ALCOHOL TOXICITY Rick was excited about his upcoming 21st birthday party.

He and his friends were planning a party at their off-campus apartment to celebrate, and his buddies hinted that they expected to have an outstanding time. The party proceeded as such parties often do, with beer flowing freely, and the group becoming more boisterous as the night wore on. About midnight, the group came up with a challenge -- the birthday boy should drink 1 shot of whiskey for each year of his life -- 21 drinks for 21 years! Could Rick do it? He cheerfully agreed to try. Rick's friends weren't particularly surprised when Rick passed out after fifteen whiskeys. His friends made him comfortable, and went on with the party. After a couple of hours a friend, John, checked on him, and discovered that Rick had vomited without coming round. Looking closer, John decided that Rick might be more than drunk -- his skin was flushed, but cold to the touch, and shaking him didn't rouse him. He seemed hardly to be breathing at all, and when John checked his pulse it was alternately slow and racing. John wasn't sure what to do. Eventually he called an ambulance, Rick was taken to the closest emergency room, and the party broke up. For a while it was touch and go for Rick in the emergency room. He had a blood alcohol level of 0.4%, which is potentially fatal, and his blood pressure was dangerously low. His stomach was pumped to minimize any more absorption of undigested ethanol, but following this, only symptom relief could be given, such as intravenous (iv) fluids and heart-stabilizing drugs. He responded to therapy and survived the crucial first 24 hours, and eventually made a full recovery. Rick was shocked by how close he had come to death, and the experience prompted him to research the different ways ethanol acts in the body to produce such serious effects. Rick discovered that the major route for the body to detoxify ethanol first involves the action of enzymes, called alcohol dehydrogenases (ADH), either in the digestive tract or in the liver. The alcohol is converted to acetaldehyde, while NAD+ is converted to NADH. Click Play to see this process, then answer the questions below. The acetaldehyde formed when the enzymes act on the alcohol is next converted to acetate by another enzyme, acetaldehyde dehydrogenase. The acetate can then be converted by the normal carbohydrate pathways to acetyl CoA, for metabolism in the citric acid cycle. Click Play to see this process, then answer the question below. As the breakdown of ethanol continues, acetyl CoA from the ethanol now becomes an energy source. It enters the citric acid cycle and is metabolized to give CO2 and cofactors for the electron transport system. Click Play to see the steps of the citric acid cycle, and then roll your mouse over each step for a closer view. Then answer the question below.