Measurement of ethyl glucuronide and ethyl sulfate in the urine can be used to monitor a patient for recent alcohol use. However, a number of factors must be taken into account when interpretting results from these tests.
Ethyl glucuronide is produced when ethanol is conjugated with glucuronide by UDP-glucuronosyltransferase (UGT) in the liver. This affects only a tiny fraction of an ingested dose of alcohol.
Ethyl sulfate is produced when ethanol is conjugated with sulfate by sulfotransferase.
Factor
Effect
urine dilution by excessive fluid intake
negative tests for the glucuronide and sulfate; reporting the result as a ratio to urine creatinine reduces false negatives
urine contamination with bacteria producing glucuronidase
degradation of ethyl glucuronide with false negative result; ethyl sulfate unaffected
urinary tract infection or urine overgrowth with yeast or bacteria
false positive for ethyl glucuronide; ethyl sulfate unaffected; this can be avoided by refrigerating the urine or adding a preservative
therapy with chloral hydrate
metabolite chloral hydrate glucuronide may be misidentified as ethyl glucuronide giving a false positive immunoassay
ingesting baker’s yeast
false positive tests for ethyl glucuronide and ethyl sulfate
drinking non-alcoholic beer
false positive tests for ethyl glucuronide and ethyl sulfate
drinking non-alcoholic wine
false positive test for ethyl sulfate
repeated use of alcohol hand sanitizer
false positive tests for ethyl glucuronide and ethyl sulfate
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