Hair ethyl glucuronide levels as a marker for alcohol use and abuse: a review of the current state of the art.
BACKGROUND
Ethyl glucuronide (EtG) is a minor alcohol metabolite that has been proposed as a stable marker in hair to detect and quantify alcohol consumption over long time periods.


METHODS
We provide an outline of currently available techniques for EtG hair sample analysis and highlight the pitfalls related to data interpretation. The literature of EtG analysis has been reviewed from January 1980 up to August 2013. In addition, we present an overview of the clinical and forensic studies which have used EtG quantification in hair as a marker for alcohol consumption/abstinence and we provide suggestions for future research.


RESULTS
EtG is a stable marker in hair that can be used to detect and quantify alcohol consumption over long time periods. This alcohol metabolite remains in hair after complete elimination of alcohol. Currently, there are three main analytical techniques used to quantify EtG in hair: gas chromatography-mass spectrometry (GC-MS), gas chromatography-tandem mass spectrometry (GC-MS/MS), and liquid chromatography-tandem mass spectrometry (LC-MS/MS). No standardized protocols are yet available for the analysis of EtG levels in hair samples, and the current protocols vary in sample preparation and extraction procedures. Variables such as hair length, cosmetic treatment, gender, and pathophysiological conditions influence the final results and should be taken into account.


CONCLUSIONS
EtG quantification in hair is a useful tool for the objective detection of alcohol consumption over extended time periods, but care should be taken when interpreting the results.
Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium. Electronic address: cleo.crunelle@gmail.com.
Cleo L
CL
Crunelle
Laboratoire National de Santé - Toxicologie, Université du Luxembourg, 162a, av. Faiencerie, L1511, Luxembourg.
Michel
M
Yegles
Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium.
Alexander L N van
ALNV
Nuijs
Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium.
Adrian
A
Covaci
Toxicology Laboratory, ZNA Stuivenberg, Lange Beeldekenstraat 267, B2060 Antwerp, Belgium.
Mireille
M
De Doncker
Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium.
Kristof E
KE
Maudens
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium; Psychiatric Hospital Sint-Norbertus, Stationstraat 22, B2570 Duffel, Belgium.
Bernard
B
Sabbe
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium; Psychiatric Centre Alexian Brothers, Provinciesteenweg 408, B2530 Boechout, Belgium.
Geert
G
Dom
Laboratory of Toxicology, Ghent University, Harelbekestraat 72, B9000 Gent, Belgium.
Willy E
WE
Lambert
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Wilrijkstraat 10, B2650 Antwerp, Belgium.
Peter
P
Michielsen
Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium; Toxicology Laboratory, ZNA Stuivenberg, Lange Beeldekenstraat 267, B2060 Antwerp, Belgium.
Hugo
H
Neels
D000428:Alcohol Drinking / Q000378:metabolism*; D000437:Alcoholism / Q000175:diagnosis / Q000378:metabolism*; D000818:Animals; D015415:Biomarkers / Q000032:analysis / Q000737:chemistry / Q000378:metabolism; D008401:Gas Chromatography-Mass Spectrometry / Q000379:methods / Q000592:standards; D005965:Glucuronates / Q000032:analysis / Q000378:metabolism*; D006197:Hair / Q000737:chemistry / Q000378:metabolism*; D006801:Humans; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards*
D015415:Biomarkers; D005965:Glucuronates; C093924:ethyl glucuronide
Alcohol; Ethyl glucuronide; Gas chromatography; Hair; Liquid chromatography; Mass spectrometry