Alcohol Metabolism

  • FOMEpizole—inhibits alcohol dehydrogenase and is an antidote For Overdoses of Methanol or Ethylene glycol.
  • Disulfiram—inhibits acetaldehyde dehydrogenase (acetaldehyde accumulates, contributing to hangover symptoms), discouraging drinking.
  • NAD+ is the limiting reagent.
  • Alcohol dehydrogenase operates via zero-order kinetics.
  • Ethanol metabolism ↑ NADH/NAD+ ratio in liver, causing:
    • Pyruvate → lactate (lactic acidosis)
    • Oxaloacetate → malate (prevents gluconeogenesis → fasting hypoglycemia)
    • Dihydroxyacetone phosphate → glycerol- 3‑phosphate (combines with fatty acids to make triglycerides → hepatosteatosis)
  • Additionally, ↑ NADH/NAD+ ratio disfavors TCA production of NADH (impaired reactions of isocitrate dehydrogenase, a-ketoglutarate dehydrogenase complex [thiamine-dependent], and malate dehydrogenase) →↑ utilization of acetyl-CoA for ketogenesis (→ ketoacidosis) and lipogenesis (→ hepatosteatosis).

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