The Pharmaceutical Journal
Vol 272 No 7281 p14-15
3/10 January 2004

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Letters to the Editor

Alcohol metabolism

Dizzy and delightful to danger of death

From Dr I. ab I. Davies, MRPharmS

While reading Pamela Mason’s article (PDF 100K) on alcohol misuse (PJ, 6 December 2003, p777), I was reminded of Gaddum’s description¹ of the four stages of alcohol intoxication, which he described as an aide-memoir as “dizzy and delightful, drunk and disorderly, dead drunk and danger of death” equating to blood alcohol concentrations of 100, 200, 300, and 400mg/100ml, respectively. I noted from the article that only two stages were considered equating to blood-alcohol concentrations of less than 50mg/100ml and of 100–500mg/100ml and above. I wonder whether, over the intervening 50 years, man has become tolerant to the effects of alcohol.

The difference in blood-alcohol concentrations between men and women has been attributed to different proportions of body water to body fat between the sexes. Although women tend to have a lower body mass than men and therefore blood volume, which is proportional to body mass, will be smaller, a difference in blood-alcohol concentration is not apparent when an equivalent dose of alcohol is administered intravenously. Neither of these facts adequately explains the difference in blood-alcohol concentrations between the sexes after oral intake of an equivalent dose of alcohol.

The difference in blood-alcohol concentration after oral administration could be due to the marked difference in the mass of liver between the sexes. On average the liver in women weighs 1.2–1.4kg and in men 1.4–1.8kg — a difference of approximately 25 per cent. Of an oral dose of alcohol absorbed and equilibrated in the liver during a first pass, 25 per cent more free alcohol would pass into a woman’s blood stream compared with a man’s. Also because a greater amount of alcohol is retained in the male liver, more alcohol will be metabolised making less available for later diffusion into the bloodstream.

I. ab I. Davies
Ballygowan, Co Down

Reference
1. Gaddum JH. Pharmacology (4th ed). London: Oxford University Press; 1953.

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