To address the hypothesis that elevated blood alcohol increases systemic oxidant stress, we measured urinary excretion of isoprostanes (iPs), free radical-catalyzed products of arachidonic acid. Ten healthy volunteers received acute doses of alcohol (Everclear-R) or placebo under randomized, controlled, doubleblind conditions. Urinary iPF2a-III increased in a time-and dosage-dependent manner after dosing with alcohol, with the peak urinary iPF2a-III excretion correlating with the rise in blood alcohol. To determine whether oxidant stress was associated with alcohol-induced liver disease (ALD), we then studied the excretion of iPs in individuals with a documented history of alcohol-induced hepatitis or alcohol-induced chronic liver disease (AC). Both urinary iPF2a-III and urinary iPF2a-VI were markedly increased in patients with acute alcoholic hepatitis. In general, urinary iPF2a-III was significantly elevated in cirrhotic patients, relative to controls, but its excretion was more pronounced when cirrhosis was induced by alcohol than by hepatitis C. Excretion of iPF2a-VI, as well as 4-hydroxynonenal and the iPF2a-III metabolite, 2,3-dinor-5,6-dihydro-iPF2a-III, was also increased in AC. Vitamin C, but not aspirin, reduced urinary iPs in AC. Thus, vasoactive iPs, which serve as indices of oxidant stress, are elevated in the urine in both acute and chronic ALD. Increased generation of iPs by alcohol in healthy volunteers is consistent with the hypothesis that oxidant stress precedes and contributes to the evolution of ALD.J. Clin. Invest. 104:805-813 (1999).iPF 2α -III excretion. All clinical studies were approved by the Institutional Review Board and the General Clinical Research Center (GCRC) Advisory Committee, as appropriate. All patients who participated in these studies consented to do so and were compensated for incurred expenses. Ten volunteers (5 males and 5 females), between the ages of 21 and 60 years (mean: 38.0 ± 11.5 years), were studied. The sample size was based on the known coefficient of variation of the methods (maximally 4.5%) and the desire to detect a dosedependent increase of at least 50% at the peak from baseline values, where α = 0.05 and the power (1-β) of the comparison is 0.85. A similar basis was used for sample size calculation in all subsequent studies. Individuals with a history of liver disease, alcoholism, or intake of any medication -specifically nonsteroidal anti-inflammatory drugs (NSAIDs), anovulant contraceptives, or vitamins -in the preceding 2 months were excluded. Other exclusion criteria included pregnancy, tobacco smoking, and a history of myocardial infarction in the preceding 3 months. Volunteers desisted from all drug and alcohol intake from the time of screening (14 days before dosing) to the conclusion of the study, except as mandated by the trial design.Volunteers were randomized under double-blind, placebo-controlled conditions for the order in which they drank 240 mL of a nonalcoholic solution of lemonade (Wyler's Lemonade) or 0.2, 0.3, 0.4, 0.6, or 0.9 g/kg body...