Overview Function elimate ethanol (EtOH) CNS depressant/toxin Kinetics NAD+ is limiting reagent alcohol dehydrogenase operates via zero-order kinetics inhibitors fomepizole inhibits alcohol dehydrogenase antidote for suspected ethylene glycol or methanol poisoning disulfiram (Antabuse) inhibits acetaldehyde dehydrogenase acetaldehyde accumulates leads to hangover symptoms prescribed to help recovering alcoholics Clinical relevance ethanol hypoglycemia pathophysiology ↑ in EtOH metabolism → ↑ NADH/NAD+ ratio NADH/NAD+ ratio changes energy generating kinetics lactate favored over pyruvate lactate + NAD+ → pyruvate + NADH no free NAD+ for required conversion glycerol-3-phosphate favored over DHAP G3P + NAD+ → DHAP + NADH malate favored over oxaloacetate malate + NAD+ → OAA + NADH presentation lactic acidosis ↑ lactate fatty liver ↑ G3P results in ↑ synthesis of TGs ethanol + extreme physical exertion severe hypoglycemia EtOH inhibits the Cori cycle by consumption of free NAD+ conversion of lactate to glucose in anaerobic metabolism lactic acidosis