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Alcohol Metabolites with Confirmation, Urine
- Ordering Info
If EtG/EtS Screen is positive or equivocal, confirmation testing will be performed at an additional charge (CPT code(s): 83789).
Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
|Alcohol Metabolites||<500 ng/mL|
|Ethyl Glucuronide||<500 ng/mL|
|Ethyl Sulfate||<100 ng/mL|
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.
To view specimen requirements and codes please Select a regional laboratory.
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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.
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