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Alcohol Metabolites with Confirmation, Urine

Test Code

90418

CPT Code(s)

80101

Includes

If EtG/EtS Screen is positive or equivocal, confirmation testing will be performed at an additional charge (CPT code(s): 83789).

Preferred Specimen(s)

1 mL random urine

Minimum Volume

0.5 mL

Collection Instructions

Avoid contact with ethanol, disinfectants, swabs

Transport Container

Plastic urine container

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 7 days
Refrigerated: 7 days
Frozen: 30 days

Reject Criteria

Preserved specimens

Methodology

Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)

Performing Laboratory

Quest Diagnostics Nichols Institute
27027 Tourney Road
Valencia, CA 91355-5386

Reference Range(s)

Alcohol Metabolites <500 ng/mL
  Ethyl Glucuronide <500 ng/mL
  Ethyl Sulfate <100 ng/mL
Please note: These results are for medical treatment only. Analysis was performed as non-forensic testing.

Clinical Significance

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are metabolites of ethanol. While EtG has been used as a long-term biomarker in urine testing for more than 7 years, EtS has more recently been incorporated into testing programs. Scientific literature indicates that EtG may be detectable for up to 80 hours and that EtS may be detectable for 24 hours or more after ethanol ingestion-depending on cutoff, metabolism, and usage patterns.
EtG is subject to degradation by certain bacteria at room temperature. The published studies to date - corroborated by Quest Diagnostics' internal studies - have shown EtS to be more stable than EtG. As a result of the potential for unstable EtG levels in urine subjected to prolonged storage at room temperature, Quest Diagnostics recommends that specimens submitted for EtG testing be received by the laboratory within 3-5 days of specimen collection.
Under certain conditions, in-vitro (outside of the body, in the specimen container) formation of EtG may also occur when certain bacteria and ethanol or ethanol-producing bacteria are both present in a urine specimen. No published reports of in-vitro synthesis of EtS exist, however, even under the same conditions in which EtG may be synthesized in-vitro.
A recent limited study provides support for the use of EtS testing as a method of distinguishing EtG results caused by ethanol consumption from dermal exposure to ethanol. EtS concentrations in that study, in both raw and corrected concentrations, did not exceed 100 ng/mL after repeated dermal exposure to ethanol.
Since March 2009, Quest Diagnostics has included testing for EtS in conjunction with EtG confirmation testing to maximize the benefits of both the sensitivity of EtG testing and the apparent stability of EtS as a separate long-term ethanol metabolite.
EtS is typically present in urine at a lower concentration than EtG, although the ratio of EtG to EtS varies significantly between individual donors. In order to be reported positive for EtG, Quest Diagnostics' reporting criteria require that EtS be present in a specimen at a minimum concentration of 50 ng/mL whenever EtG is present at a concentration greater than or equal to 500 ng/mL.
As with EtG, the presence of EtS in a urine specimen does not establish the source of the ethanol containing product and the possibility of "incidental exposure" and post-collection specimen changes needs to be considered when interpreting results. EtG and EtS testing, as with any controlled substance testing, measure only the presence and concentration of EtG (or EtS) in a given urine specimen. Quest Diagnostics recommends clinical correlation and/or MRO review when interpreting EtG and EtS results.

Alternative Name(s)

ETG

LOINC®' Code(s)

The Result and LOINC information listed below should not be used for electronic interface maintenance with Quest Diagnostics. Please contact the Quest Diagnostics Connectivity Help Desk for more information at 800-697-9302.

NOTE: The codes listed in the table below are not orderable Test Codes.

Result
Code
Result NameLOINC CodeComponent Name
84999990PLEASE NOTE:8262-8Service comment 02
86007755ALCOHOL METABOLITES55349-5Ethyl glucuronide
86007756ETHYL GLUCURONIDE45324-1Ethyl glucuronide
86007757ETHYL SULFATE60676-4Ethyl sulfate

Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

LOINC assignment is based on a combination of test attributes, including the method used by the performing laboratory. For tests not performed by Quest Diagnostics, codes are assigned by the performing laboratory.

* The tests listed by specialist are a select group of tests offered. For a complete list of Quest Diagnostics tests, please refer to our Directory of Services.