Determination of ethyl glucuronide in urine using reversed-phase HPLC and pulsed electrochemical detection (Part II)

Effects of postmortem interval, putrefaction, diabetes, and location of death on the analysis of ethyl glucuronide and ethyl sulfate as ethanol biomarkers of antemortem alcohol consumption

This study evaluated the forensic value of ethanol biomarkers ethyl glucuronide (EtG) and ethyl sulfate (EtS) under different conditions, including diabetes mellitus, drug abuse, and advanced decomposition. In addition, we explored whether ethanol, EtG, or EtS formation occurred in patients who died as a result of diabetes mellitus. Fifty-two routine postmortem cases were divided into three groups. Group 1 included only the post-mortem cases in which at least blood samples were available (n=47). Group 2 included all cases with positive BAC (n=28). Group 3 included the cases with negative BAC while information surrounding the cases suspected antemortem alcohol consumption and cases that tested negative for ethanol but positive for EtG and EtS. We analyzed multiple bodily fluid specimens, including the vitreous humor, for ethanol biomarker analysis and accurately identified antemortem ethanol consumption or postmortem ethanol synthesis. We also determined the utility of urine samples for analyzing ethanol and its metabolites in putrefaction cases. If no urine sample was available at autopsy due to urination before death or diabetes-associated glucosuria, vitreous humor samples were an appropriate alternative for ethanol biomarker testing. We observed postmortem ethanol synthesis in diabetic individuals even with a short postmortem interval (PMI), however, glucose did not increase postmortem ethanol production in individuals with diabetes under appropriate preservation. The shorter the PMI, the better the ethanol source can be determined. Postmortem ethanol production occurred in all body fluid specimens analyzed herein, including the vitreous humor. EtG and EtS levels were stable and provided accurate insight into ethanol sources, even in cases of postmortem ethanol production. While the present study focused on the use of vitreous humor for the analysis, it is expected such samples may not be available in cases of advanced decay. In cases where no other bodily fluid specimens are available, solid tissue specimens are highly preferred.

Biomarkers of Alcohol Consumption in Body Fluids - Possibilities and Limitations of Application in Toxicological Analysis

BACKGROUND

Ethyl alcohol is the most popular legal drug, but its excessive consumption causes social problems. Despite many public campaigns against alcohol use, car accidents, instances of aggressive behaviour, sexual assaults and deterioration in labor productivity caused by inebriated people is still commonplace. Fast and easy diagnosis of alcohol consumption is required in order to introduce proper and effective therapy, and is crucial in forensic toxicology analysis. The easiest method to prove alcohol intake is determination of ethanol in body fluids or in breath. However, since ethanol is rapidly metabolized in the human organism, only recent consumption can be detected using this method. Because of that, the determination of alcohol biomarkers was introduced for monitoring alcohol consumption over a wider range of time.

OBJECTIVE

The objective of this study was to review published studies focusing on the sample preparation methods and chromatographic or biochemical techniques for the determination of alcohol biomarkers in whole blood, plasma, serum and urine.

METHODS

An electronic literature search was performed to discuss possibilities and limitations of application of alcohol biomarkers in toxicological analysis.

RESULTS

Authors described the markers of alcohol consumption such as: ethanol, its nonoxidative metabolites (ethyl glucuronide, ethyl sulfate, phosphatidylethanol, ethyl phosphate, fatty acid ethyl esters) and oxidative metabolites (acetaldehyde and acetaldehyde adducts). We also discussed issues concerning the detection window of these biomarkers, and possibilities and limitations of their use in routine analytical toxicology for monitoring alcohol consumption or sobriety during alcohol therapy.

Bioanalytical procedures and developments in the determination of alcohol biomarkers in biological specimens

Excessive alcohol consumption is a global problem, and consequently its evaluation is of great clinical and forensic interest. Alcohol biomarkers have been the focus of several research works in the past decades, with new compounds being studied in more recent years. The main objective of this review is to discuss topics for an analyst to consider when evaluating alcohol consumption through the analysis of alcohol biomarkers in biological specimens. For this, existing alcohol biomarkers will be reviewed, including carbohydrate-deficient transferrin, 5-hydroxytryptophol, ethanol, hemoglobin-associated acetaldehyde, fatty acid ethyl esters, ethyl glucuronide, ethyl sulfate and phosphatidylethanol. Additionally, their potential will be discussed, as well as analytical considerations, main challenges, limitations, data interpretation and existing methodologies for their determination in biological specimens.

Ethyl glucuronide and ethyl sulphate determination in serum by liquid chromatography–electrospray tandem mass spectrometry

BACKGROUND

Ethyl glucuronide (EtG) and ethyl sulphate (EtS) are two ethanol metabolites that can be detected in serum up to 8 h after ethanol elimination. Their presence is therefore indicative of recent ethanol consumption in case of delayed sampling after an event (e.g. car crash).

METHODS

A LC-ESI-MS-MS method for the determination of EtG and EtS in serum was developed and validated. Two product ions together with the parent ions were monitored for identification. Pentadeuterated-EtG was used as internal standard.

RESULTS

Excellent linearity for EtG (from 0.22 to 45 micromol/l) and EtS (from 0.40 to 80 micromol/l) was observed (r(2)>or=0.9998). LOD and LLOQ were 0.04 and 0.20 micromol/l for EtG and 0.08 and 0.40 micromol/l for EtS, respectively. Accuracy (bias) and precision (relative standard deviation), studied at four different quality control levels, were always better than 7%. Matrix effects were found to be negligible. The method was applied to several samples obtained from known alcoholics and social drinkers.

CONCLUSIONS

A sensitive and specific determination of EtG and EtS in serum samples was achieved despite a simple and fast sample preparation. To our knowledge, this is the first fully validated method for the simultaneous determination of the two alcohol metabolites in serum.

Biomarkers of alcohol abuse in racehorses by liquid chromatography/tandem mass spectrometry

A rapid and sensitive method was developed for the screening, quantification and confirmation of ethyl glucuronide (EG) and ethyl sulfate (ES) as biomarkers for alcohol administration to racehorses using liquid chromatography coupled on-line with triple quadrupole tandem mass spectrometry. Urine sample aliquots (0.1 mL) were pre-treated by protein precipitation. Separation of EG and ES was achieved on an Ultra PFP column. Isocratic elution with a flush step was performed using 0.1% formic acid in water (A) and 0.1% formic acid in acetonitrile (B). Analysis was performed by negative electrospray ionization in multiple reaction monitoring mode. The retention times for EG and ES were 1.7 +/- 0.30 and 3.4 +/- 0.30 min, respectively. The internal standard used was d(5)-ethyl glucuronide with a retention time of 1.7 +/- 0.30 min. The entire separation was completed in <5 min. The limit of detection (LOD) and of quantification (LOQ) for both analytes were 100 ng/mL (S/N > or =3) and 500 ng/mL, respectively. The limit of confirmations (LOC) for EG and ES were 500 ng/mL and 1.0 microg/mL, respectively. The assay was linear over a concentration range of 0.5-100 microg/mL (r(2) > 0.995). Intra- and inter-day accuracy and precision were less than 15%. The analytes were stable in urine for 24 h at room temperature, 10 days at 4 degrees C and 21 days at -20 degrees C and -70 degrees C. Ion suppression or enhancement due to matrix effect was negligible. The measurement uncertainty was <14% for EG and <25% for ES. This method was successfully used for the quantification of EG and ES in urine samples following alcohol administration to research horses and for screening and confirmation of EG and ES in urine samples obtained from racehorses post-competition. The method is simple, rapid, inexpensive, and reliably reproducible.

An improved method to detect ethyl glucuronide in urine using reversed-phase liquid chromatography and pulsed electrochemical detection

Pulsed electrochemical detection (PED) following reversed-phase liquid chromatography (LC) has been applied recently to the detection of ethyl glucuronide (EtG) in the urine of live and deceased individuals. In this paper, several key improvements to the method are made to enhance sensitivity, reproducibility, and accuracy. These improvements include (i) further optimization of the sample preparation procedure that has increased the recovery from ca. 50% to 84+/-3% in synthetic urine matrix; (ii) changing the internal standard from methyl glucuronide (MetG) to propyl glucuronide (ProG), which does not elute within the interference of the matrix; and (iii) altering the mobile phase of the separation from acetonitrile to t-butanol to virtually eliminate signal suppression in PED. As a consequence, detection limits have been reduced to 0.01 microg mL(-1), reproducibility has been improved by a factor of two, and sample size has been reduced five-fold. Blind studies in synthetic urine showed no significant difference between the amount recovered and the true value determined at the 95% confidence level for all samples. Importantly, PED requires no derivatization, and it can detect virtually all glucuronides.