New approaches to the objective diagnosis of alcohol abuses

Driving under the influence of alcohol is one of the most common risk factor of road accidents and it is one of the main causes of mortality. Since the detection of ethanol in the body is possible only for a relatively short time after intake, the assessment of a condition of alcohol intoxication/addiction has been and still is an issue in clinical and forensic toxicology. In recent years, however, the diagnosis of alcohol abuse has been revolutionized by the introduction of new specific biomarkers, among which EtG is one of the most promising. Ethyl glucuronide (EtG) is a minor alcohol metabolite, formed by conjugation of ethanol with activated glucuronic acid, and it has been proposed as a stable marker to detect and quantify alcohol consumption. The major advantage of EtG is an extended detection window after ethanol consumption. The aim of the present study was to evaluate the use of blood EtG as a potential marker in the occurrence of fatal and non-fatal alcohol-related traffic accidents. Moreover, the correlation between ethanol and EtG was studied to establish whether or not ethanol ingestion occurred at the time of the road accident. On these grounds, an analytical LC-MS/MS method for blood EtG has been validated. Subsequently, real blood samples of subjects involved in fatal and non-fatal road accidents have been analysed. Finally, the serum and blood concentration ratio has been evaluated to verify the EtG partitioning between the different portions of blood. Conclusions show a relevance of blood EtG for BAC interpretation.