumption. I would imagine that the saturation would reach the cells and tissues throughout the body and eventually be eliminated through urine. I still haven't found much information about the storage of ETG in the body and the rate of elimation compared to water consumption.

I am curious about one thing concerning concentrations of creatine and etg. If the sample is in the range where it is not considered a dilute by the lab, but barely makes the cutoff for creatine levels and the etg levels just barely register under the cutoff, does that mean you pass? In other words if your creatine levels were on the high side and you gave a highly concentrated sample and the etg just registered over the cutoff, the lab would not adjust for the concentration and you would fail. Am I correct in my assumption that the labs do not take that into consideration for the most part?

Labs usually list creatinine level on the test results but do not adjust the EtG reading (called normalizing). Anyone can make the calculation with both figures present but it is seldom done. Those administering or ordering the test usually have no knowledge of how to interpret results.

That is problematic as all research recommendations since 2003 are based on this normalization. Recommended cutoff levels, ranges within which incidental exposure show up, are all based on creatinine normalization. Yet the labs and those using the test continue to rely on actual quantity in reporting and despite the recommendations of SAMHSA, the agency that regulates federal drug testing.

Most labs consider any creatinine reading >19 mg normal without further qualification.

Here is an example of an individual reported positive for EtG at 876 ng/mL. Creatinine was reported at 375. Test cutoff was 500 ng/mL.

Actual quantity measured: 876
Normalized to creatinine: 234

The formula is very simple:

100/creatinine X quantity of EtG: 100/375 X 876 = 234

This individual is a total abstainer. Hasn't had a drink in 30 years, either reading is clearly within range expected from incidental exposure, but the MD reviewing the test cut off her pain medication for non-compliance.

According to Greg Skipper, MD* "Normal urine can vary up to 20 fold in concentration. The more concentrated urine will report 20 times higher EtG/EtS levels than more dilute." (http://etg.weebly.com/etgets-not-proof-of-drinking.html)

*Dr. Skipper introduced this test in the US. His site provides valuable information.

The Role of Biomarkers in the Treatment of Alcohol Use Disorders (http://kap.samhsa.gov/products/manuals/advisory/pdfs/Advisory_Biomarkers_Revision.pdf), 2012 Revision Spring 2012, Volume 11, Issue 2, Department of Health and Human Services.

Hallelujah!! I just got out of court and I passed. It was not worth the stress or the consequences. I did want to add that I calculated 10 drinks. Also, someone in the same program made a comment that they used a 500 cutoff. I am not sure because on one occasion I tested positive for low level alcohol and I had not drank. They sent it off for confirmation and it came back unconfirmed. I think they were trying to pressure me into admitting and the consequences are much greater if it is confirmed. I honestly don't see how accidental exposure could have put me at 500. Hopefully, I have eased a few minds of people that are already in a similar situation.