Can PEth be Detected with a Cutoff of 20 ng/mL after Single Alcohol Consumption?

Phosphatidylethanol (PEth) can be determined in capillary blood collected as dried blood spots (DBS) and is a promising direct alcohol biomarker for the determination of drinking habits. Its use for abstinence monitoring needs to be evaluated. Studies with patients undergoing alcohol withdrawal have shown that the elimination of PEth can take up to 2 months. For the determination of PEth 16:0/18:1, a cutoff of 20 ng/mL has been agreed upon in the major US laboratories. However, it is not yet clear what minimum blood alcohol concentrations (BACs) have to be achieved by a single drinking episode to result in PEth concentrations above this cutoff after previous long-term abstinence. To determine whether low drinking amounts can result in a positive PEth concentration above 20 ng/mL, we recruited 12 participants ('social' drinkers). After 4 weeks of abstinence, alcohol was consumed at two separate drinking events with target BACs of 0.5 and 0.3 g/kg, resulting in maximum BACs in the ranges of 0.30-0.63 g/kg and 0.10-0.28 g/kg, respectively. Capillary blood was collected at different time points of the drinking experiment, and PEth was extracted from DBS and analyzed by liquid chromatography-tandem mass spectrometry. Despite drinking doses up to 0.58 g ethanol per kg body weight and reaching BACs of up to 0.63 g/kg, PEth 16:0/18:1 and PEth 16:0/18:2 could not be detected at or above the 20 ng/mL cutoff in any participant at any time after the drinking events. We conclude that after long-term abstinence the cutoff of 20 ng/mL for single alcohol consumption leading to BACs up to 0.63 g/kg is not exceeded.