Scope of the problem Alcohol abuse is a worldwide problem that places significant strain on health care resources, especially in the United States. The physiologic and psychologic issues associated with alcohol abuse and alcohol-related disease account for as many as 15% of emergency department (ED) visits. Binge drinking may result in coma and even death, particularly in adolescents and young adults. When considering intoxication, withdrawal syndrome, or alcohol-related injury or diseases, alcohol-related emergencies are common reasons people seek emergency medical care. Many of the diseases that develop from chronic alcohol abuse may be life-threatening. The physiologic, psychologic and social effects of alcohol abuse are likely to be devastating to patients and their families, an important consideration when caring for patients suffering from alcohol-related diseases. Anatomic essentials The term alcohol refers to ethanol or ethyl alcohol. The primary metabolism of ethanol is hepatic via alcohol dehydrogenase. The metabolism of ethanol has been studied to great extent. Typically, it follows zero-order kinetics for most people; however, it may follow first-order kinetics in high doses or chronic abusers. It is therefore best to describe alcohol metabolism as non-linear. As alcohol consumption increases, alcohol dehydrogenase activity increases. The average rate of alcohol metabolism in an adult is roughly 20-30 mg/dL/hr; occasional drinkers metabolize alcohol more slowly, and chronic alcohol abusers generally metabolize faster.
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