title: The usefulness of biomarkers of alcohol abuse in hair and serum carbohydrate-deficient transferrin: a case report.
abstract: The detection of carbohydrate-deficient transferrin (CDT) in serum is widely accepted to identify chronic alcohol consumption over the previous two weeks, but minor ethanol metabolites detected in hair often complete the information obtained. In particular, ethylglucuronide and cocaethylene (a marker of simultaneous intake of cocaine and alcohol) allow correct interpretation of data obtained in forensic cases. We refer to a negative CDT value obtained from a serum sample collected during hospitalization of a man admitted for cardiac arrest who died about 14 h later. Clinical analysis performed on admission showed a high ethanol level and a positive urinary screening for cocaine. The toxicological analyses of post-mortem samples found cocaine metabolites in his urine and blood. The negative CDT level suggested the ethanol concentration at admission to be an acute episode. Cocaine and cocaethylene well above the cut-off suggested by the literature were found in hair analyzed for the entire length (about 1 cm). Ethylglucuronide detected on the same hair sample confirmed chronic abuse of ethanol in the previous month, at least. The present report suggests caution in the interpretation of biomarkers of alcohol abuse, encouraging the detection of more than one marker to avoid misinterpretation.
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Nadia
authors.identifier: http://orcid.org/0000-0002-5949-4223
authors.initials: N
authors.lastname: De Giovanni
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cittadini
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Martello
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D003042:Cocaine / Q000097:blood / Q000652:urine; D005965:Glucuronates / Q000032:analysis; D006197:Hair / Q000737:chemistry*; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D008297:Male; D015813:Substance Abuse Detection / Q000379:methods; D014168:Transferrin / Q000031:analogs & derivatives* / Q000032:analysis
chemical_list: D015415:Biomarkers; D005965:Glucuronates; D014168:Transferrin; C056759:carbohydrate-deficient transferrin; C093924:ethyl glucuronide; D003042:Cocaine
keywords: CDT; alcoholism; cocaethylene in hair; ethylglucuronide in hair