Rule out alcohol intake resumption

Q: 48 years old male with past history of alcohol abuse but is in remission for the last few months brought to ER with change in mental status. Wife insists that the patient is sober and very compliant with his rehab program in the last 4 months. Which of the following tests can best determine a patient's compliance with alcohol abstinence? - select one

A) Urine ethyl glucuronide 

B) Phosphatidylethanol testing

C) Carbohydrate-deficient transferrin

D) Gamma-glutamyl-transferase

E) Simple Urine toxicology screen 

Answer: B

Many tests have been suggested to rule out mental status change in patients with history of past alcohol abuse who are now in a sober state, but clinicians need to rule out the resumption of binge drinking.

Phosphatidylethanol testing (choice B) is a whole blood аlсоhоl biomarker and is highly specific for recent аlсоhοl use over the preceding two to three weeks.

Urine ethyl glucuronide (choice A), though may pick recent consumption, false positives are common due to other exposures to аlсоhol like hand sanitizer or other sources where alcohol is commonly mixed, such as many over-the-counter medicines/syrups.

Carbohydrate deficient transferrin (choice C) is a good test to detect a change in heavy drinking with a decrease in level, which correlates with a decrease in regular heavy drinking.

Gamma-glutamyl transferase (choice D) is similar to carbohydrate-deficient transferrin but is nonspecific, though cheaper.

Urine toxicology (choice E) can only detect recent use (within the last 72 hours). Also, it cannot distinguish between heavy and light use.

#toxicology

References:

1. Andresen-Streichert H, Müller A, Glahn A, et al. Alcohol Biomarkers in Clinical and Forensic Contexts. Dtsch Arztebl Int 2018; 115:309.

2. Woźniak MK, Wiergowski M, Namieśnik J, Biziuk M. Biomarkers of Alcohol Consumption in Body Fluids - Possibilities and Limitations of Application in Toxicological Analysis. Curr Med Chem 2019; 26:177.

3. Helander A, Hermansson U, Beck O. Dose-Response Characteristics of the Alcohol Biomarker Phosphatidylethanol (PEth)-A Study of Outpatients in Treatment for Reduced Drinking. Alcohol Alcohol 2019; 54:567.