Pharmacokinetics of ethanol: a review

The pharmacokinetics of ethanol in man are reviewed from a historical perspective from the earliest attempts at kinetic analysis of urinary data in 1899 to the present nonlinear analysis of blood alcohol concentration (BAC) and time data. Review of the various kinetic theories that have been utilized to describe the kinetics of alcohol metabolism is provided. Extensive review is made of recent investigations supporting the application of Michaelis-Menten enzyme kinetics to describe alcohol metabolism. Results of direct, nonlinear least-squares computer fitting of BAC following intravenous and oral feeding of alcohol both in the fasting and fed states are presented with appropriate theory. The kinetics of the oral absorption of alcohol and the relationship among stomach emptying rate, the apparent absorption rate, and the area under the BAC-time curve are discussed and data presented. The kinetics of multiple Michaelis-Menten pathways are discussed with application to the (potential) contributions of the MEOS and/or ADH systems to the observed BAC curve and resultant kinetic parameters. Several methods of obtaining pharmacokinetic (Michaelis-Menten) parameters from BAC curves and their interpretation and usage in comparative studies are presented.