Local Computer Code = UETG

Preferred Sample Type

Ethyl Glucuronide (EtG) and Ethyl Sulphate (EtS)

Suitable Specimen Types

  • Plain Spot Urine
Minimum 0.1mL urine.

Specimen Transport

First class post from external laboratories.

Sample Processing in Laboratory

Only primary urine tubes accepted.

Sample Preparation


Turnaround Time

7 days

Sample Stability

Stable for 28 days at room temperature and 4°C.

Ethyl Glucuronide (EtG) and Ethyl Sulphate (EtS)

General Information

Ethyl glucuronide (EtG) and ethyl sulphate (EtS) are the end products of the non-oxidative metabolism of alcohol and account for <0.1% of overall alcohol metabolism. EtG and EtS appear in the urine at approximately 90-130 hours post elimination of alcohol and are deemed intermediate biomarkers of alcohol metabolism. EtG and EtS have high clinical sensitivity and can detect as little as a single drink enabling early detection of alcohol relapse in individuals who have previously abstained. Moreover, the concentration of EtG and EtS directly correlates with the degree of alcohol exposure and can indicate when binge drinking has occurred. EtG and EtS are non-volatile and water soluble improving their analytical stability compared to direct ethanol measurement.

This assay will be used primarily by the Hepatology department at UHB as part of a clinical decision tool to assess the suitability of patients for liver transplant. The utility of these markers as early indicators of relapse may therefore be used as a motivational tool to encourage patients to abstain from alcohol. The assay may also be used by external hospitals for similar purposes.

It is important to recognise the clinical limitations of EtG and EtS. These biomarkers will also reflect extraneous alcohol exposure e.g. from hygiene products and hand sanitisers etc. It has also been shown that EtS may be increased in patients taking Rifaximin, a broad-spectrum antibiotic used in the treatment of hepatic encephalopathy (Webzell et al 2020). This drug is used frequently amongst the cohort of patients in whom EtG and EtS will most likely be measured. 

Patient Preparation



Additional references: Substance Abuse and Mental Health Services Administration (SAMSHA) Advisory: The role of biomarkers in the treatment of alcohol use disorders, 2012 Revision. HHS; 2012;11(2):1-7. doi: 10.1037/e558582006-001

Reference Range

Internal Interpretation Guidance for Hepatologists

EtG <250 ng/mL - Negative result. No further action required.

EtG = 250-500 ng/mL (&EtS >100 ng/mL) - Low positive result. Result may indicate previous heavy drinking (i.e. 1-3 days), previous light drinking (i.e. 12-36 hours) or recent extraneous exposure e.g. hand-sanitisers, mouthwash. 

EtG = 500-1000 ng/mL (& EtS >100 ng/mL) - Positive result. Result may indicate previous heavy drinking (i.e. previous 1-3 days) or recent light drinking (i.e. past 24 hours).

EtG >1000 ng/mL (&EtS >100 ng/mL) - High positive result. Results may indicate heavy drinking on the same day or previously (i.e. previous day or two) or light drinking on the same day.

Due to Rifaximin interference on EtS, only EtG will be used to confirm positive cases of alcohol consumption at UHB.

Please refer to links below for further sources of information for interpretation and sources of positive interference.

Source of Reference Range

US SAMHSA Guidance 2012 and Mayo Clinic Laboratories (adapted for use at UHB)


  • EQA Scheme?: Yes
  • EQA Status: LGC Drugs of abuse in urine

The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database: http://www.heftpathology.com/frontpage/test-database.html.

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235