Detecting undisclosed alcohol abuse in life insurance applicants has always been a challenge to life underwriters and medical directors. This case report describes a 38-year-old woman with classic signs, symptoms, behavior and biochemical markers of undisclosed alcohol abuse. Review of 10 years of medical records revealed chronic abnormally low serum creatinine results associated with abnormally elevated liver function tests, and repeated denials to attending physicians of ever consuming alcohol. Kidney function throughout the 10-year history was not impaired. Low serum creatinine may be a good marker for detecting undisclosed alcohol abuse, but only when there is no kidney injury, dysfunction or impairment obscuring it.

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