How Long Can Alcohol Be Detected in Urine EtG Testing?

Alcohol consumption can leave traces in your body. EtG testing is one of the most sensitive tests for detecting traces of alcohol. EtG stands for ethyl glucuronide, which is a direct metabolite or by-product of alcohol or ethanol. So unlike traditional alcohol tests that only detect the most recent use, EtG testing offers a wider window to monitor alcohol intake. When you face a court-ordered test, workplace screening, or medical evaluation for any treatment, understanding what this test is will help you navigate these situations to ensure accuracy of the information.

In this post, you will learn more about what EtG is, what it is used for, and how long it can be detected in the urine.

Key Takeaways

• EtG is a sensitive test, which is more sensitive than standard ethanol urine tests, which can detect only until 12 hours

• EtG testing can detect alcohol consumption for 24-72 hours in most cases

• EtG stands for ethyl glucuronide, which is a metabolite when alcohol is being metabolized by the body

• Higher cutoff levels at 500 ng/mL may be more specific but may miss lighter drinking

• Lower cutoff levels at 100 ng/mL may detect smaller amounts but may be affected by incidental or unintentional alcohol exposures

• EtG testing is being used in various settings including the medical and legal where monitoring abstinence is required

• EtG elimination is affected by the individual’s hydration status, metabolism, and degree of exposure

• Non-beverage-related exposures like mouthwash and hand sanitizers may cause low-level positive results

What is an EtG Test and How Does it Work?

EtG is a metabolite that is the direct product of alcohol metabolism. So the presence of this metabolite can infer recent ethanol ingestion. It can be detected after 80 hours of post-alcohol consumption. This means that it remains in the body long after ethanol itself.

This makes EtG testing very valuable for monitoring abstinence or recent circumstances for clinical, legal, and treatment. The detection window may depend on several factors, like:

• Amount of alcohol consumed

• Metabolism of each individual

• Test sensitivity

The EtG test is specialized unlike the standard breathalyzers or blood tests that directly detect alcohol. 

What is Ethyl Glucuronide (EtG) and How is it Formed?

EtG is a direct metabolite of ethanol, as previously mentioned, which forms in the liver when you consume alcoholic beverages. Alcohol gets metabolized in the liver 90% of the time.

During the process of breaking down the alcohol, a small portion of it undergoes a process called glucuronidation, which is a process of combining alcohol with glucuronic acid so it forms EtG. The substance travels via bloodstream and gets filtered out by the kidneys, where it gets excreted in the urine.

So even when the alcohol has been out of your system, the EtG can still be detected. Your liver is the organ that becomes a chemical processing unit, which transforms a substance into its byproducts. The processing of these substances is important so the body can eliminate the toxins easily.

How Are EtG Tests Conducted?

EtG testing is straightforward but it is a carefully controlled process, so the results are accurate. When you arrive for testing, you will be given a collection container where you will collect the urine sample. The process is typically under supervision to prevent tampering of the sample.

More often the collection facility maintains a strict chain-of-custody protocol. This means that all persons who handle your sample are documented.

Once the sample is collected, it will be brought to the laboratory where technicians have sophisticated equipment. The equipment is called liquid chromatography-mass spectrometry (LC-MS) to analyze the sample. The LC-MS separates specific molecules so it can detect EtG in the urine.

The analysis takes about hours, about 24-48, before the results become available for you or the requesting organization. The lab report will indicate whether the EtG is present above the established cut-off. However, the result would only indicate positive or negative.

How Long Can Alcohol Be Detected in Urine EtG Testing?

The window to detect urine EtG depends significantly on several factors. Most people fall within predictable timeframes. These detection periods are important to understand because it will help you make informed decisions regarding alcohol consumption if testing is required.

What is the Standard Detection Window for EtG in Urine?

Most individuals had a detection window in urine for approximately 24-72 hours after drinking alcohol. This timeframe is typical for most, in which standard EtG tests can detect alcohol metabolites in the urine. However, it can even be detected until 80 hours after heavy and binge-drinking.

However, the exact duration that the metabolite is excreted in the urine is dependent on the amount of alcohol you drank.

For example, a single beer might be detectable only for 24 hours. But having several drinks can extend the detection period for 72 hours. So even when you have a weekend drinking session with your friends, it may be detectable on a Tuesday’s random EtG testing at your workplace.

Why EtG Can Be Detected Longer During Heavy Drinking?

People who binge drink typically have a longer detection window for EtG. This extended detection period primarily results from several things:

• Significantly higher amount of alcohol consumed in a short timeframe leading to increased quantities of alcohol to be processed by the liver. As a result it produces increased levels of EtG.

• Saturation of the body’s metabolic pathways (which basically just means that the body’s way of processing has already been saturated). Normally, alcohol is processed efficiently by the liver enzymes. But binge drinking increases the amount that should be processed. This quickly overwhelms this processing pathway, which reduces the efficiency of the body to process the alcohol and slows down the time. It ultimately results in an increased level of EtG, hence it remains detectable in the body longer than it would for most people.

• Accumulation of alcohol is another reason, which makes it deposited to tissues like liver, muscle, and fat. These tissues act as reservoirs, which slowly release EtG back into the blood even after alcohol consumption. This prolongs the detection time of the substance in the urine.

• Binge drinking also results in dehydration, which further increases the concentration of EtG in your urine. The dehydration-induced concentration prolongs the period of detection by urine tests.

Because of these combined factors, the detection window for EtG in urine after binge drinking extends beyond what it’s supposed to during moderate drinking.

Is the ETG Test Accurate, and What are the Chances of False Positives?

EtG testing offers remarkable sensitivity for alcohol detection. But this sensitivity comes with important considerations with regards to interpretation and accuracy. The understanding of this basic concept — potential for false results — which helps both the technicians and test subjects make informed decisions.

The sensitivity of the test varies according to the cutoff thresholds established testing facilities. Testing facilities that use lower cutoffs (around 100-200 ng/mL) can detect even small amounts of EtG. But lowering the sensitivity can increase the risk of false positives from incidental alcohol. Conversely, tests that use 500 ng/mL as cutoff can decrease the risk of false positives while identifying intentional drinking.

But you need to understand that there is no single laboratory test that’s 100% accurate. False results are still risks even when the test has a high sensitivity.

There will be cases of false negative results:

• If the samples are tested too long after drinking (more than the 80-hour maximum period)

• If the alcohol consumed was insufficient to produce detectable EtG levels

• Tampering attempts, like addition of chemicals. Although modern testing facilities are now able to determine tampered samples

Can Non-Alcoholic Sources Cause a Positive EtG Test?

It is a legitimate question as to whether substances other than alcohol can test positive in EtG testing. The test’s remarkable sensitivity has prompted this concern. So significant research has been conducted to show any incidents of unintentional positive EtG testing.

True enough, incidental exposures with alcohol-containing substances, such as topical hand sanitizers and mouth wash, can result in false positive reports. Frequent use of ethanol-based products, which may contain 60-65% ethanol, can produce a positive EtG test result. Health care workers, for example, with ethanol exposures like this, but denied having consumed alcohol, have shown to be positive in EtG testing with a level as high as 770 ng/mL following repeated exposures in a day.

There are also reports of false positive EtG testing using propanol-based hand sanitizers through immunoassays (a form of laboratory test) without drinking alcohol.

One study reported that inhalation of ethanol vapor led to a detectable EtG at 124 ng/mL following exposure. Concentrated or occupational exposure to ethanol vapor — that is in the industrial settings — can lead to absorption of the alcohol via the lungs. However, typical workplaces are highly unlikely to trigger false positive results.

Ethanol in medications or foods, such as cough syrups or fermented dishes, may contribute to low-level detection of EtG. Therefore, the updated regulation has recommended that clinical correlation is always important. One of the reasons cited is that the cutoff for intentional vs incidental exposure for alcohol has not been determined yet due to various factors including, but not limited to:

• Amount of “incidental exposure”

• Metabolism of each individual

• Degree of hydration

• Kidney function

False positive EtG testing can also happen through bacterial degradation by E. coli and by high levels of glucuronidase in bacterial UTI (urinary tract infection), kidney disease, and even bladder cancer. It may even occur with in vitro (within the body) bacterial conjugation of glucuronide with ethanol.

Confirmatory testing is, therefore, warranted so as to safeguard against false claims regarding incidental exposure. When the initial screening yields a positive result, many clinical laboratories require secondary analysis using more specific methods in an attempt to differentiate significant alcohol consumption from incidental or unintentional exposures.

What are the Applications of EtG Tests in Legal and Medical Contexts?

The applications of EtG tests in legal and medical contexts are diverse (although caution still must be exercised in interpreting the results).

Legal Applications

• Probation and parole monitoring. Courts often use EtG testing to ensure that individuals under parole or probation comply with alcohol abstinence conditions, especially in cases of driving under influence (DUI)

• Family law and child custody cases. In family disputes citing alcohol use and abuse as an instigating circumstance or in cases where alcohol use can affect child welfare, EtG testing is used as an influencing factor in court decisions.

• Workplace and employment testing. EtG testing is often employed in safety-sensitive jobs like aviation and transportation industries.

• Forensic and court evidence. Legal proceedings due to alcohol abstinence may require EtG testing for claims and disputes. Although in these cases, courts usually employ confirmatory tests due to false positive results in incidental exposures.

Medical Applications

• Monitoring in alcohol abstinence programs. EtG testing is widely used in alcohol and drug rehabilitation centers to verify patient compliance with abstinence.  EtG tests can detect alcohol for up to 72-80 hours maximum. Unlike traditional alcohol testing like the blood or breath, which only detects up to 10-12 hours after the last drink.

• Pre- and post-liver transplantation. EtG tests help verify patients’ abstinence as a preparation for liver transplantation. In the same manner, it is also used post-liver transplantation for monitoring to ensure graft health.

• Substance use disorders monitoring. EtG tests help in covert monitoring of patients under the recovery program for substance use disorders. It offers a better picture of alcohol use than self-reporting or breath analyzers.

• Cardiovascular and epidemiological research. EtG testing also offers support to scientific research, which attempts to find the correlation between alcohol use and risks for cardiovascular (heart) disease. It would serve as a biomarker for research.

One study found that 93% of self-reported abstinence had EtG concentration of less than 100 ng/mL. The study was adjusted for renal function, age, and sex. This study had been pivotal in providing insights as to the difference between incidental and intentional ingestion of alcohol.

Nonetheless, like mentioned previously, it is important to always practice caution when interpreting results.

Where Can I Get an EtG Test?

The demand for EtG testing has increased in various sectors. Hence, its availability became straightforward. Multiple options exist depending on the specific situation and testing requirements.

Medical laboratories and diagnostic centers offer EtG testing and are the most common access points for individualized testing. There are even facilities that offer testing even without physician or government request. These facilities have maintained their own collection protocols and use certified equipment to ensure reliable results.

You can check with your local healthcare systems, such as:

• Hospitals

• Urgent care facilities

• Addiction rehabilitation programs

Often, these medical facilities provide EtG testing as part of their expanded health assessments rather than standalone services.

There are also specialized testing centers focusing primarily on alcohol and drug screening emerging in many communities. Usually, these centers cater to employment screening or individuals seeking confidentiality in their testing.

For court-ordered testing, there have been pre-approved centers or facilities that will cater to this, which are designated by the legal authority requiring such tests. These facilities may include:

• Probation offices

• Contracted private facilities

• Courthouse testing centers

These facilities have met law-required chain of custody practices in order to admit the results in legal proceedings. Individuals under the court-ordered EtG testing should verify approved testing locations with their probation officers or legal representatives to ensure compliance with specific court requirements.

Conclusion

EtG testing may have remained controversial since its advent due to lack of consensus when it comes to cutoff. The cutoff is determined on individual metabolism, degree of exposure, hydration status, and the health of the kidneys. Caution must be exercised when interpreting the result as it would result in unnecessary imposition of punishments that may lead to unemployment. However, studies have still been going on regarding the usefulness of EtG testing in various settings.

Alcohol has always been one of the culprits for damaging liver health. Whether you require EtG testing or not, you should always safeguard your liver from the damaging effects of alcohol. Try a Ribbon Checkup kit for liver health monitoring today!

Frequently Asked Questions

Can EtG tests detect one beer?

Yes. EtG tests can detect even a single beer for 24-48 hours especially with lower cutoff levels at 100 ng/mL. Beyond this period, the detection becomes less reliable.

Will water dilute EtG in urine?

No. Water neither dilutes EtG in the urine nor accelerates its elimination. EtG elimination is determined by your metabolism, not by water consumption.

Does EtG show up in regular drug tests?

No. Regular drug panels do not include EtG as a biomarker. EtG has its own specific test that’s designed specifically to detect the presence of EtG as a metabolite. For comprehensive panels, however, it may include EtG but it is not included on standard drug screening.

 

Written by Jaclyn P. Leyson-Azuela, RMT, MD, MPH
Jaclyn P. Leyson-Azuela, RMT, MD, MPH, is a licensed General Practitioner and Public Health Expert. She currently serves as a physician in private practice, combining clinical care with her passion for preventive health and community wellness.

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