# Alcohol --- An **alcohol** is a chemical compound that is structurally similar to [[carbohydrates]] but has one or more [[functional group#Biologically Important Functional Groups|hydroxyls]] on it. Although we do not use it as a nutrient, we do still metabolize it as [[biological energy|energy]]. [[alcohol use disorder]] ## Metabolizing Alcohol **Alcohol [[metabolism]]** begins when it is still in the [[stomach]] and then is finished in the [[liver]]. For non-alcoholics, there are two main enzymes are **alcohol dehydrogenase** or **ADH** and **aldehyde dehydrogenase** or **ALDH**, which turn the alcohol into acetaldehyde, then the acetaldehyde into acetate. Acetate can then be converted into [[acetyl CoA]]. For alcoholics, an alternate pathway, the **microsomal ethanol oxidizing system** or **MEOS** kicks in. This pathway is inducible, which means the enzymes for it can be produced in higher and higher numbers. ![[alcohol metabolism.png]] ### First-Pass Metabolism **First-pass metabolism** occurs in the stomach, where gastric ADH oxidizes the alcohol before it even has a chance to enter the bloodstream. This has a huge effect on alcohol tolerance; for example, women have less of this enzyme in general, so more alcohol "gets out of the stomach" and can enter the bloodstream. ### More Alcohol, More MEOS In the liver, the ADH pathway handles the oxidation of alcohol for non-alcoholics. As the person drinks more and more over time, the ADH pathway looses efficiency and MEOS takes over. This actually acts to increase the liver's alcohol metabolism efficiency greatly, which is why a heavy drinker "builds up a tolerance". MEOS also metabolizes a bunch of OTC, prescription and recreational drugs as well, which can be a problem if you mix drugs and alcohol. Since the MEOS enzymes prioritize working on alcohol, the other drugs can accumulate in the bloodstream, which is called *metabolic diversion*. ## Alcohol Intoxication & Poisoning - drowsiness - impaired coordination - slurred speech - mood changes - aggression - uninhibited behavior Nursing consideration - rule out other causes of the s/s of alcohol intoxication - head injuries - hypothermia ___