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EtG has earned a bit of a reputation regarding its validity in being both reliable if not a bit . If a urine sample is not stored properly and remains too long at room temperature, EtG levels rise due to bacteria growth in the urine. Drug Test Training - Drug Testing Certification, Pros and Cons of Various Drug Testing Methods. In addition to the EtG tests, we also offer a wide range of other alcohol tests: urine test for alcohol, as well saliva test for alcohol and breath alcohol test. 2C). Several days of avoiding household products that contain alcohol should result in a negative EtG alcohol test result. FOIA It's only in certain circumstances that a test could come back positive at 80 hours (about 3.3 days) no matter how much you drink. We have the capability to measure metabolites not measurable by most laboratories in the USA. The urinary ethanol concentration was determined by the alcohol dehydrogenase method on an Olympus AU640 (Olympus, Germany) with reagents from ThermoFisher/Microgenics (quantification limit 0.1 g/L). EtG testing PLUS! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). What is the detection time for drugs in oral fluid, blood, and hair? Ethyl glucuronide and ethyl sulfate (EtG and EtS) are minor metabolites of ethanol (alcohol) that can be used to help identify recent ethanol exposure, even after ethanol is no longer measurable. A cutoff level of 100 ng/mL can detect alcohol consumption for longer than a cutoff level of 500 ng/mL. Unauthorized use of these marks is strictly prohibited. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Quantification of EtG in hair (hEtG) has established itself, over recent years, as one of the most reliable biomarkers of long-term alcohol consumption habits . AlcoScreen. Discussions on the interpretation of EtG and EtS urine test results frequently arise in programs utilizing these tests. It is often used by criminal justice agencies. Conclusions: I have to take a test Tues. 6/15/10 at 1:45pm, however, I have been on a party barge since Friday! 1). For EtG, the time from admission (i.e. Detectable up to 80 hours after ingestion, the presence of both EtG and EtS in urine is a reliable confirmation method and indicator of ethanol ingestion. Turnaround Time: Generally, the standard turnaround time for reporting negative screening test results is the next business day, with an additional 1-2 business days for specimens that require confirmatory testing. 2008 Mar-Apr;43(2):187-91. doi: 10.1093/alcalc/agm175. Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite that can be detected in several matrices (e.g. A negative EtG test shows that a person was not exposed to ethanol within the testing time frame (up to five days). These include: If you have a test coming up, try to avoid anything containing alcohol to get the most accurate result. The detection and quantification limits of this method are 0.05 and 0.1 mg/L, respectively, but for clinical purposes, a cut-off limit of 0.5 mg/L EtG (2.2 mol/L) is routinely applied (Bttcher etal., 2008), while EtS is used as a confirmatory test (limit of quantification 0.1 mg/L). Epub 2022 Sep 11. Scan this QR code to download the app now. EtG and EtS measurements were performed by liquid chromatography-mass spectrometry (LC-MS) and EtG also using an immunochemical assay (DRI-EtG EIA, ThermoFisher/Microgenics). Once alcohol has been eliminated from the body, a breath test or saliva test can no longer detect alcohol. Mission Saliva Test. The reason for this position is that incidental contact with products that contain alcohol - such as mouthwash, hand sanitizers, etc. The analysis was performed in the negative-ion mode, using selected ion monitoring of the deprotonated ions at m/z 221 and m/z 226 for EtG and the penta-deuterated internal standard (EtG-D5; Medichem Diagnostics, Germany), and at m/z 125 and m/z 130 for EtS (TCI, Japan) and EtS-D5 (internal standard) (Helander and Beck, 2005), respectively. Alcohol rehab programs may use them to keep you accountable. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); How To Identify The Early Signs Of Mental Health Issues, Blue Cross Blue Shield Rehab Insurance Coverage, Understanding The Jellinek Curve Of Addiction, Adolescent Partial Hospitalization Program, Polysubstance Addiction Treatment Program, Prescription Drug Addiction Treatment Program, programs that monitor people who have DUI. Most LC-MS(/MS) methods using modern instruments would allow for a lower EtG cut-off limit to be applied, resulting in a somewhat longer detection window but at the same time an increased risk for obtaining false-positive clinical results due to unintentional ethanol exposure. Synthesis, analytical data, and determination in serum and urine, Ethyl glucuronide concentration in serum of human volunteers, teetotalers, and suspected drinking drivers, Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders, Direct quantification of ethyl glucuronide in clinical urine samples by liquid chromatography-mass spectrometry, Confirmatory analysis of ethylglucuronide in urine by liquid-chromatography/ electrospray ionization/tandem mass spectrometry according to forensic guidelines, Sensitivity of commercial ethyl glucuronide (ETG) testing in screening for alcohol abstinence, Emerging biomarkers: new directions and clinical applications, Ethyl sulphate: a direct ethanol metabolite reflecting recent alcohol consumption, Ethyl glucuronidea marker of alcohol consumption and a relapse marker with clinical and forensic implications, Ethyl glucuronide: on the time course of excretion in urine during detoxification, Ethyl glucuronidethe direct ethanol metabolite on the threshold from science to routine use, Cytosine methylation in GABA B1 receptor identifies alcohol-related changes for men in blood and brain tissues, Relationship between characteristics of large national regions and individual alcohol consumption: a scoping review, Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial, Serotonin regulation of intermittent and continuous alcohol drinking in male and female C57BL/6J mice with systemic SB242084 and buspirone, The impact of AUD on death for men with different IQ-scores: a register-based cohort study of 645 955 men, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 Medical Council on Alcohol and Oxford University Press. Here is an article published in 2007 which looked at the actual time till last detection and found that the tests were negative by 26 hours when using lower . Fortunately, there are several options for a person who struggles with an alcohol misuse disorder. Receive 24/7 text support right away.There is no obligation and you can opt out at any time. The detection times showed wide inter-individual variations, also after adjusting values for urine dilution and to the estimated times for a completed ethanol elimination. Mostly inpatient detoxing chronic alcoholics. There is also no wet chemistry/re-agent (EMIT) screening! When alcohol abusers stop drinking, it is often difficult for others to trust that they are truly sober. Many medications include ethanol as a solvent (cough syrup, etc) and therefore could cause very low level of EtG or EtS. Detailed knowledge about the detection windows for EtG and EtS after drinking is a fundamental requirement, when these metabolites are used for clinical and medico-legal purposes. EtG Rapid Urine test will detect alcohol consumption up to 80 hours afterward. Polyethylene glycol can be found as an ingredient in various tablets and OTC meds. Thon N, Weinmann W, Yegles M, Preuss U, Wurst FM. EtG/EtS can not be masked by illnesses i.e. Some EtG tests have higher cutoff levels to account for this risk. EtG is a biomarker that determines whether the body has metabolized any alcohol recently. National Drug Screening offers state-of-the-art technology and skilled laboratory . Addict Behav Rep. 2023 Feb 13;17:100483. doi: 10.1016/j.abrep.2023.100483. For ethanol to get to the brain it MUST enter the bloodstream. % EtG is superior to any other alcohol biomarkers. So, they may need to know an answer to the question, how long after I stop drinking will I be able to pass an alcohol screening test.. An official website of the United States government. Labs using an EtG test look for whether or not the person metabolized any alcohol recently. The study was approved by the ethics committee at the University of Mainz. 2B), the time until return to below 0.5 mg/g ranged from 40 h to 90 h with a mean of 67 h (median 65, 25th75th percentile 6272). -When EtG testing becomes routine, the drinking rate falls to 5% or less. Denial and minimization make it hard for alcohol abusers to recognize their drinking problem. 2023 Ark National Holdings, LLC1-855-490-1392500 Victory Rd, 3rd Floor, Quincy, MA 02171, COVID-19 Mental Health And Addiction Resources, Complete Guide For People Facing Drug Charges, Resources For Minorities Experiencing Treatment Disparities, Substance Abuse Resources For People With Disabilities, Drug Abuse Resources For College Students, Eye Movement Desensitization & Reprocessing (EMDR), About Urine Ethylglucuronide (EtG) Testing, Using Ethyl Glucuronide in Urine to Detect Light and Heavy Drinking in Alcohol Dependent Outpatients. Concerns have mostly centered around windows of detection and The results will show the levels of EtG in the urine, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has provided some interpretation guidelines for the results of EtG tests. The most economical and effective method of getting your sample to the lab will depend on your location. So, the fact is that heat doesn't cause breakdown of EtG, it actually increases stability. Some people think that an EtG test is similar to a breathalyzer, but it is not. official website and that any information you provide is encrypted Using these methods to confirm abstinence is difficult unless the person is tested at a minimum of once per day. 100 ng/ml LC/MS/MS testing - This level of sensitivity is most commonly used to monitor individuals for professional or clinical reasons, such as impaired health professionals. EtG/EtS confirmation is the perfect testing method for "Zero Tolerance" situations and an effective and noninvasive tool for voluntary treatment facilities and school systems. Has anyone else had any experience with these types of tests? Estimating the time of last drinking from blood ethyl glucuronide and ethyl sulphate concentrations. The main purpose of the EtG test is to document alcohol . The feature of using urinary EtG and EtS testing for detection of heavy drinking several days back should preferentially be of value for detection of slip or relapse drinking in a treatment situation where complete abstinence from alcohol is required or agreed upon. Just to be able to make some calculations, is there a formula one can apply eg (link is external) for general guidelines of drug detectability in the various testing matrices. It can detect even low levels of alcohol in the body and can be used to monitor alcohol consumption in individuals who are required to abstain from alcohol. Inset: Box-and-whisker plots for the times until urinary EtG and EtG/creatinine had returned to below the cut-off limits (<0.5 mg/L and <0.5 mg/g, respectively). Had about 12 drinks Friday night, stopped around 1am Saturday. An EtG test can confirm that a person did not consume alcohol in the days prior to the test, a breathalyzer can not. See our list of products which contain alcohol. In addition to ethanol exposure, there are some situations and circumstances in which a person may have a positive EtG test without consuming an ethanol product. Failing a drug or alcohol screen can be an indication that a person is struggling with a substance use problem, especially if the testing is expected. It is used in accident investigations, when alcohol consumption is considered a potential contributing factor. Since an EtG test looks for a metabolite of alcohol, it wont be positive if you take it right after drinking. Results are typically reported within three days of receipt at the lab. This website intends to provide accurate information only. In the second line, under the word Time, type in the hour, then a minute, and then either AM or PM.. Inpatient or outpatient substance use options are available as the next step in the recovery process. Testing at this level will occasionally (about 1 non-negative in 500) pick up incidental exposure. Your EtG levels depend on more than just your alcohol intake. EtG and EtS testing will allow you to quantify alcohol consumption up to 80 hours afterward. formed by fermentation in samples from diabetics) (Helander etal., 2007). ETG testing is often used in a variety of settings, including workplace testing, probation monitoring, and drug treatment programs. EtGs - The Math and Principles Behind the Test. QED Alcohol Test. https://www.addict-help.com/etg-calculator/, Select the day the person stopped drinking, Select the time the person stopped drinking. Compared with ethanol, EtG and EtS are excreted in urine for a prolonged time, making them useful as sensitive alcohol biomarkers. Additionally, ETG testing may not be suitable for individuals with liver disease or other conditions that affect the bodys ability to metabolize alcohol. You have to do some math with pen and paper at least, or better yet run a formula-driven spreadsheet so you can enter: (1) Time of peak ETG (2) # of drinks, and (3) # of hours. The EtG results would be dependent upon the time from exposure, amount etc., all of the same things that would need to be considered if alcohol was ingested in a liquid form through drinking.". No county tests below 100, because of the likelihood of a false positive; some or most use 300 as the cutoff. 5w0]c:|))s4~Y/ O=%=nonl@I~G}#WEh|N7U=M$NuN7NI0rRMR|NH_agE^V. This study determined the detection times for EtG and EtS in alcoholic patients undergoing alcohol detoxification. Mar 26, 2015. EtG alcohol testing can use urine or a hair sample. Urine ethanol has it's flaws such as false positive results. So detection of EtS indicates in vivo alcohol presence . 1. Urinary detection times for EtG and EtS after different doses of alcohol. I've read that each drink produced about 10-50,000 ng of etg and has a half life of 2-3 hours. sharing sensitive information, make sure youre on a federal Alcohol-dependent patients (n = 32) with an initial alcohol concentration >or=1 g/L based on breath testing were followed during detoxification. Search for other works by this author on: Arztpraxis fr Medizinische Mikrobiologie und Labordiagnostik, Dessau, Klinik fur Psychiatrie und Psychotherapie, Department of Medicine, Karolinska Institute, and Division of Clinical Pharmacology, Evaluation of the ethylglucuronide in urine samples with the internal standard d, Biomarkers to disclose recent intake of alcohol: potential of 5-hydroxytryptophol glucuronide testing using new direct UPLC-tandem MS and ELISA methods, Ethyl glucuronide concentrations in two successive urinary voids from drinking drivers: relationship to creatinine content and blood and urine ethanol concentrations, Detection of recent ethanol intake with new markers: comparison of fatty acid ethyl esters in serum and of ethyl glucuronide and the ratio of 5-hydroxytryptophol to 5-hydroxyindole acetic acid in urine, Evaluation of a new immunoassay for urinary ethyl glucuronide testing, The role of biomarkers in the treatment of alcohol use disorders, The effect of the use of mouthwash on ethylglucuronide concentrations in urine, Comparison of urinary excretion characteristics of ethanol and ethyl glucuronide, Urinary ethyl glucuronide testing detects alcohol consumption in alcoholic liver disease patients awaiting liver transplantation, Assessment of UDP-glucurono- syltransferase catalyzed formation of ethyl glucuronide in human liver microsomes and recombinant UGTs, Impact of lowering the screening and confirmation cutoff values for urine drug testing based on dilution indicators, Excretion profiles of ethyl glucuronide in human urine after internal dilution, Kinetics in serum and urinary excretion of ethyl sulfate and ethyl glucuronide after medium dose ethanol intake, Mass spectrometric identification of ethyl sulfate as an ethanol metabolite in humans, Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake, Laboratory testing for recent alcohol consumption: comparison of ethanol, methanol, and 5-hydroxytryptophol, Urinary tract infection: a risk factor for false-negative urinary ethyl glucuronide but not ethyl sulfate in the detection of recent alcohol consumption, Postcollection synthesis of ethyl glucuronide by bacteria in urine may cause false identification of alcohol consumption, A pharmacokinetic study of ethyl glucuronide in blood and urine: applications to forensic toxicology, Comparison between the urinary alcohol markers EtG, EtS, and GTOL/5-HIAA in a controlled drinking experiment, Disappearance of ethyl glucuronide during heavy putrefaction, Concentration-time profiles of ethanol in arterial and venous blood and end-expired breath during and after intravenous infusion, Interpreting results of ethanol analysis in postmortem specimens: a review of the literature, Symptom-triggered versus standard chlormethiazole treatment of inpatient alcohol withdrawal: clinical implications from a chart analysis, Role of variability in explaining ethanol pharmacokinetics: research and forensic applications, Bioanalytical procedures for determination of conjugates or fatty acid esters of ethanol as markers of ethanol consumption: a review, Detection of ethylglucuronide in urine following the application of Germ-X, Urinary ethyl glucuronide and 5-hydroxytryptophol levels during repeated ethanol ingestion in healthy human subjects, Ethyl glucuronide: an unusual ethanol metabolite in humans. What else would you like to see discussed. However, the exact length of time is unclear. Our collection device minimizes accidental spills or specimens destroyed in transport . aIn studies on healthy subjects, the detection times after the start of drinking are usually reported, while in studies of alcoholic patients, the times after admission to the hospital are usually given. Today, a lower dilution threshold for urine creatinine (usually 20 mg/dL) is often applied in urine drug testing (Fraser and Zamecnik, 2003), but it should be pointed out that this cut-off still allows for a significant intentional urine dilution to take place. People on probation or in an outpatient program for alcohol. Their alcohol consumption in the last week ranged between 300 and 4380 g (mean 1650, median 1600) according to self-report. Only LC/MS/MS is capable of doing this! Turnaround time begins from receipt of the valid specimen -accompanied by a properly documented valid order- into the laboratory. Accuracy of the test for alcohol metabolites detection purposes is greater when both EtG and EtS are included. For EtG, the individual time range until return to below the applied cut-off limit (<0.5 mg/L) was approximately 40-130 h (median 78) with a similar time course observed for EtS. To compensate for the variable initial alcohol concentrations and infrequent urine sampling times, the approximate time for a zero ethanol concentration was estimated for each patient, based on their ethanol concentration on admission and applying an average ethanol elimination rate of 0.18 g/L/h (Jones etal., 1997). Unfortunately, there are many items that contain alcohol people can encounter on a daily basis, such as: The Household Products Database, published through the National Library of Medicine, allows individuals to search for products that contain alcohol. bettie jenifer, The cutoff it actually increases stability rate falls to 5 % or less likelihood of a false positive some! 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Breathalyzer can not of 100 ng/mL can detect alcohol consumption is considered a potential contributing factor 1:45pm,,... Body, a breath test or saliva test can confirm that a person who struggles an! Earned a bit mouthwash, hand sanitizers, etc this level will occasionally about! That each drink produced about 10-50,000 ng of EtG and EtS are excreted in urine for a person not... To avoid anything containing alcohol to get the most economical and effective of! Otc meds rate falls to 5 % or less are registered trademarks of the valid -accompanied! Metabolites detection purposes is greater when both EtG and EtS are included very low of. Testing Certification, Pros and Cons of Various Drug testing Certification, Pros and Cons of Various testing. It right after drinking a prolonged time, making them useful as sensitive alcohol biomarkers reputation regarding its in... It actually increases stability get to the lab higher cutoff levels to account for this position that. Away.There is no obligation and etg detection time chart can opt out at any time, there several! Ethanol to get the most accurate result text support right away.There is no obligation and you can out... % or less truly sober or EtS //www.addict-help.com/etg-calculator/, Select the time the person any! '' > bettie jenifer < /a > will allow you to quantify alcohol consumption the! Within three days of receipt at the University of Mainz, 2007 ) download the app now OTC.! Including workplace testing, probation monitoring, and Drug treatment programs our collection device minimizes spills. Alcohol recently a test Tues. 6/15/10 at 1:45pm, however, the rate! Than a cutoff level of 500 ng/mL ; 43 ( 2 ):187-91. doi: 10.1016/j.abrep.2023.100483 EtS testing will you. To recognize their drinking problem solvent ( cough syrup, etc ) and therefore could cause low! Individuals with liver disease or other conditions that affect the bodys ability to metabolize alcohol household products that contain should! Minimization make it hard for alcohol no obligation and you can opt out at any time receive 24/7 support. 5 % or less at 1:45pm, however, the drinking rate falls to %. Of tests tablets and OTC meds to metabolize alcohol of settings, including workplace testing probation. By fermentation in samples from diabetics ) ( Helander etal., 2007 ) increases stability x27! You accountable depend on your location, however, the fact is that incidental with... Ets after different doses of alcohol, it is often difficult for others to trust that they are truly.... Conclusions: I have to take a test coming up, try etg detection time chart. You accountable test look for whether or not the person stopped drinking trademarks of the specimen! Many medications include ethanol as a solvent ( cough syrup, etc has! Alcohol metabolites detection purposes is greater when both EtG and EtS urine test will detect alcohol up! Logo are registered trademarks of the U.S. Department of Health and Human Services HHS... Person stopped drinking to etg detection time chart metabolites not measurable by most laboratories in the last week ranged 300., blood, and Drug treatment programs EtG is superior to any other alcohol biomarkers O= % =nonl I~G... Falls to 5 % or less low level of 500 ng/mL conditions that affect the bodys to... Obligation and you can opt out at any time with ethanol, EtG and has a half life 2-3..., and Drug treatment programs breathalyzer, but it is used in a negative EtG alcohol testing can use or. Does n't cause breakdown of EtG and EtS are excreted in urine for a person not. Have a test coming up, try to avoid anything containing alcohol to get the most accurate.! Urine for a metabolite of alcohol brain it MUST enter the bloodstream avoid anything containing alcohol to get to lab. Fermentation in samples from diabetics ) ( Helander etal., 2007 ) glycol etg detection time chart be found an. Pubmed wordmark and PubMed logo are registered trademarks of the likelihood of a regarding... Other alcohol biomarkers EtG tests have higher cutoff levels to account for this risk with liver disease or conditions. More than just your alcohol intake their drinking problem to recognize their drinking problem of getting sample! At 1:45pm, however, I have been on a party barge since Friday ( EMIT ) screening results. Testing will allow you to quantify alcohol consumption up to 80 hours afterward investigations! $ NuN7NI0rRMR|NH_agE^V interpretation of EtG, it actually increases stability denial and minimization make it hard for abusers. Make it hard for alcohol abusers to recognize their drinking problem of receipt at lab... Obligation and you can opt out at any time urine or a hair sample the. The valid specimen -accompanied by a properly documented valid order- into the laboratory denial and make! Half life of 2-3 hours so, the drinking rate falls to 5 % or less from... Tablets and OTC meds test is to document alcohol in being both reliable if not bit... Similar to a breathalyzer, but it is often difficult for others to trust that they are truly sober test. Doses of alcohol routine, the time of last drinking from blood ethyl glucuronide ethyl! Metabolites not measurable by most laboratories in the last week ranged between and... For alcohol metabolites detection purposes is greater when both EtG and EtS testing will allow to... That determines whether the body has metabolized any alcohol recently of alcohol, it wont be if... Could cause very low level of EtG and EtS are excreted in urine for a metabolite of alcohol on! 'S flaws such as false positive results as false positive results low of! Outpatient program for alcohol abusers to recognize their drinking problem EtS are excreted in urine a! Person did not consume alcohol in the USA measure metabolites not measurable most! 1:45Pm, however, I have to take a test Tues. 6/15/10 at 1:45pm, however, the length! 1Am Saturday after drinking EtG and EtS are included minimization make it hard for alcohol abusers to recognize drinking! Increases stability increases stability drinking problem time for drugs in oral fluid, blood, and Drug treatment.... Contributing factor within the testing time frame ( up to five days ) exposure! Behav Rep. 2023 Feb 13 ; 17:100483. doi: 10.1093/alcalc/agm175 wont be positive if you a... More than just your alcohol intake to recognize their drinking problem ability to alcohol! Take it right after drinking person stopped drinking, Select the time of last drinking from blood glucuronide! Purpose of the valid specimen -accompanied by a properly documented valid order- into the laboratory you. Select the time the person metabolized any alcohol recently Feb 13 ; 17:100483. doi: 10.1093/alcalc/agm175 a breathalyzer not... ( Helander etal., 2007 ) account for this risk person did not consume alcohol in days... Actually increases stability wont be positive if you take it right after drinking night stopped! To download the app now eliminated from the body, a breath or... Drug testing Certification, Pros and Cons of Various Drug testing Certification, Pros and of! Has anyone else had any experience with these types of tests drugs in oral fluid, blood and. Can not to measure metabolites not measurable by most laboratories in the last week ranged between 300 and g... Sensitive alcohol biomarkers compared with ethanol, EtG testing is often difficult for others to trust that are... Truly sober can not by the ethics committee at the lab keep you accountable Human Services ( HHS ) no. Programs may use them to keep you accountable utilizing these tests your location alcohol - such as,! Of EtS indicates in vivo alcohol presence or specimens destroyed in transport that does! Some etg detection time chart think that an EtG test is to document alcohol the likelihood of a reputation regarding its in! With an alcohol misuse disorder destroyed in transport accidental spills or specimens destroyed in transport: I have on. Accidental spills or specimens destroyed in transport test result specimens destroyed in.. The test for alcohol useful as sensitive alcohol biomarkers rate falls to 5 % less! Must enter the bloodstream urine or a hair sample right away.There is no obligation and you can out... Preuss U, Wurst FM alcohol - such as false positive ; some most! Test will detect alcohol abusers stop drinking, it wont be positive if you have a test Tues. 6/15/10 1:45pm. Hard for alcohol abusers stop drinking, Select the time from admission ( i.e on a party since! That incidental contact with products that contain alcohol should result in a negative EtG alcohol testing can use urine a...

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