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Chapter 23: Alcohols

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A 45-year-old moderately obese man has been drinking heavily for 72 h. This level of drinking is much higher than his regular habit of drinking 1 alcoholic drink per day. His only significant medical problem is mild hypertension, which is adequately controlled by metoprolol. With this history, this man is at significant risk for

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(A) Bacterial pneumonia

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(B) Cardiac arrhythmias

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(C) Hyperthermia

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(D) Tonic-clonic seizures

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(E) Wernicke-Korsakoff syndrome

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This man’s regular rate of alcohol consumption is not high enough to put him at risk of long-term consequences such as Wernicke-Korsakoff syndrome, increased susceptibility to bacterial pneumonia, or alcohol withdrawal seizures. This pattern of “binge drinking” does put him at increased risk of cardiac arrhythmia. The answer is B.

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A 42-year-old man with a history of alcoholism is brought to the emergency department in a confused and delirious state. He has truncal ataxia and ophthalmoplegia. The most appropriate immediate course of action is to administer diazepam plus

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(A) Chlordiazepoxide

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(B) Disulfiram

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(C) Folic acid

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(D) Glucosamine

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(E) Thiamine

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This patient has symptoms of Wernicke’s encephalopathy, including delirium, gait disturbances, and paralysis of the external eye muscles. The condition results from thiamine deficiency but is rarely seen in the absence of alcoholism. The diazepam is administered to prevent the alcohol withdrawal syndrome. Glucosamine is primarily used for pain associated with arthritis. The answer is E.

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The cytochrome P450-dependent microsomal ethanol oxidizing system (MEOS) pathway of ethanol metabolism is most likely to be maximally activated under the condition of low concentrations of

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(A) Acetaldehyde

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(B) Ethanol

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(C) NAD+

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(D) NADPH

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(E) Oxygen

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The microsomal ethanol-oxidizing system (MEOS) contributes most to ethanol metabolism at relatively high blood alcohol concentrations (>100 mg/dL), when the alcohol dehydrogenase pathway is saturated due to depletion of NAD+. So, the MEOS system contributes most when the NAD+ concentration is low. NADPH and oxygen are cofactors for MEOS reactions. The concentration of acetaldehyde does not appear to affect the rate of either the ADH or the MEOS reactions. The answer is C.

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A freshman student (weight ...

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