The usefulness of biomarkers of alcohol abuse in hair and serum carbohydrate-deficient transferrin: a case report

• Published in: Drug testing and analysis 2015-08, Vol.7 (8), p.703-707
• Main Authors: De Giovanni, Nadia, Cittadini, Francesca, Martello, Simona
• Format: Article
• Language: English
• Subjects: Adult; alcoholism; Alcoholism - blood; Alcoholism - diagnosis; Biomarkers - analysis; CDT; cocaethylene in hair; Cocaine - blood; Cocaine - urine; ethylglucuronide in hair; Glucuronates - analysis; Hair - chemistry; Heart Arrest - complications; Humans; Male; Substance Abuse Detection - methods; Transferrin - analogs & derivatives; Transferrin - analysis
• ISSN: 1942-7603; 1942-7611
• DOI: 10.1002/dta.1763

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. Copyright © 2014 John Wiley & Sons, Ltd. We refer about a negative CDT obtained during hospitalization of a man admitted for a cardiac arrest with blood ethanol concentration of 1.99 g/l and died about 14 hrs later. Cocaine and cocaethylene were found in hair analysed for all the length. Ethylglucuronide detected on the same hair sample confirmed the chronic abuse of ethanol. The present report suggests cautiousness on the interpretation of biomarkers of alcohol abuse.