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Ethanol, or ethyl alcohol, is commonly referred to as "alcohol." This term is somewhat misleading since there are numerous other alcohols to which a patient may be exposed. However, ethanol is probably the most commonly used and abused xenobiotic in the world. Its use is pervasive among adolescents and adults of all ages and socioeconomic groups, and represents a tremendous financial and social cost.3,209

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The ethanol content of alcoholic beverages is expressed by volume percent or by proof. Proof is a measure of the absolute ethanol content of distilled liquor, made by determining its specific gravity at an index temperature. In the United Kingdom, the Customs and Excise Act of 1952 declared proof spirits (100 proof) as those in which the weight of the spirits is 12/13 the weight of an equal volume of distilled water at 11°C (51°F). Thus, proof spirits are 48.24% ethanol by weight or 57.06% by volume. Other spirits are designated over or under proof, with the percentage of variance noted. In the United States, a proof spirit (100 proof) is one containing 50% ethanol by volume. The derivation of proof comes from the days when sailors in the British Navy suspected that the officers were diluting their rum (grog) ration and demanded "proof" that this was not the case. They achieved this by pouring a sample of grog on black granular gunpowder. If the gunpowder ignited by match or spark, the rum was up to standard, 100% proof that the liquor was 50% ethanol. This became shortened to 100 proof (Table 77–1).In addition to beverages, ethanol is present in hundreds of medicinal preparations used as a diluent or solvent in concentrations ranging from 0.3% to 75%.28,44,52,106,164,208 Mouthwashes may have up to 75% ethanol (150 proof) and colognes typically contain 40% to 60% ethanol (80 to 120 proof).16,104,164,177 These products occasionally cause intoxication, especially when unintentionally ingested by children.31,49,88,210

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Table 77–1. Clinical Pharmacology and Pharmacokinetics of Ethanol
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Veisalgia, "alcohol hangover," comes from the Norwegian kveis, "uneasiness following debauchery," and the Greek algia, pain. The "hangover" syndrome has been attributed to congeners, substances that appear in alcoholic beverages in addition to ethanol and water.26,33,34 Congeners contribute to the special characteristics of taste, ...

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