Ask Me Help Desk - I need help reading an EtG alcohol test results

And ethyllgucuronide (ETG) > 10,000 ng/ml
Ethyl sulfate (ETS) (4690 ng/ml)
Creatine 93.7 mg/dl
What do these results on a EtG alcohol test with reslts of Ethyl Glucuronide detected with a 100 ng/ml cutoff mean?

EtG and EtS are created from alcohol (EtOH) and creatinine is measured, in this instance, to assess sample validity. The creatinine is in normal range (>20).

Creatinine can also be used to normalize EtG/EtS but in this instance that would cause the reading to be even higher.

Did this involve drinking in proximity to the test?

The readings aren't terribly high but nonetheless it will be interpreted as alcohol consumption... higher than would be expected from incidental exposure. It's interesting that EtG isn't directly quantitated (just >10000). The EtS reading would indicate EtG closer to 20000.

The fact that the amounts are shown (quantitated) discloses that this was a confirmatory test which means EtG was detected at the screening level (immunoassay) and then confirmed by a more precise method.

Yes EtG detected by LC/MS/MS
And ets detected by LC/MS/MS (4690 ng/ml)
Is this positive proof that alcohol was consumed?

Quote:

Originally Posted by kennyb64

yes etg detected by LC/MS/MS
and ets detected by LC/MS/MS (4690 ng/ml)
is this positive proof that alcohol was consumed?

No. EtG should never be used as proof of drinking even though it often is in a forensic setting.

Here is a link to Dr Greg Skipper's website. Just click on the blue highlighted section and that explains how the test should be utilized.

Ethylglucuronide by Skipper.

Also, see the following:

NOTICE: Any person or entity that is subjected to or relies on EtG testing should read this Advisory issued by the US Department of Health and Human Services, September 2006 and remains in effect as of date of this posting. Copy available here > US DHHS Advisory

I want to thank you Dr. Bill. I read both articles that you suggested, and acquired very pertinent information that I had been searching for hours to find. In particular, the US DHHS Advisory site provided me with information that I intend to use in court on July 2nd if necessary. I received a false positive last week for 5/21, where I was volunteering on a blood drive and was exposed to both fumes of rubbing alcohol and anti-bacterial hand sanitizer. I knew that I had obstained from the usage of alcohol, but was not able to give a concrete explanation to my probation officer, who said he was recommending another 24 hours of community service to the court. The false positive had a negative impact on me, most of all because it had the appearance that I had been lying to my AA and NA groups, my primary care doctor, psychiatrist, therapist, and probation officer. I not only found out what caused the false positive, but I also found out that a CtG or CtS test should not be used alone; accusing someone of using when they haven't, was also covered in the article, how it can lead to a relapse, which I admit I contemplated. Having been to jail, is it really worth risking your freedom? I don't intend on using again, especially while on probation, and afterwards because my next DUI will be a felony.

Quote:

Originally Posted by Snakette

I want to thank you Dr. Bill. I read both articles that you suggested, and acquired very pertinent information that I had been searching for hours to find. In particular, the US DHHS Advisory site provided me with information that I intend to use in court on July 2nd if necessary. I received a false positive last week for 5/21, where I was volunteering on a blood drive and was exposed to both fumes of rubbing alcohol and anti-bacterial hand sanitizer. I knew that I had obstained from the usage of alcohol, but was not able to give a concrete explanation to my probation officer, who said he was recommending another 24 hours of community service to the court. The false positive had a negative impact on me .....

Here is another rich morsel of information for you. EtG is unstable in the urine sample and may increase or decrease in the container post-collection. That may not be particularly compelling in your case because EtS does not suffer that result (or so it is currently claimed).

When reading this result remember that all samples sent to the lab are unrefrigerated. This study alone negates any value or validity to EtG testing. That is one reason these results remain unpublished in any professional journal or public article.

Is it your contention that the readings above resulted from incidental exposure?

Do not rely upon exposure to rubbing alcohol unless it is ethanol based. Isopropanol will not result in EtG/EtS synthesis. Rubbing alcohol could be either. If ethanol based it is very high content >70% and that is pure alcohol Comparing to whiskey that would be 140 proof.

O-3. Sumandeep Rana, Wayne Ross, Redwood Toxicology Laboratory. Incidence of post-collection synthesis and hydrolysis of ethyl glucuronide (EtG) and ethyl sulfate (EtS) in random unpreserved urine specimens

EtG level 2000? That's all they would tell me what does this mean? How many drinks are they saying I've "had" because I know I did not drink and this is bull.