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Based at the Commonwealth Harvard Alcohol learn and educating application, this clinically orientated paintings is designed to provide internists and first care practitioners the information and abilities essential to realize and deal with sufferers with alcoholism.
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Additional resources for Alcoholism: A Guide for the Primary Care Physician
The peak plasma concentration of ethanol is dependent predominantly on the rate and extent ofabsorption and is not greatly affected by the rate of metabolism. The very small increases in the rate of metabolism that may occur in the chronic drinker will not have any appreciable effect on the peak plasma concentrations achieved by a standard dose of alcohol (Fig. 1). The principal metabolite of ethanol is acetaldehyde. Of a number of enzyme systems that have been identified in vitro as capable of catalizing this oxida- 4.
The genetic evidence comes from studies designed to separate nature from nurture. Comparisons of identical and fraternal twins 2 ,3 indicate that identical twins have a higher concordance for drinking behavior and possibly alcoholism. Adoption and half-sibling studies have more clearly separated heredity and environment. In comparing Danish children of alcoholics (whether raised by their own alcoholic parent or adopted) to a control population of children without an alcoholic parent (but with similar circumstances of adoption), Goodwin found that sons of alcoholics had four times the risk of developing alcoholism, whether raised by their biologic parents or by nonalcoholic foster parents.
Ethanol may stimulate the appetite, especially in the elderly. Ethanol is useful in intravenous feeding regimens (7 kcal/g) with awkward requirements for calories and restrictions On volume. The use ofethanol for nerve blockade has been discussed previously. Ethanol treatment of poisoning with methanol, ethylene glycol, and isopropanol is described subsequently. 38 AW. J. A. Friedman The Pharmacology of Acetaldehyde and of Congeners Acetaldehyde is the principal first metabolite of ethanol. The first step is rate limiting for the whole metabolic pathway, so the concentration of acetaldehyde in the plasma is constant for any plasma ethanol concentration above 20 mg/dL.
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