Ethanol-Based Hand Sanitizing Gel Vapor Causes Positive Alcohol Marker, Ethylglucuronide (EtG), and Positive Breathalyzer

Word count 298) Context: Ethylglucuronide (EtG), a minor metabolite of alcohol, is an important new marker that can detect alcohol use for several days or more after alcohol itself leaves the body. The test has rapidly gained widespread use where alcohol abstinence is desirable (e.g. in health professional monitoring programs, alcohol treatment programs, high schools, criminal justice settings, liver transplant clinics etc). As with any new test, it is important to understand its limitations, especially, it turns out, regarding non-beverage sources of alcohol that can affect EtG levels. We describe a case and follow-up studies in which ethanolbased hand sanitizing gel (EthGel) caused elevated EtG levels for a pharmacist who disputed disciplinary actions by her licensing board. Objective: To document that EthGel causes elevated EtG levels and to identify the route of absorption. Design, Setting, Participants: Following discovery of the index case in 2004, twenty-four subjects were tested for EtG before and 30min and 6 hours after exposure to EthGel in four groups: controls, skin exposure only, vapor exposure only, and both skin and vapor exposure. Breathalyzer was used to measure breath alcohol levels. Results: EthGel caused elevated EtG and breathalyzer primarily from alcohol vapor. For “Skin Only”, “Vapor Only”, and “Both” Groups the mean EtG levels at 30 min were 42ng/ml (range 0-102ng/ml), 106ng/ml (18-328ng/ml), and 176ng/ml (0348ng/ml) respectively. Breathalyzer levels of .01-.02gm% persisted for up to 40-60min in subjects with who had high EtG levels. Conclusion: EthGel exposure, particularly inhalation of fumes, caused positive EtG levels. Subjects being monitored with EtG testing should be warned to avoid products containing alcohol, including fumes from EthGel and similar compounds. Further studies should be conducted to